What to Do If Your Pet Insurance Claim Is Denied

Maybe your dog mistook a sock for a snack. Or a small scratch on your cat's nose turned into a not-so-small infection. You rush to the vet and approve the treatment plan without hesitation, confident your pet insurance will cover it.

For most pet owners, that's exactly what happens. Over 70% of insured pet owners say their policy paid for most or all of a significant vet bill, according to new research by Money and Healthy Paws Pet Insurance.

But not every claim goes that smoothly.

The reality is, sometimes insurers say no. Your pet’s condition may be labeled pre-existing, your claim form could be missing a key detail or the prescribed treatment may not be covered under your policy.

If your pet insurance claim was denied and you think the decision was wrong, here's what to do next.

1. Read the denial letter carefully

The denial notice should clearly explain why your claim was rejected, and outline the process for appealing the decision. Sometimes the fix is a simple paperwork error, like a missing page from your vet's invoice.

2. Call your insurer

If you're still unclear why the claim was denied or need clarity on the next steps, call your pet insurance company directly. Ask what additional details and documentation are needed and if there's a deadline for filing an appeal. Take notes, including the date and time of the call and the name of the representative you spoke with, in case you need to follow up or escalate the issue later.

3. Gather supporting documents

When you submit a claim, insurers typically require an itemized invoice and up to 12 months of medical records. Additional documentation — like diagnostic test results, X-rays or a letter from your vet explaining the diagnosis and treatment — can also help support your case.

"Claims are commonly denied if sufficient medical records aren’t provided," says Sammi-Jo Nevin, president of the North American Pet Health Insurance Association (NAPHIA).

"If you’ve recently changed vets and are submitting your first claim, we recommend getting medical records from your previous vet [too]," she says. "This can often help speed up claim review and reimbursement."

4. File your appeal

With all the necessary paperwork on hand, you're ready to make your case.

This usually means filling out an appeal form (insurers also call it a review request form or claim redetermination request form), and submitting any additional information the company requests through its online portal or by email, fax or mail.

A signed letter from your veterinarian addressing why the claim was denied and why the insurer's conclusion is wrong can strengthen your appeal.

Appeals aren't resolved overnight. In some cases, the insurance company will tap an in-house vet or "another licensed representative" to review the case, according to Nevin. Reviews can take approximately 30 business days, but they'll let you know once they've made a decision.

5. Go up the chain

If your appeal is denied, ask for a supervisor or specialist to review the case. Just know that a second appeal usually requires providing new information to support your claim — resubmitting the same documents twice probably won't change the outcome.

If you’ve gone through the appeals process and still disagree with the outcome, you can file a complaint with your state's insurance department.

Why pet insurance claims get denied

With most pet insurance plans, you pay the vet upfront and submit a claim with an itemized invoice to your insurer. Then the insurance company reviews it, and reimburses you for all covered expenses.

If your claim is denied, it could be because:

Your plan doesn't cover it

Much like car insurers won't foot the bill for an oil change, standard pet insurance policies won't cover the cost of annual checkups, dental cleanings or other types of routine care.

Your insurer may pay for treatment if your pet develops a preventable illness, like heartworm or a tick-borne disease, but only if you've kept up with recommended vaccines and parasite prevention.

The condition predates your policy

The fine print matters here, because what insurers consider "pre-existing" isn't always obvious.

Say your dog tore a ligament in his left knee before you bought pet insurance, and later develops similar symptoms in his right knee after you purchased coverage. The insurer will likely treat the new injury as a complication from the earlier one, and deny the claim. (In insurance terms, this is called a bilateral pre-existing condition.)

You chose limited coverage

Some pet owners opt for accident-only coverage because it costs less or because their pet is too old to qualify for a comprehensive policy

The drawback is that these plans don't cover illnesses. So even if a trip to the ER starts with a small limp, you’ll be paying out of pocket if the vet ultimately diagnoses hip dysplasia or another underlying medical condition.

You've maxed out your benefits

When you enroll your pet in an insurance policy, you typically choose how much your insurer will reimburse you yearly. Annual coverage limits start around $2,500, though some policies offer unlimited payouts.

If you hit your policy's cap, you'll be responsible for any additional costs even if the services are otherwise covered.

You missed the deadline to file a claim

Many insurers require claims to be filed within 90 to 180 days of treatment. If you miss that window, your claim could be denied.

Revisit your coverage yearly, especially when costs climb

The best way to avoid a denial letter is to review your policy at least once a year to make sure your coverage still fits your pet's — and your budget's — needs.

The coverage you bought just a few years ago might not go as far today. A recent survey by Money and Healthy Paws Pet Insurance found that veterinary care costs increased by 43% in the last five years, and many pet owners are now spending thousands each year just on routine care.

If adding coverage would stretch your finances too thin, Nevin recommends calling your insurance provider.

"Commonly, the company can work with [you] on options," she says.

More from Money:

More Pet Owners Are Going Into Debt to Pay Vet Bills. Here's Why That's Risky

The Lifetime Cost of a Pet — and How to Pay for It

The Rising Cost of Pet Care: What Owners Pay for Arthritis, Dental Disease and Other Chronic Conditions