What Pet Exam Fees Are Covered by Pet Insurance

Health care is one of the most expensive parts of pet ownership. To help budget for veterinary costs, many Americans are enrolling their pets in health insurance plans. Unfortunately, most pet insurance companies only reimburse you for expenses related to accidents and serious illnesses, not preventative wellness exams. Keep reading to learn how to find pet insurance that covers exam fees so you can find the right plan for you and your pet.

What is a pet wellness exam?

A pet wellness exam is essentially the same as a human’s yearly physical. As with people, the early diagnosis of a health condition is critical for preventing and identifying serious conditions early on.

The physical exam generally lasts about 30 minutes. During the appointment, your veterinarian will examine your pet and ask questions about their:

• Diet and drinking habits
• Activity levels
• Bathroom frequency
• Lifestyle

Your vet may also run annual blood work along with additional tests to check for signs of any hidden medical issues.

At the end of the appointment, your veterinarian may recommend preventative care, such as vaccines, parasite control (such as heartworm and ticks), and more.

Does pet insurance cover wellness exams?

Unfortunately, most standard pet insurance plans don’t cover the cost of wellness exams. They typically pay for medical care from an accident such as a broken leg or serious illnesses like cancer.

If you want wellness coverage, you’ll need to upgrade to a plan that includes preventative care coverage or purchase a separate plan altogether. When researching pet insurance that covers wellness example, be sure to look for words like “preventative,” “wellness,” or “comprehensive” in the policy description.

Paul Guyardo, CEO of Fetch by The Dodo, explains that pups and their parents can have a better experience with Fetch.

“Many pet insurance companies defend their lack of coverage for veterinary exam fees by saying that not covering them allows them to pay claims for more serious illnesses while keeping costs low,” Guyardo says. “Others say that they only cover ‘unexpected’ health issues and that veterinary exam fees fall into the category of expected expenses.”

Fetch is an outlier and innovator among pet insurance companies. Exam fees for sick vet visits are covered just like any other line item of a vet bill, subject to deductibles and policy limits, of course. And despite Fetch’s unprecedented benefits, their policy premiums are comparable with other health insurers.

How much is a pet exam?

The average pet wellness exam costs anywhere from $50 to $250. However, what that price includes may vary. It doesn’t always account for services such as:

• Vaccines ($15 - $28 per vaccination)
• Fecal tests ($25 - $45)
• Heartworm tests ($45 - $50)
• Geriatric screenings ($85 - $110)
• Dental cleaning ($70 - $400)

How pet insurance works with pet exams

Most pet insurance plans follow a reimbursement model rather than the typical health insurance co-pay system. In most cases, you’ll pay the bill upfront, submit your claim, and your insurance company will reimburse you once you meet your deductible.

Many insurers allow you to file a claim using the pet insurance company’s app or website. In most cases, you’ll complete a claim form and submit an itemized invoice or receipt.

Your insurance provider will then review the claim. If the care is covered and you’ve met your deductible, your insurer will reimburse you. Some providers complete this process within days, while others may take up to a month.

Here’s an example of how the process works.

• Visit: You take your nine-year-old dog Sparky to the vet for his annual exam

• Bill: You receive a $220 bill which you pay in full at the end of the visit

• Claim: Because you’ve met your deductible, you’re eligible for reimbursement and submit a claim with your insurance company

• Reimbursement: Your reimbursement rate is 60%, and once your claim is approved, the insurance company reimburses you for $132

A few companies, such as Trupanion, work directly with vets. In that case, they will pay the vet the reimbursement rate at check out, and you’ll pay the rest.

In the scenario above, the insurance company would pay the vet $132 directly (60% reimbursement rate), and you’ll only pay $88 out of pocket (40% remaining balance). Doing so eliminates the wait for reimbursement, making it a good option if you prefer to spend less upfront.

Types of pet exams a pet insurance policy may cover

Whether you have a standard pet insurance plan or a comprehensive wellness plan, pet insurance does not cover the following:

• Care related to a pre-existing condition (in some cases)

• Pregnancy and birth care

• Cosmetic procedures (including grooming, nail care, ear cropping, claw removal, etc.)

Some insurance companies have age or lifetime care limits for a specific ailment. For example, if Sparky has diabetes and requires insulin injections, your insurance provider may only pay the first $5,000 in treatment expenses. You’ll be responsible for any amount that exceeds that throughout Sparky’s life.

Your pet insurance plan may cover the following types of pet exams, depending on your coverage.

Full-body physical exam

If your pet is in an accident or has a serious illness, such as getting hit by a car or ingesting a toxic chemical, most insurance plans will reimburse you for a full-body physical exam.

You’ll need to enroll your pet in a wellness plan if you want your insurance to cover the cost of a preventative exam not associated with an illness or accident.

Dental exam

Dental exams are an essential part of keeping your pet healthy. Pets that don’t receive regular dental care can develop periodontal disease, gingivitis, broken teeth, and other painful conditions. Most vets recommend your pet have an annual dental exam.

During this exam, your vet will sedate your pet, do x-rays and perform a dental cleaning. If necessary, they’ll remove damaged teeth.

A standard pet insurance plan may cover a dental exam if it’s connected to a dental emergency, such as a broken tooth. However, your insurer will only cover an annual preventative dental exam if you have a wellness plan.

Diagnostic tests

Veterinarians often run diagnostic tests to learn more about your pet’s health. Common diagnostic tests for pets include:

• Fecal tests (starting around $25)
• Heartworm tests (starting around $45)
• Geriatric screenings (starting around $85)
• X-rays (starting around $75)
• Bloodwork (starting around $100)
• Ultrasounds (starting around $300)
• Urine tests (starting around $25)
• MRIs (starting around $1,500)
• Allergy tests (starting around $200)
• Other labs (starting around $200)

Standard pet insurance policies may cover these diagnostic tests if connected to an emergency or accident. For example, if your dog is hit by a car, your standard pet insurance will reimburse you for the X-rays, MRIs, and lab work associated with identifying and treating any injuries. They would not, however, cover a fecal and heartworm exam at your pet’s yearly wellness appointment.

However, if you have wellness coverage, your provider may cover any diagnostic tests ordered by your vet during their annual appointment.

Exams for emergency treatment

Both standard and preventative wellness pet insurance plans will cover exams related to emergency treatment. They’ll also reimburse you for any of the following related to an emergency or accident:

• Treatments
• Hospitalizations
• Prescriptions
• Follow-up exams

For example, let’s say you have a dog named Bella who eats a sock and needs surgery to remove it. Your pet insurance provider will cover her emergency room visit, surgery, pain medication, and follow-up exams related to the surgery to remove the sock.

Buying pet insurance with exam coverage

Buying pet insurance can get confusing since there are so many variables involved. It’s best to conduct some preliminary research before making a decision. Here are two initial steps to take:

• Research your pet’s breed: Some conditions are more common in certain breeds, and you want to ensure you choose an insurance policy that covers them.

• Talk to your veterinarian: If you already have a vet, ask if they partner with a pet insurance company. Doing so will allow you to avoid vet restrictions if you want to stick with your current provider. However, if you don’t mind switching or you don’t currently have a preferred vet, this won’t be an issue.

• Research pet insurance companies: Next, research the best pet insurance companies. Your current home or auto insurance provider may offer pet insurance so you can bundle your policies, or you may choose an insurer specializing in pet insurance.

• Narrow your options: You want to narrow your choices to two or three insurers and get a quote. Be sure to compare apples to apples, so pay attention to the coverage, deductible, reimbursement rate, and limits to receive an accurate quote.

• Enroll: Once you select your plan, complete the enrollment process online. This should be simple, but note that you may need to submit your pet’s medical records to enroll fully.

Summary of Money's What pet exam fees are covered by pet insurance

Standard pet insurance plans will typically reimburse you for pet exam fees associated with accidents and illnesses. However, you’ll need a wellness plan if you want reimbursement for preventative care like an annual checkup.

Some insurers offer a wellness plan as an add-on, while Fetch on the Dodo is the only insurer with a standard policy that includes an annual wellness exam.