Does Pet Insurance Cover Surgery?

If you think of your pet as part of your family, you might be considering purchasing pet insurance. A pet insurance policy could be a worthwhile investment for pet owners who want to avoid ever having to choose between their pet's health and unexpected veterinary bills.

For example, if your pet was ever in an accident, a pet insurance policy could help you cover the costs of emergency surgery. However, pet insurance has notable restrictions, and understanding them can help you determine whether this type of policy is right for your animal and your wallet.

Read on to learn more about pet insurance and surgical procedures.

Does pet insurance cover surgery procedures?

Pet insurance may cover medically necessary surgery. However, elective procedures such as ear cropping, tail docking and declawing aren't covered by most, if not all, pet insurance plans.

Similarly, procedures related to pre-existing conditions aren't covered by most pet insurance companies.

Coverage also varies by policy type. Here are the most common types of policies and what they generally cover:

• Accident and illness policies: Reimburse you for veterinary expenses related to the diagnosis, treatment and hospitalization of unexpected accidents and illnesses, including surgery for a variety of issues and conditions.

• Accident-only policies: Reimburse you only for expenses related to sudden and unexpected accidents and injuries like broken bones, abrasions and poisoning.

• Wellness policies: Cover routine procedures and wellness expenses like vaccinations, dental cleanings and annual checkups. These may also cover spaying and neutering.

Covered surgical procedures

Some pet insurance policies cover pet exam fees, and most will reimburse you for a variety of surgical procedures — provided they aren't related to a pre-existing condition. It's also important to note that, for a surgery to be covered, it must be medically necessary.

In general, surgical procedures related to unexpected injuries or illnesses are covered. Those may include surgery to treat broken bones and torn ligaments and remove tumors, infected teeth and foreign objects. High-cost surgeries such as hip and knee replacements may also be covered.

However, coverage can vary significantly by policy and insurance company. For example, while most pet insurers exclude pre-existing conditions from coverage, some may cover curable pre-existing conditions that have been in remission for a specified period.

Most policies also include waiting periods before coverage kicks in. And depending on the company, there may be separate waiting periods for accidents and illnesses.

Surgical procedures that typically aren't covered

Again, pet insurance policies typically don't cover elective or cosmetic procedures such as tail docking, ear cropping and declawing. Many pet insurance plans also exclude spaying and neutering, yet some companies offer wellness policies that cover them.

Coverage for surgery related to birthing complications also varies considerably by company. While most insurers won't cover such procedures, some may cover things like emergency c-sections when medically necessary.

And, as stated before, most pet insurance policies exclude pre-existing conditions. This means that if your pet was treated for a health issue before you purchased the policy, surgeries related to that condition will likely not be covered.

Nevertheless, some pet insurers may cover curable pre-existing conditions after a waiting period, so shop around and read policy details carefully if this is something you're concerned about.

Common types of pet surgeries

Many pet insurance policies provide coverage for common types of pet surgeries. For example, most accident and illness policies cover tumor removal, bladder stone removal, foreign body removal (when your pet swallows something they shouldn't) and cruciate ligament surgery. Emergency dental surgeries are generally also covered.

Neutering and spaying are also routine procedures, but they may be classified and elective and generally fall under coverage exclusions for accident and illness policies.

As coverage can vary by policy and pet insurance provider, we recommend you carefully review your policy's terms and conditions to understand which surgeries are covered and any limitations or exclusions that may apply.

How does pet insurance work for surgery?

Most pet insurance policies follow a reimbursement model. This means you must pay for the surgery upfront and then submit a claim for reimbursement with the pet insurance company.

Generally, you'll also have to meet a deductible before your coverage quicks in. Once you've satisfied the deductible, the insurance company will cover a percentage, typically 70% to 90% of your pet's eligible veterinary expenses.

Say your pet requires a $5,000 emergency surgery. If your plan has a $500 deductible and an 80% reimbursement rate, you would pay the first $500 out of pocket. After that, the insurance company would cover 80% of the remaining $4,500.

That means the insurance company would reimburse you $3,600 (80% of $4,500) and you would be responsible for the remaining $900. So, you would pay a total of $1,400 out of pocket (the $500 deductible and $900 coinsurance) for the $5,000 surgery.

Pet insurance companies that cover surgeries

While most pet insurance companies cover surgeries, the extent of the coverage can vary significantly by insurer and plan. Review the details of the policies you are considering to ensure you're getting the right type of coverage for your pet.

For example, Embrace Pet Insurance covers most types of surgeries unrelated to pre-existing conditions, provided they are not cosmetic procedures or c-sections.

Trupanion, on the other hand, offers a policy rider that covers some costs associated with breeding, whelping or queening, including medically necessary planned c-sections. However, to qualify for coverage the pet must not be pregnant at the time of enrollment.

For more information about policy options and coverage details, read our guide to the best pet insurance companies.

How to file a pet insurance claim to recover surgery costs

Making a pet insurance claim to cover surgery costs is typically straightforward. Here's a quick step-by-step guide:

1. Pay for the surgery upfront: As mentioned earlier, most pet insurance policies operate on a reimbursement model. This means you'll likely have to cover the surgery costs initially.
2. Get a detailed invoice: After the surgery, ask your vet for a detailed invoice. This document should include the date of the procedure, a description of the surgery and the total cost.
3. Submit a claim: Most pet insurers allow you to submit claims online or via a mobile app. You'll need to fill out a claim form and attach a copy of your detailed invoice.
4. Wait for approval: The insurance company will review your claim and, if approved, will reimburse you for a portion of the cost based on your policy.
5. Receive reimbursement: Once approved, you'll receive your reimbursement. The timeframe can vary but typically takes between two weeks to a month.

Summary of Money's guide to whether pet insurance covers surgery

When looking into pet insurance, pay attention to the details regarding what types of surgeries are covered under the policy. Most pet insurance companies cover a wide variety of surgical procedures that result from accidents or illnesses, but the specifics can vary significantly between companies.

Ultimately, pet insurance can be a worthwhile investment for some pet owners. It generally covers many types of surgery and can help you ensure your furry friend gets the care they need without breaking the bank.