How to File a Pet Insurance Claim

Getting pet insurance for your dog, cat or pig is only part of the story. At some point, you’ll probably have to file a claim. Since pet insurance generally follows a reimbursement model, it’s good to know how this process works and when to expect your money. This article walks you through the claims process step by step.

Key points to remember

  • Study your policy before using it, so you know what is covered and what is not.
  • Obtain receipts and required medical records from your veterinarian after your pet has been treated.
  • Complete and submit the claim form in a timely manner.
  • Check that your request is being processed.
  • Arrange for direct deposit of your refund to expedite turnaround times.
  • If your request is refused, know how and where to lodge an appeal.

Step 1: Perform a “direct payment” pre-verification

If your insurance is one of the few that offers to pay your vet directly and you want to use that, you should check with the vet’s office to make sure they accept direct payment from your insurer before seeking treatment. for your pet. Direct payment being an option, if your veterinarian does not accept it, you will be transferred to the insurer’s reimbursement plan if you continue the visit.

Step 2: Know your waiting period

Almost all pet insurance policies have a waiting period of 10 to 30 days from the effective date of the policy until coverage begins. Make sure you are past the waiting period before seeking regular care. If you face an accident or a serious illness, the waiting period may not matter and your animal will probably not be covered for this event.

Step 3: Review policy coverage, terms and conditions

To avoid financial surprises, make sure you know if the treatment your pet needs is covered by your policy, along with all relevant terms.

  • Exclusion of pre-existing conditions – Most policies will not pay for birth defects, hereditary conditions or anything diagnosed and treated before the policy start date.
  • Other exclusions – Often excluded are preventative treatments or wellness care, dental care, vaccinations, flea prevention, neutering or neutering and behavioral training. Note: Some policies come with a wellness endorsement that covers these exclusions.
  • Deductible – This is the amount you pay before coverage begins (after the waiting period). Some policies have a per-incident deductible; others are annual.
  • Co-payment – Once you have reached the deductible, you may have to pay co-insurance or a co-payment. If your reimbursement rate is 80%, your copayment is 20%, for example.
  • Limit – This is the maximum amount (per incident and/or duration of the contract) that will be reimbursed to you.

Step 4: Obtain a claim form and complete it

Insurers offer claims handling in several different ways. Many use online claim forms or a mobile app. Others allow you to download and print the claim form. Familiarize yourself with the process used by your insurer by going to the insurance company’s website and looking for the section to file a claim, preferably before you have to file one.

Once you have access to the claim form, gather all the additional documents you need, including bills paid by the vet and all required medical records, such as SOAP (subjective, objective, assessment and plan) notes. for the specific treatment your animal received. .

Complete the claim form carefully, making sure to describe the treatment, not the symptoms, and to follow all instructions exactly. Your veterinarian’s office can help you if you need it.

Step 5: Submit the claim

Once you have completed the claim form and gathered all documents, submit your claim online, via mobile app, email, fax or regular mail following the instructions for including bills and medical records depending on the process you are using.

Submit your claim in a timely manner after processing. Some insurers impose a deadline of 90 days or less to file a claim.

Step 6: Check that your complaint has been received

Depending on your insurer, you may receive a notification that your claim has been received or you may need to check with the insurer for this information. How long this will take will likely depend on the process you are using. If you submit online or through a mobile app, notification can be almost instantaneous or within 48-72 hours.

Your first claim will likely take longer to process, as the insurer will want to review your pet’s medical history.

Step 7: Wait for the review and processing of the request

Some insurers say they process most claims within 24 hours, but 15 to 30 days is more common. Many insurers will want to review your pet’s medical history when you file your first claim. This will extend the processing time for this claim, with all subsequent claims being processed within the insurer’s usual timeframes.

Your insurer may contact you during the review process to request additional information. Be sure to respond quickly, as the request likely resets the clock during review and processing.

If your insurer offers direct deposit for reimbursement, sign up to speed up the process of getting your money.

Step 8: Receive notification of approval or rejection

Upon completion of the review and processing of the request, you will receive a notification that your request has been approved or denied in whole or in part. You will also know the amount of your refund. Approval may be accompanied by a check for the reimbursement amount or by direct deposit if you registered in advance.

Step 9: Cash the check or appeal

If your request is approved and you agree with the refund amount, you’re done. If your policy includes direct payment to the vet, you will be notified that the vet has been paid and if you have a balance owing. If you disagree with the finding, your next step is to file an appeal.

Step 10: Know how and where to complain

The appeal process begins with your insurer. Check the insurer’s website for a section titled “Appeal” or “Claim Review”. Follow the appeal process instructions and be prepared for this process to take up to 30 days, just like your original claim.

If the appeals process proves unsatisfactory, contact your state’s office of insurance commissioner. You can obtain contact information through the National Association of Insurance Commissioners (NAIC) or on your state government’s website.

Can you get insurance that covers routine pet care, not just illness?

Preventive treatments and wellness care are often excluded. But some companies offer separate pet wellness plans.

Can I benefit from a discount if I insure several animals?

The essential

Knowing how the claims process works will help ensure that you get the coverage you purchased. Be sure to collect the records you need, so you have a backup for your claims. If you don’t receive your check, make the extra effort to appeal your case.