Ideally, you or your veterinarian should receive reimbursement after submitting a pet insurance claim within a few days. Hopefully, in the future, it can be a real time transaction.
In this article, I will provide tips to avoid delayed reimbursement after claim submission. This topic is also covered in my book, Pet Health Insurance:A Veterinarian's Perspective.
Read your policy and/or the company's website for specific instructions on what the company requires to process a claim. If you have any questions about the requirements, call the company to clarify. Most companies require a claim to be filed within a certain period of time after treatment of a condition - typically 90 - 180 days.
When there is a delay in reimbursement, the most common reasons are:
- Claim form not completely filled out or signed
- Paid invoice not included with claim form
- Medical record not included with claim form
- More information needed
Determine the best way file a claim and related documents. Some companies now have Apps to simplify the process. You can take a picture of the invoice and medical record related to the claim and send it directly to the company. This usually provides the surest and fastest means of filing a claim and receiving reimbursement - especially if the company does direct deposit into your bank account.
Some companies allow you to scan the documents and file a claim online, email them, fax or send via regular (snail) mail.
Ideally, the company will email, text or call you when they receive the claim to let you know the claim is being processed. If you haven’t heard back from the company within a couple of days, call to make sure they received the claim and don’t need anymore information. I’ve seen the following statement repeated over and over when reading reviews, “I sent them the claim, but they said they never received it or they need more information from my veterinarian.”
If you have already sent in your pet’s medical record for review or with a previous claim, you’ll usually only have to send in the medical notes pertaining to the current claim. A couple of benefits to having a company do a medical record review when you sign up for a policy is not only learning if there are any pre-existing conditions that won't be covered, but also expediting future claim reimbursements because your pet's medical history has already been reviewed.
There may be times when your pet is faced with a condition requiring hospitalization and/or surgery - a potential big expense. If it’s not an emergency and you can wait several days before the procedure is done (e.g. surgery to repair a torn cruciate ligament), it may be wise to contact the company about pre-certifying coverage for the procedure(s). Your veterinarian may need to provide the company with a treatment plan and estimate.
Hopefully, in the near future, pet insurance companies will be able to pre-certify any claim within minutes (24/7) and eliminate any uncertainty about whether an injury or illness is covered - even in an emergency situation.
I invite readers to leave a comment about their positive or negative experiences when submitting claims to their pet insurance company. Also, I would love for representatives of pet insurance companies to leave comments explaining how they are making it easier for policyholders to submit claims and receive reimbursement quickly and provide any additional tips to make this process smoother.