I have been perusing one of the top-rated pet insurance review websites the past couple of days concentrating on negative reviews across the whole spectrum of companies. There were 3 complaints that seemed to be occurring over and over.
Top 3 Complaints
1) Claims being denied because of a pre-existing condition.
2) Premiums increasing dramatically since policy was bought.
3) Reimbursement delays after a claim is filed.
Based on the evolution of the pet insurance industry during the last decade, I could have easily predicted at least the first 2 complaints.
All is not lost, however, because there are steps you can take to avoid each of these situations even before purchasing your policy. It's always better to try and avoid problems rather than have to deal with them later.
This is by far the #1 reason that pet insurance claims are denied. It does not sit well with pet owners who pay premiums for months/years only to have a claim denied because of something that occurred in the past before they purchased pet insurance.
Pet insurance companies find evidence of pre-existing conditions either by what you reveal to them about your pet's medical history when you sign up for a policy, or primarily by looking at your pet's medical record. Most companies won't do a medical record review until you file your first claim. For some, that might happen during the first few months after purchasing pet insurance, but for others, it could be several years later.
In the interest of transparency, only purchase a policy from one of the companies that will do a medical record review as soon as coverage becomes effective after signup. This is usually after the waiting period. In most cases, you will have to request a review of your pet's medical record.
For this process to work, there must be full transparency by the policyholder and the insurance company. First, you agree to send the insurance company all of your pet's medical records from the time period they specify. Some companies want to look at all medical records. Others may only need the past 12 months. The shorter time frame, the better. This includes every veterinarian/veterinary hospital you've visited in that particular time frame.
After the insurance company reviews your pet's medical record, they agree to let you know in writing any conditions your pet may have had in the past that won't be covered under the terms of the policy. If they have reviewed all of your pet's medical records and additional records don't show up later that they haven't reviewed, this should provide certainty to all parties about what's covered and not covered in the future.
Pet insurance premiums are set according to the species (dog, cat, bird, exotic), breed and age of your pet and where you live (zip code). Over time, premiums will go up either due to age or actuarial adjustments. In my opinion, the most significant influence on premiums, particularly large increases, is actuarial adjustments. Here is an easy to understand explanation of actuarial adjustments given by Laura Bennett, one of the CoFounders of Embrace pet insurance:
To keep your coverage affordable over the lifetime of your pet, you should only purchase pet insurance from a company that offers multiple ways to customize your policy. The more options - the better. This will provide you with the most flexibility to downgrade your coverage when premiums increase outside of your budget.
Ideally, you'd like to be able to adjust:
1) The policy maximum
4) Optional coverages
If a company only allows you to adjust one or two of these variables, you may not be able to adjust the coverage exactly like you want to lower your premium enough to stay within your budget.
Nothing can make you more frustrated with an insurance company than weeks of back and forth over what an insurance company needs to adjudicate a claim. This process should be as seamless and timely as possible.
Having a medical record review done after signup should go a long way toward preventing this type of frustration. Then you will usually only have to submit the medical records (including doctor notes) applicable to the particular problem you are submitting a claim for. You'll need to also submit the receipt showing your payment of the bill associated with the claim.
Every pet insurance policy states the maximum length of time you have to submit a claim after a pet is treated. If you don't submit the claim within this timeframe, you run the risk of the claim being denied.
Before purchasing a policy, inquire about the usual claim turnaround time. Being able to submit a claim quickly using a phone app or an online portal should speed up the process of getting reimbursed.
If a company doesn't acknowledge they have received the claim within a few days, you should contact them and make sure they have all of the documentation they need to adjudicate the claim.
Buying a policy from a company who will pre-certify a claim can also speed up the reimbursement of the claim. Not all companies will do this. Hopefully, someday, claim pre-certification will be available 24/7 and reimbursements can be done in close to real-time.
To decrease the chances of a claim being denied because of a pre-existing condition, buy a policy from a company that will do a medical record review soon after signup and before the first claim is filed.
To be able to keep your premium affordable over the lifetime of your pet, buy a policy from a company that allows you maximum flexibility when customizing your policy.
To prevent reimbursement delays, purchase a policy from a company that allows efficient ways to submit a claim and has a track record of quick reimbursement of claims. Also, stay in frequent contact with the insurance company checking on the status of claim adjudication if the reimbursement wasn't paid as quickly as expected.