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Medical Bills Your Pet Insurance May Not Cover (Tedder)

Pet insurance can help take the sting out of sky-high medical bills, but not every vet visit will necessarily be covered by your plan. It pays to know what’s included in a typical policy and what isn’t.

A growing number of companies offer health insurance for your pet, and there’s some variation in coverage depending on the company. Beth Wymer, an insurance expert with Pumpkin Pet Insurance, describes the exclusions section for pet insurance, and the list of disclaimers, as "the most critical aspects of a policy."

Yet several common expenditures are rarely if ever included, at least in the accident & illness policies most pet owners have. Here’s a rundown of those omissions, along with what they may mean for you.

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Preventive procedures

Routine vet visits can help identify a pet's illness in its early stages, and so potentially spare the animal a more invasive (and expensive) procedure down the road. Such care also allow for procedures such as vaccinations and deworming to a puppy, which can alone easily run to several hundred dollars, according to the American Kennel Club. (Kittens require a similar regimen at comparable cost, according to the Memphis-based PetVax hospital chain.)

While these visits are invaluable in terms of care, they’re not covered as part of an accident and illness plan, the type that most pet-owners choose. Wymer recommends that owners “look for companies that offer such plans as an add-on option."

The cost of such an addition is fairly modest -- about $20 a month for a dog, according to a Money survey of premiums. However, so may be the return, which could amount to no more than a few hundred dollars in most years.

You might talk to your vet about the expected costs of preventive care, to help decide if adding wellness insurance is worthwhile.

If you already have a policy, check its fine print. Failing to keep up with routine care can be costly when it comes to illness coverage. Wymer warns that some plans “won’t even cover treatment or care for preventable illnesses, like heartworm disease, if an owner didn’t stay up to date on routine care." Dr. Sarah J. Cutler, a veterinarian based on Katonah NY, echoes that risk. She cites the example of having had an insurance company deny coverage for a dental procedure because “there were notes in the records about tartar on the teeth, and the owners didn’t have a dog’s teeth cleaned right away.”

Treatment of pre-existing conditions

It’s standard for pet insurance not to cover a pet's pre-existing conditions -- as in any ailments that existed in the animal prior to the policy going into effect. "Once a condition is deemed pre-existing, pet owners will be required to pay out of pocket for any associated treatments for the life of the animal," says Wymer.

What isn’t standard is how companies define such conditions. Instead, there’s a mishmash of rules and stipulations, such as one company excluding conditions that have been diagnosed or symptoms have developed at any time before coverage begins, and another that shows symptoms or requires treatment during the 18 months before enrollment. The way that inclusions and exclusions are described also vary.

Such inconsistencies have helped a drive in the industry toward standardizing such definitions, to help pet owners more easily compare competing policies, and possibly reduce premiums, too. Until those are developed, though, pay attention to those definitions as you shop for coverage.

Some pre-existing conditions may eventually be treatable under an illness policy. Wymer adds that some companies have what’s called a “curable conditions clause” in which “pre-existing conditions that are curable, treatment and symptom-free for 180 days, can be deemed cured and therefore no longer excluded" she says.

That clause, notes Dr. Cutler, can allow coverage for recurring issues such as vomiting and diarrhea, which may otherwise be denied as pre-existing conditions “regardless of cause for the rest of the pet’s life."

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Burial or cremation

Just as human health insurance doesn’t cover funerals and related costs, most pet-insurance policies do not cover the cost of burying or cremating your late pet.

However, our company-by-company comparison of what is and isn’t included in pet insurance policies did turn up a few companies that included one or both procedures. The range of expenses covered varies, however. And cremation, the more common coverage, typically costs between $50 and $350, depending on the options you choose, according to the Cremation Institute.

Given the potentially low figure for final-care costs, keep in mind that two contributions required of you under the policy will affect how fully, if at all, you’re reimbursed for those expenses -- and any other procedures covered by pet insurance, for that matter.

You’ll receive no reimbursement for bills if you haven’t reached your deductible for the year -- which you typically set at between $200 and $1,000, with lower amounts triggering higher premiums. Once the figure is reached, you’ll probably still have to pay 20% or 30% of every bill, because that's the typical level of co-payment with pert insurance.

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