I wanted to bring up an important topic, and one that most of you fellow pet owners probably aren’t aware of – or you are, but don’t realize it. What?! Let me explain…

HMO. Managed care. Human healthcare system (US). Sound familiar?

As most of you are aware of, human health insurance companies in the US like to dictate to doctors/hospitals/clinics what they are allowed to charge and subsequently, what the insurance company will pay out.

For example, if you go see a shrink through your healthcare provider, and that shrink usually charges $250 an hour (hmm maybe I’m in the wrong line of business…nevermind.) but the health insurance company says “to get our clients, join our network, but we will only pay you $75 an hour”. The same goes for regular doctor check-ups, emergency room visits, hospital stays, etc.

Ok now that you know what I’m talking about; let’s touch on our veterinary healthcare system. Oh wait, there’s isn’t one…yet.

As pet insurance becomes more popular in the US, many veterinarians are becoming worried that pet insurance will start dictating their prices. That is, the more that people buy into pet insurance to cover their pets, then their pet insurance company says “we will only reimburse you up to $200 for that knee surgery because that is a ‘reasonable cost’”. Well, when you get your veterinary bill for $1,000, what would you do in that situation? I know what I would do “hey veterinarian, why are you overcharging me?” It turns into a debate over who should you trust, veterinarian or pet insurance company? Well, as a representative of a pet insurance company, let me give you what I think is the correct answer: YOUR VETERINARIAN.

There is a reason why they went to school for many years and decided to go into veterinary medicine. They truly like pets. They want to make them healthy. They want to take care of their clients (your pets) and their owners (you).

I’ve seen many comments over the past few months on this blog about benefit fee schedules and people getting upset that their pet insurance didn’t pay out enough, or didn’t pay as much as they were expecting.

By now you’re probably thinking “ok, Melissa, get to the point already”.

Here it is: make sure you understand what your pet insurance company is paying out on. Most pet insurance companies do have some sort of reimbursement schedule or fee guide, whether or not they clearly market it. If you’re okay with getting about 50% of your claim reimbursed, then maybe that’s ok with you. But for most of us, we’re expecting to get the advertised “90% of your costs” or “80% of your veterinary bill” back.

Be wary of things like “usual and customary fees” or “reasonable costs”. Ask the question “Do you pay out based on what my veterinarian actually charges?”

Now, for those readers who haven’t yet gotten pet insurance or ran into the problem above, could the rest of you please share your horror stories? Did you think you would get $700 back but actually ended up only getting $300?

While pet insurance is still in the process of “catching on” I hear way too many stories from pet owners all ending in “I shoulda, woulda, coulda gotten pet insurance before I was slapped with this [insert exorbitant amount of money here] bill!”

We all hear stories through the grapevine about how so and so had to spend $5,000 on their cat’s hit by car injury, or $7,000 on their dog’s cancer treatment. And what do (most of us) think in return?

“It will never happen to me!”

“Well,” I say back to those people, “please teach me your psychic ways so that I can know how to best predict the future and so that I know whether or not I will be slapped with a large vet bill and determine if I should get pet insurance or not…”

…wait…

The sad truth is that it DOES happen. And for so many people out there, it happens when it’s “too late”. If you care about your pet like a child (and I know most of us do) pet insurance should really be something you look into so that you don’t have to get a second mortgage on your house or max out your credit cards just to make sure your furry friend stays alive.

I would really like those of you who have had similar stories to share. Do you wish you would have gotten pet insurance ahead of time? Let’s try to save other pet owners from hefty vet bills!

In the meantime, check out some actual claims and associated veterinary costs.

It is believed that, at least in the US, veterinarians have been wary of pet insurance because they don’t want to take the extra time to fill out paper work, fax over forms, etc. Some have even found themselves recommending a particular company, only to have that company go out of business shortly there after, and then find themselves with a bunch of angry pet owners. Luckily, pet insurance companies are realizing this and attempting to make the process as seamless as possible.

However, some veterinarians still can get stuck in the middle. For those companies who reimburse based off “usual and customary fees” or fees that the company deems reasonable for a given procedure, the pet owner may then feel like they were over charged by their vet. From some veterinarians that we’ve heard from, they don’t want to get stuck in the middle so they don’t go out of their way to recommend companies, but they will do their best to honor their clients wishes and fill out necessary paperwork.

Of course there are veterinarians on the other end of the spectrum, who love pet insurance and have seen how it has helped save lives when the pet owner wouldn’t normally have been able to afford a given procedure.

As a pet owner, would you feel your vet was doing you a disservice if they weren’t informing you of pet insurance, if it turns out it could have helped you? Do you think it should be their job to help process paperwork? If I have any veterinarian followers out there, I’d love to hear your opinion as to why or why not you may tell your clients about pet insurance.

An important consideration when choosing pet insurance is if, and how much, a plan would cover you if you had to see a specialist or go to an emergency facility. Doesn’t it always happen that your pup falls and hurts himself late at night when the vet isn’t open?

This forces you to go to an emergency clinic, which typically costs a lot more. While pet insurance would more than likely cover treatment of a broken leg, how much would they cover at an emergency clinic?

Some companies will cover the same amount as if you saw your normal veterinarian, while others will lower the coverage amount. The same goes for referral specialists. Say your cat developed some kind of skin allergy and had to visit an allergist. Often specialists end up costing much more. True, this is also something that most pet insurance companies would cover, but at what cost?

Make sure that when you’re looking into insurance, that you find out if you are covered for treatments outside of your normal veterinarian.

I’ve decided to somewhat break from the mold today because I feel the need to share my scary day from yesterday…

What started off as any old day, get up, get ready, make coffee, let Goldie out, drive in to work, sit at desk, start working…you get the picture, turned out to be a little crazy. Goldie, my lucky lucky dog, gets to accompany me into the office every day where she is always greeted by her other canine office companions and they run around all day. If we could only all be so lucky.

I know that she has a tendency to follow her nose and wander away if left to her own devices, so when I couldn’t find her around the office I didn’t think too much of it at first. After all, she’s always somewhere. I started asking around and got a response that someone saw her outside and assumed I had been with her and that we went somewhere. And so set in a little bit of panic.

…And it kept building as I realized that she had somehow gotten outside (and I won’t point fingers, but I still don’t understand how someone would let her out WITHOUT knowing about it…). Of course a million horrific images popped into my head at once as I ran to get my car keys to go start driving around.

“What if she ran into the woods somewhere and doesn’t know how to get back?”

“What if she gets hit by a car”

“What if someone takes her”

And worst of all “What if I have to go home tonight without Goldie?”

You know, basic ‘mama with lost dog’ panic. My heart dropped even further as I noticed that her collar was sitting on my desk (her and Charlie tend to get rough when they play, so we remove their collars in the morning).

Slowly people in the office started hearing about the story and were starting to gather and heading outside. My first instinct was the jump in my car and head left - call it mother’s intuition, but I found her ‘taking herself for a walk’ about a block down the road on the sidewalk. As soon as she saw me and my car she went crazy, as I think she had followed her nose a little too far and got turned around.

PHEW!

Well that was my first (and hopefully last) near dog loss experience. And did I mention I’ll never take Goldie’s collar off again? And yes, she is microchipped, but you never know, right?

Anyway, I’d love to hear similar stories…and how you stayed sane!!!

And here is the last series of questions…

16. Can I afford the monthly premium, deductible, and required co-pay?

Don’t think this question needs much explaining..but, just make sure you think about the different costs and what the co-pay would mean to you.

17. Is there any penalty if I cancel my policy?

It’s my understanding that with insurance, you’re always owed back any premium that you’ve paid ahead of time. However, make sure to check with each company just in case you decide you don’t like the coverage. And, as in most pet insurance companies, if you decide to switch, any conditions that began with one company will likely not be covered by another.

I hope you have found these questions helpful. I’d love to take credit for them, but they did come from The American Animal Hospital Association, so you can thank them;)

For the last few weeks I have been putting out a series of questions that you should ask yourself/a potential pet insurance provider before purchasing insurance. Please read Series 1, Series 2, Series 3, and Series 4 to catch up!

13. How are claims submitted? How long do I have to submit a claim? Will my costs change based on the number of claims I submit?

This is an important process to understand, since, duh, this is how you get your money back! Make sure you understand what you have to do, what your veterinarians has to do, and exactly how long you have to do it. Some companies require you submit your claim within 30 days of the treatment, some 3 months, some a year, but make sure you understand that time line. The last thing you’d want is a denied claim simply because you exceeded the amount of time you have to submit!

14. How long does it take, on average, to be reimbursed?

This is a little trickier to get a straight answer. There aren’t many rules regulating how long a company has to reimburse a client. Some companies will advertise their average turnaround time, while others will dance around the question. Either way, do your best and see what you can get out of them.

15. Does this policy use a list of “usual and customary fees” to determine how much I will be reimbursed? Is that list up-to-date? Are the fees consistent with what my veterinarian expects to charge?”

For this I would recommend getting this answer in writing. Find out exactly how much you will get reimbursed on an approved claim, and even think about taking those costs/fees into your veterinarian to see if they make sense. If your veterinarian says “no way, these prices are way too low” then you might want to consider another company.

9. Do I understand exactly what the policy covers?

This is to reiterate the importance of understanding what you’re getting! Too many pet owners get into pet insurance without fully understanding, then get angry for not understanding! Now, true, there are some companies that try to take advantage of the unknowing consumer, but if you don’t do you research thoroughly, you can’t blame anyone but yourself!

10. How much coverage does this policy provide for chronic, hereditary, or pre-existing conditions?

This is a really important question to ask and be made aware of, especially if you own a breed that is prone to certain conditions. Most companies will not cover any pre-existing conditions, so if your pet has had a medical history make sure to ask how that will affect future coverage.

Chronic conditions is also a really important topic. Please read all the fine print. Many companies start a brand new policy upon renewal, making anything in the previous policy term pre-existing and NOT covered. For example, if your cat were to get diabetes and treatment was covered, then you renewed your policy 3 months later, there is the possibility that treatment would no longer be covered. This is a BIG one, so please, please ask the provider how they handle chronic conditions!

That brings me to my next question…

11. How does this provider handle renewals?

As mentioned above, some policies are annual policies, and therefore have to be renewed each year. Make sure to find out how renewal will affect your coverage. The last thing you’d want is to be paying into insurance for 4 years to have your dog develop skin allergies in the 4th year, only have them covered in that 4th year, but then being stuck with that insurance company because you’ve already put so much money into it and his skin allergies would be pre-existing anywhere else. Talk about frustration.

NOTE: There are companies that have continuous policies or that offer additional coverage for chronic or recurring ailments.

12. Are there certain types of accidents or health problems that aren’t covered?

Again, this goes back to making sure you know what is and isn’t covered. Specifically ask what incidents would be excluded for coverage. For example, most companies don’t cover accidents to working dogs (guard dogs, police dogs, etc.) or any complications from breeding or pregnancies. Since intact pets are more prone to certain cancers and other ailments, there are often exclusions if your pet isn’t spayed or neutered, so make sure to also inquire about that.

I would love to hear additional feedback: comments, suggestions, further questions, etc. Until next time…

In an effort to help you all out when looking into pet insurance, I am continuing my series on questions to ask potential pet insurance providers. Here is my third set of questions.

7. Will this provider reimburse services provided by my veterinarian or am I required to use a veterinarian in this provider’s network?

I really only know of one or two companies that require you to use a veterinarian within their provider network. Since most pet insurance reimburses the pet owner, the pet owner can see whichever veterinarian they choose. However, make sure to double check when picking out a provider.

8. Does this provider have an appeals process I can use if my claim is denied?

Many pet insurance providers will offer you the opportunity for you and/or your veterinarian to appeal a denied claim. This usually gives the veterinarian (if they’re willing) the chance to further explain the pet’s history or chosen treatment. Some providers will then even send the claim and appeal to a third part group of veterinarians for review. I think this is a good system to have in place, and offers pet owners extra peace of mind.

Again, please feel free to ask questions or embellish on anything I have mentioned here.

As I mentioned in my previous post about pet insurance provider questions, I will be running a series of useful questions that you should ask yourself and your potential pet insurance provider if you’re looking into pet insurance. Here is my second set of questions.

4. Does this provider offer a variety of deductibles?

The American Animal Hospital Association suggests going with a company that allows for high deductible plans, but this is entirely up to you. Their reasoning is that it keeps monthly premiums down, while still covering those major accidents or illnesses. If you would prefer to only cover those really expensive trips to the vet, then I would also recommend finding a company that lets you have a high deductible.

5. Does this provider exclude coverage for pets the same species, breed, and age as mine?

You should be aware that there are companies that will have certain breed-specific exclusions. If you have a breed that may be prone to certain conditions, you might want to ask the provider if they have any exclusions for your specific pet.

6. Did this provider respond quickly and thoroughly when I requested more information?

This is another question to get the feel for the company. If they were slow in getting you more information, chances are they will be slow at processing any claims that you make. I would suggest going with a company that is very upfront and honest about giving you the right information, and giving you the information that you specifically ask for.
Again, please feel free to ask questions or embellish on anything I have mentioned here. Stay tuned next week…