Purchasing insurance for your dog, cat, or potbellied pig is only a portion of the story. You may undoubtedly have to file a claim at some point. As pet insurance typically follows a reimbursement model, it is important to understand how this process works and when you might anticipate receiving payment. This article walks you through the claims process in detail.
Steps For File a Pet Insurance
Step 1: Conduct a Direct Pay Pre-Check
If your insurance is one of the few that offers direct payment to your veterinarian and you want to utilize it, you must verify with the veterinarian’s office that it takes direct payment from your insurer before bringing your pet in for treatment. If your veterinarian does not take direct payment, you will be routed to the insurer’s reimbursement plan.
Step 2: Know Your Waiting Period
Almost all pet insurance policies have a 10- to 30-day waiting period from the policy’s effective date until coverage begins. Ensure that the waiting period has passed before seeking routine care. In the event of an accident or significant disease, the waiting period may be irrelevant, and your pet will likely not be covered.
Step 3: Review Policy Coverage, Terms, and Conditions
To avoid unpleasant financial shocks, ensure that the treatment your pet requires is covered by your coverage and that you are aware of all relevant terms and restrictions.
Exclusion for preexisting conditions: Most policies exclude coverage for congenital defects, hereditary conditions, and anything identified and treated prior to policy inception.
Other exclusions typically include preventative or wellness care, dental care, immunizations, flea prevention, spaying or neutering, and behavioral training. Nevertheless, some plans include a wellness rider that covers these exclusions.
This is the amount you must pay before coverage begins (after the waiting period). Some insurance has an incident-by-incident deductible, while others have an annual deductible.
After meeting the deductible, you may be required to pay co-insurance or a co-pay. For instance, if your reimbursement rate is 80%, your co-pay will be 20%.
This is the maximum amount you will be paid (per occurrence and/or policy term).
Step 4: Obtain a Claim Form and Fill It Out
Insurers offer numerous options for claims handling. Many use smartphone apps or online claim forms. Others allow you to download and print the form. Prior to filing a claim, visit the website of your insurer and locate the section on claim filing.
Once you have access to the claim form, gather any extra documentation you require, such as paid invoices from the veterinarian and any required medical records, such as the SOAP (subjective, objective, assessment, and plan) notes for the treatment your pet got.
Complete the claim form with care, describing treatment, not symptoms, and adhering to all directions precisely. If needed, your veterinarian’s office can provide assistance.
Step 5: Submit the Claim
Once you have completed the claim form and gathered all supporting evidence, you can submit your claim online, through a mobile app, email, fax, or by normal mail, following the directions for including bills and medical records, depending on the method you choose.
Step 6: Verify That Your Claim Was Received
Depending on your insurance, you may receive notification that your claim has been received, or you may need to contact the insurer to find out. How long this will take depends on the method you employ. If you submit online or using a mobile application, you may be notified very immediately or within 48 to 72 hours.
Step 7: Wait for Claim Review and Processing
Although some insurers claim to process the majority of claims within 24 hours, 15 to 30 days is more typical. When you submit your initial claim, many insurers may require a review of your pet’s medical history. This will lengthen the time required to handle this claim, while the following claims will be processed according to the insurer’s standard timeline.
During the evaluation process, your insurer may contact you for further information. Ensure prompt response, as the request will likely reset the review and processing timers.
Step 8: Receive Notification of Approval or Denial
At the conclusion of the claim review and processing, you will be notified of whether or not your claim was granted in full or in part. In addition, you will learn the amount of your reimbursement. Approval may come in the form of a refund check or, if you elected direct payment in advance, via direct deposit.
Step 9: Cash the Check or File an Appeal
If your claim is granted and the amount of reimbursement is acceptable, you are finished. If your coverage involves direct payment to the veterinarian, you will be notified whether or not there is a remaining amount. If you disagree with the conclusion, you must file an appeal.
Step 10: Know How and Where To Complain
Your insurer initiates the appeals process. Check the insurer’s website for the “Appeal” or “Claim Review” area. Follow the instructions for the appeals process and be prepared for it to take up to 30 days, just like your first claim.
If the appeals process is unsatisfactory, contact the office of your state’s insurance commissioner. You can acquire contact information via the National Association of Insurance Commissioners (NAIC) or the website of your state government.
Can You Get Insurance That Covers Routine Care for Pets, Not Just Illness?
Prevention and wellness care are frequently excluded. However, some businesses provide distinct wellness plans for pets.
Can I Get a Discount if I Insure More Than One Pet?
Numerous businesses provide this discount. Look for the contract with the best terms.
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