How To Make A Pet Insurance Claim
When it comes to filing a pet insurance claim, it’s important to understand the specifics of your pet insurance policy, especially waiting periods and uncovered costs. The actual filing process is pretty straightforward and most insurers allow you to file claims online. The veterinarian may even handle it in some cases.
Keep reading to learn all you need to know about filing a claim and what to do if the claim gets denied.
Review your insurance policy
Pet insurance reimburses pet owners for the cost of treating unexpected accidents, injuries and illnesses. Pet owners pay insurance companies a monthly premium to keep the coverage active. Location, coverage level, plan features and even the pet’s breed and age affect how much pet insurance costs.
On top of monthly premiums, you must also pay any copayment, coinsurance and deductible due for pet exam fees, treatments and other covered pet care. In most cases, you’ll also pay the veterinary costs upfront and then file for reimbursement.
When signing up, you choose a reimbursement rate for covered vet bills which might be as low as 60% or as high as 100% if the insurer offers this option. You’re responsible for paying the remaining percentage of the bill (the coinsurance) out-of-pocket.
In addition to the reimbursement rate, most insurers set annual, lifetime or per condition payout limits. The policy won’t reimburse additional expenses once your pet’s medical bills reach that limit. Most companies allow policyholders to pick their preferred reimbursement rate and payout cap, so you can tweak the benefits to find a cheap pet insurance policy that fits your budget.
Methods of payment
Insurance companies use two different methods of payment: reimbursement and direct pay to the vet.
Reimbursement through a pet insurance claim
It’s far more common for a pet insurance company to send the pet owner a reimbursement check after processing the claim. This means you must pay the veterinarian the whole cost upfront or set up a payment plan at checkout. Plus, unlike the direct pay option, you’re responsible for filling out the claim forms and gathering the necessary documentation
Once approved, the insurer deposits the money directly into your bank account or sends a paper check. You can then use the money to pay off any payment plan you have with the veterinarian.
Direct pay to the vet
Some insurance companies pay the veterinarian directly. This means you don’t have to pay anything out-of-pocket upfront, and the veterinarian handles the claims process.
In practice, direct payment to the vet can work in two ways. The veterinarian receives the insurance money right at check-out through a direct payment software or the insurance company sends the reimbursement check to the vet’s office at a later time.
How to file a pet insurance claim
Before filing a pet insurance claim, you should first identify the services your pet qualifies for and your plan's waiting period rules. After you submit a claim, the insurer will let you know if you need to submit additional documentation or arrange to pay for uncovered costs.
Make sure the waiting period has passed before seeking services
Pet insurance plans have waiting periods during which treatment won’t be covered, and any claims submitted will be denied. The length of the waiting period depends on the plan specifics and the type of procedure — treating a knee ligament injury versus a broken bone, for example. Your plan’s documents should detail the waiting periods, but you can also check the insurer’s website or call to confirm.
Typically, coverage for injuries and accidents starts within one to 14 days, while coverage for illnesses may not start until after 30 days. Care for hip dysplasia and ligament-related issues in the knees and elbows may have a longer waiting period of four to 12 months.
Note that if something happens to your pet during the waiting period, the insurance company will consider it a pre-existing condition and exclude it from future coverage. Curable conditions like infections may have coverage after six to 12 months of no symptoms, but incurable diseases like cancer won't be covered for future claims.
Confirm whether your policy will cover your pet's treatment and conditions
When you signed up for pet insurance coverage, you likely had two to four plan options with varying coverage levels. What pet insurance covers depends on the plan type and any add-ons selected. The three types of coverage are listed below:
- Accident and illness coverage: This plan will cover various services if a pet gets hurt in an accident or becomes ill. For example, it would pay for X-rays and surgery if your dog gets hit by a car or develops a knee condition.
- Accident-only coverage: A common option for older pets that don’t qualify for illness coverage, this plan only covers vet care for accidents such as poisoning, getting bit by another animal, tearing a ligament or getting hurt by a car. It’s a more budget-friendly option than comprehensive coverage, but you’ll be responsible for the entire bill if your pet’s issue is an illness, not an accident.
- Wellness coverage: Wellness packages or add-ons help with routine checkups, vaccinations, testing and other wellness services not covered by pet insurance. It may help you save money on your pets in the long run since your vet can identify any issues early on. You can purchase these plans separately or add them to the base policy as a rider.
Note that pet insurance plans can also have add-ons. We already mentioned wellness riders, but other add-ons include coverage for alternative therapies, behavioral training or rehabilitation and even lost and found rewards.
After determining whether the veterinary visit qualifies for coverage, double check the insurance company’s exclusions. Standard exclusions include but aren’t limited to:
- Pre-existing conditions (including those inherited)
- Dental care
- Preventable health conditions
- Flea treatments
- Pregnancy care
- Behavioral issues
- Optional procedures (including neutering and cosmetic treatments)
- Non-veterinary costs (such as pet food and grooming)
Finally, verify that you haven’t exceeded any plan limits or caps. If you have a deductible, you must pay it before coverage kicks in.
Complete a pet insurance claim form and submit it
Once your pet's policy coverage is confirmed, file the pet insurance claim immediately after the veterinary visit. To file the claim, you’ll need an official itemized invoice. Ask your vet for a document detailing the reason for the visit, treatments received and costs.
Next, find out how to submit a claim with your insurer. Many companies have an online platform — website or mobile — equipped to handle the entire claims process. If you’d prefer other methods, you may also print out a paper claim form to mail or fax.
You'll provide the same information whether you complete the form online or by hand. The insurer will need:
- The policy number
- The policyholder's contact information
- The pet’s name
- Date and location of the vet visit
- Reason for visit and care received
- Invoice amount
To finalize the form, you must sign and date the document and upload the itemized invoice. At this point, the insurer will also ask if you want to receive the reimbursement by paper check or direct deposit. The latter option is faster and requires providing routing and account numbers.
Wait for an approval or denial notification
After you submit the pet insurance claim, the insurer will send a confirmation and may let you track the claim's status on your account. Expect the insurer to contact you if it needs more documents to back up the claim. For example, you may need to provide your pet’s medical records if the insurer suspects a pre-existing condition or another disqualifying factor such as neglect.
The claim could be approved within a few weeks to a month if no problems occur. However, disputed or missing claim information can stretch the timeline or lead to your claim being denied. Whether your claim is denied or approved, you’ll receive an explanation of benefits (EOB) that tells what is covered, what isn't and why.
If approved, ensure that no balance is due
If you paid out of pocket at the vet and received your reimbursement money later on, make sure that you don’t have a balance with the vet. This might happen if you set up a payment plan to avoid paying all at once and haven’t yet completed the payments.
If denied, file an appeal with your insurer
The insurer usually allows at least two weeks to appeal the decision if a claim is denied. During an appeal, the insurance company reviews the claim and any accompanying documentation.
If your pet insurance claim is denied, you must:
- Write an appeal letter to the insurance company. This letter must explain why the specific services should be covered and justify it with the policy's terms. It should also note any possible errors made by the insurance company that could have led to the denial.
- Consider including further documentation about the visit and the pet’s medical history to show that the coverage should apply.
- Send the appeal letter and accompanying documentation to the insurance company through one of the methods it allows. Email and fax are quicker than mail for this purpose.
It can take up to 30 days for your pet insurance company to review the appeal. If the company denies your first appeal, you may be allowed to submit a second one.
Frequently asked questions
How soon after taking out pet insurance can you file a claim?
Does pet insurance go up if you file a claim?
How long does a pet insurance claims process take?
Can you cancel a pet insurance policy right after a claim?
- Verify that the vet care service falls under your coverage and make sure the waiting period has passed.
- Locate your pet insurance company’s online claim form or print one out.
- Fill out the claim form with all the requested information, including the visit reason, cost and official invoice.
- Submit the invoice and documentation to your insurance company online, by mail or by fax.
- Wait for the insurance company to process the claim and send the reimbursement money.
- Use the reimbursement money to pay any outstanding balances at the vet.
- If the initial claim is denied and you have grounds for appeal, follow the insurer’s appeal process and submit additional documentation. You may be able to appeal twice.