Getting pet insurance for your dog, cat, or potbellied pig is simply the beginning. You will almost certainly have to file a claim at some point.
Because pet insurance is typically based on a reimbursement basis, it’s important to understand how that process works and when you may anticipate your money.
This guide will walk you through the claims procedure step by step.
Steps to Take in Making a Claim for Pet Insurance
Step 1: Conduct a Direct Pay Pre-Check
If your insurance is one of the few that will pay your veterinarian directly and you want to utilise it, you must first check with the vet’s office to ensure that it takes direct payment from your insurer before seeking care for your pet.
If your veterinarian does not take direct payment, you will be sent to the insurer’s reimbursement plan if you proceed with the visit.
Step 2: Know Your Waiting Period
Almost all pet insurance policies include a 10- to 30-day waiting period from the date the policy begins until coverage begins.
Before obtaining regular care, ensure that you have completed the waiting time.
If you have an accident or a major sickness, the waiting period may be irrelevant, and your pet will most likely not be covered for this incident.
Step 3: Review Policy Coverage, Terms, and Conditions
To minimise expensive surprises, make sure you understand if your pet’s treatment is covered by your policy, as well as all relevant terms and restrictions.
- Preexisting conditions exclusion: Most policies won’t pay for congenital defects, hereditary conditions, or anything diagnosed and treated prior to the policy start date.
- Other exclusions: Preventive treatment or wellness care, dental care, vaccinations, flea prevention, spaying or neutering, and behavioural training are often excluded. However, some policies come with a wellness rider that does cover these exclusions.
- Deductible: This is the amount you pay before coverage kicks in (after the waiting period). Some policies have a per-incident deductible; others are annual.
- Co-pay: Once you meet the deductible, you may have to pay co-insurance or a co-pay. If your reimbursement rate is 80%, your co-pay will be 20%, for example.
- Limit: This is the maximum amount (per incident and/or policy term) you will be reimbursed.
Step 4: Obtain a Claim Form and Fill It Out
Insurance companies process claims in a variety of methods. Many people make use of online claim forms or smartphone apps.
Others allow you to download and print the claim form. Familiarize yourself with your insurer’s claim filing process by visiting the insurance company’s website and looking for the section on claim filing—preferably before you need to file one.
Once you have access to the claim form, gather any extra papers you require, such as paid vet invoices and any required medical records, such as the SOAP (subjective, objective, assessment, and plan) notes for the specific therapy your pet got.
Complete the claim form carefully, describing treatment rather than symptoms, and follow all directions to the letter. If you require assistance, contact your veterinarian’s clinic.
Step 5: Submit the Claim
Once you’ve finished the claim form and gathered all necessary evidence, submit your claim online, through a mobile app, email, fax, or standard mail, following the directions to include invoices and medical records.
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 obtain that information.
The length of time depends on the method you use. If you submit online or using a mobile app, you may receive a notification very immediately or between 48 to 72 hours.
Step 7: Wait for Claim Review and Processing
Some insurers claim to handle most claims within 24 hours, however, it is more normal to wait 15 to 30 days.
When you file your initial claim, many insurers will want to evaluate your pet’s medical history.
This will lengthen the time it takes to process this claim, with all subsequent claims being processed in accordance with the insurer’s standard schedule.
During the evaluation process, your insurer may contact you to request additional information.
Make sure to react soon, as the request will most likely reset the timer for review and processing.
Step 8: Receive Notification of Approval or Denial
After claim assessment and processing, you will be notified if your claim was allowed or denied, in whole or in part.
You will also learn how much your reimbursement will be. Approval may come in the form of a cheque for the amount of the reimbursement or by direct deposit if you opted up ahead of time.
Step 9: Cash the Check or File an Appeal
You’re done if your claim is granted and you agree on the amount of refund.
If your policy provides direct payment to the veterinarian, you will be notified if the veterinarian has been paid and if there is a balance owed.
If you disagree with the decision, you must file an appeal.
Step 10: Know How and Where To Complain
Your insurer is the first step in the appeals procedure. Look for a section on the insurer’s website named “Appeal” or “Claim Review.”
Follow the instructions for the appeal process, and be prepared for it to take up to 30 days, just like your original claim. If the appeals process fails, contact the office of your state’s insurance commissioner.
Contact information is available via the National Association of Insurance Commissioners (NAIC) or your state government’s website.
Knowing how the claims process works will help you get the coverage you paid for. Make sure you have all of the necessary records to back up your claims.
Make an extra effort to appeal your case if you don’t receive your cheque.