Pet Insurance Claims


Pet Insurance and How to Make a Claim


BEFORE YOU CHOOSE A POLICY...

ll pet insurance is not the same. The policies available from different companies varies greatly. Some offer lifetime cover (Will pay for conditions such as diabetes for the lifetime of your pet).

Others offer cover that will only pay for a condition such as diabetes for a fixed term (usually 1 year). Some offer to pay back only a percentage of the claim total.

Most insurers will not pay for a condition that has appeared in the pets’ clinical history before (e.g. a heart murmur detected in the past may possibly make a heart condition that develops later in your pets’ life something that could be seen as a pre-existing condition and therefore unclaimable). 

Please read the small print carefully to establish that the pet insurance you choose is the one that suits your needs. We find that some people are disappointed at the point of claiming that their insurance does not cover what they supposed.

Some people find that the total amount covered falls short of the cost of treatment, especially if the pet has complex medical problems or is referred to a specialist. Make sure the total cover agreed is what you need.

Please be aware that there are many insurers offering may different policies. The policy you choose is a contract between you and your insurer. We are not aware of the details of any policy you take out.

SWITCHING PET INSURANCE TO ANOTHER SUPPLIER

You can cancel an existing policy and move to another insurer if you wish. Be aware of the pitfalls as a new insurer will still be aware of your pets’ clinical history, so if your animal already has a medical condition it is unlikely that a new insurer will cover this. It is well worth establishing carefully what a new insurer will offer before deciding to move.

I HAVE PET INSURANCE-HOW DO I MAKE A CLAIM?
Download a claim form from your insurance company or ask them to send you one by post or e.mail.
Fill in all the details requested including the name of what you are claiming for. This does not have to be in medical language but can be your own description, (e.g. ‘lameness’) Some insurers have several pages so read them carefully and only fill in the sections it asks you to complete. There will be sections/pages that are for veterinary staff only to complete. You must not fill these in yourself.

Once this is done bring it to reception. Do not post it in as we need to check that the form has been filled in correctly. Any that are posted in to us will be sent back or destroyed. Do not hand your form to a vet-it needs to be checked at reception to make sure we have all the details we need from you.

You need to supply us with a stamped A4 envelope for us to submit your claim. All new claims require full clinical history of your pet to accompany the claim. This will include previous medical history if you have used another vet before moving to us. This is why we need such a large envelope. (In the case of PetPlan and some other insurers we are able to submit claims electronically via our secure VetOne system called Vet Envoy.

Where we can utilise VetEnvoy, clients do not need to supply us with a stamped envelope.  Please ask us if your insurer is able to accept Vet Envoy electronic claims if you wish us to submit your claim this way. We still need your completed forms to keep on file for your insurer. It typically takes us up to 7 days to complete and send off a claim. We have dedicated staff who are trained to administer your claims. It can take around 30 minutes to process usual claims-complex ones can take longer. We make a charge for this service which needs to be paid before we will process any claim. This charge covers our trained staff, office materials costs, and VetEnvoy charges to us. All elements claimed for need to be paid in full before we will process your claim form.

WHAT IS A DIRECT CLAIM
A direct claim is where we make a claim for your insurer to pay us rather than pay you.
The only clients we make direct claims for are ones who have joined our ‘Animal Plan’.
Animal Plan clients need to pay us their excess and exclusions before we will submit a claim and hand in a completed claim form before we agree to undertake a direct claim for them.
We do not charge an insurance admin fee to our Animal Plan clients as a perk.
If you want to know more about our Animal Plan please call us or ask at reception.

We do not offer direct claims to other clients as we typically wait longer than the insurer’s client to receive payment for a direct claim. As we are not aware of your insurance cover details we also do not know what will be settled, if anything. Animal Plan clients are still liable to pay any outstanding in the event of a shortfall in the claim amount or non-payment from their insurer which needs to be resolved within 8 weeks of any claim made.

HOW DO I KNOW IF MY INSURER WILL PAY?

You can call your insurer and explain what you are looking to claim for. If it is for a procedure that is planned for the future e.g. (cruciate repair) we can give you an estimate for you to discuss with your insurer. We can also make a pre-authorisation where we approach your insurer with specific detail and your pets’ previous clinical history on which your insurer can base their decision. This can take several days before we have a decision from your insurer so is not possible for urgent treatment.

CAN I CLAIM FOR TREATMENT I HAVE HAD SOMEWHERE ELSE

Yes you can, but whichever vet or specialist conducted the treatment has to submit this part of your claim themselves. We can only process claims for treatment we have given at The Animal House Ltd.

WHAT IS A CONTINUATION CLAIM?

A continuation claim is one where you are continuing to make claims for the same condition after your first, initial claim. (This might be more medication for an animal with epilepsy after the first claim for medical treatment). We still need to follow the same process but your insurer will usually supply a smaller form that you need to complete and your insurer usually does not request full clinical history. You can provide a smaller stamped envelope for these claims if we are not able to use VetEnvoy.  We still make a charge for processing these.

IF I AM NOT HAPPY WITH MY INSURER OVER A CLAIM CAN YOU HELP?
We are happy to approach your insurer for you and ask them to re-consider a claim.

We are not able to give our opinion but we can ask them to review the case and make clarifications. (e.g. we may have used a procedure or medication for a purpose that is relevant to your pets’ condition that is not understood by the insurer.)

For us to be able to do this you need to contact your insurer and give them permission to speak to us. Without this we are not able to uncover the problem with your claim. Occasionally, there can be a mistake made by the client, by us or by the insurer.

Where it happens that we have made an error we will refund the insurance administration fee and resolve the claim issue. If an issue remains unresolved by your insurer you can contact the Insurance Ombudsman. Be aware as the contract is between you and your insurer our ability to help is limited.
To ask for a claim to be reviewed please e.mail theresa@vetanimalhouse.net with the details of what you wish to query. Do not ask the vet to do this as this is not what they do.

We typically find in the case of clients disappointed with an insurer that the small print uncovers that the policy taken out did not cover what the client supposed and that these declined or short-fall claims are exactly what the client contractually agreed to

IS PET INSURANCE WORTH IT?
We cannot know what is best for e each individual’s circumstance but we generally find that most clients benefit from having pet insurance. Each year veterinary science evolves and we see more and more procedures and treatments that we can offer.

We are able to do so much but the newer procedures and treatments can come at a cost. We can arrange for C.T. scanning, MRI’s, etc. We have stem cell treatment, laparoscopic procedures, chemotherapy etc-all in house.

We can generally keep pets healthier and living for longer, even with life-long conditions such as diabetes and epilepsy but they can be a big drain on the owner’s finances.

We know clients who take far more from their insurer each year than they pay to the insurer and without it they would find it difficult to meet the costs of treatment. It is a generalisation, but we would suggest that having pet insurance is beneficial for most pet owners.