How to file a pet insurance claim

Maybe your dog has broken his leg, and you know you have hefty vet bills coming your way. If he is one of the 6.25 million insured pets in the United States, you can rest assured knowing you don’t have to fork out the full cost of his care. Your insurance policy will most likely cover part (if not all) of the cost. To be reimbursed, you need to file a claim.

To increase your chances of being reimbursed, get familiar with the process and parameters of filing a claim with your insurer. That means knowing how to file a pet insurance claim, understanding whether your claim qualifies for reimbursement and learning how to appeal a claim when your first attempt is rejected.

How pet insurance claims work

There are two main claim reimbursement structures. If your policy works on reimbursement, you have to pay the vet bill up front and get the insurance company to reimburse you. With direct pay, the insurer pays the vet directly.

There are advantages and disadvantages to both reimbursement structures:

• Direct pay: This process is faster and easier. It doesn’t require you to pay hefty vet bills out of pocket. Not all insurers or policies offer direct pay, and not all vets accept it.
• Reimbursement: You take your pet to the vet, pay the bill and submit a claim to the insurer. You have flexibility in choosing a vet. The downside is that you have to pay the bill out of pocket. This can be a financial burden, especially considering how much it costs to insure a pet.

Pet insurance reimbursement rates and deductibles

Insurers often have pricing options with different reimbursement rates, depending on your pet insurance plan. You split the cost of the vet bill with the insurance company. For example, if your reimbursement rate is 80%, you will pay 20% of the vet bill. This cost split between you and the insurance is called coinsurance.

The deductible is the fee you pay upfront before your insurer’s reimbursement kicks in. For instance, you may be responsible for the first $500 of any covered vet costs for the year.

Like reimbursement rates, your policy sets your deductible, meaning it’s an expense you should anticipate.

You need to understand your specific policy coverage before you file a claim. Your policy details will inform you everything from reimbursement rates and deductibles to waiting periods and exclusions. Familiarize yourself with these details to avoid unpleasant surprises in the claim process.

Qualifying expenses for pet insurance

Plans and coverage can vary drastically, so keep that in mind when looking at the following examples of what may qualify for a pet insurance claim.

Covered incidents typically include:

• Accidents
• Diagnostics (such as X-rays and blood tests)
• Hospitalization
• Illnesses
• Medications
• Surgeries

Review the wording of your policy for more details on covered conditions and exclusions to avoid disappointment. Before submitting a claim, make sure the expense is covered.

Pre-existing conditions

With pet insurance, pre-existing conditions — those present before you enrolled your pet — are typically excluded from coverage.

Some companies are more lenient. In certain cases, “curable” pre-existing conditions may be covered.

For example, if Fido has a broken leg before being insured, that is a pre-existing condition. However, if a certain period has passed without any issues related to the leg injury, Fido’s leg will be considered cured and will now be covered for future incidents.

Waiting periods

Waiting periods can also impact whether your claim qualifies for reimbursement. A waiting period is the time between the day you buy your policy and the date (and time) when your coverage begins.

Your pet is technically not covered until the waiting period is over. In most cases, you can’t file a claim for an accident or illness that occurred during the waiting period.

Common exclusions

Here are a few examples of common exclusions that don’t qualify for a pet insurance claim:

• Behavioral problems:  Policies typically won’t cover expenses related to aggression, destructive chewing or other behavioral issues such as separation anxiety.
• Congenital conditions:  Conditions your pet was born with, such as hip dysplasia or certain allergies, may not be covered.
• Cosmetic procedures:  Tail docking, ear cropping and other elective surgeries are usually excluded.
• Pre-existing conditions:  As noted, any illnesses or injuries your pet had before the policy began or during the waiting period are typically excluded.
• Routine care and preventive medications: This includes check-ups, vaccinations, spaying/neutering, flea and tick medication and more.

You can typically get coverage for many of the above conditions and procedures by choosing a different plan or purchasing additional coverage, but your premiums may be significantly higher.

Steps to file a pet insurance claim

Here’s an easy-to-follow, step-by-step guide on how to file a pet insurance claim:

1. Contact your insurance company as soon as possible after the incident.
2. Gather necessary documentation such as:
   • An itemized vet bill showing the date of service, diagnosis, procedures performed and medication costs.
   • Medical records from the vet, including a detailed diagnosis and treatment plan
   • Proof of payment (if you’re filing for reimbursement).
   • Any other documents requested by your insurance company (e.g., accident report for injuries).
3. File a claim via the company’s app, mail, phone or online portal.
4. Be ready and available) to answer questions about your pet’s condition and treatment.
5. Keep copies of all submitted documents for your records.

After you submit your claim and it is approved, you will be reimbursed by check or direct deposit, depending on your pet insurance company and what you have selected.

What to do if your pet insurance claim is denied

Insurance companies don’t always pay up when you assume they would. Claims can be denied unexpectedly.

Here are a few reasons why a pet insurance claim might be rejected:

• The injury, illness or issue is considered a pre-existing condition.
• It’s an exclusion within your policy’s wording.
• There’s a lack of documentation or missing information.
• Your plan doesn’t offer that coverage.
• The insurance company suspects fraud.
• The incident occurred during the waiting period.

A claim denial is unfortunate but not necessarily set in stone. Look closely at the reason for rejection and assess whether you can appeal the decision. You can appeal the verdict if you think the claim was denied due to an error.

How to appeal a denied pet insurance claim

Contact your insurance company’s appeals department and be prepared to explain your case clearly and professionally.

To help your case, gather any additional documentation. This could include veterinary records from before your policy began (to address pre-existing condition concerns) or receipts for alternative treatment options.

You can try to use the insurance company’s overly complex messaging to your advantage. Semantics got me a full reimbursement for my dog’s root canal in one instance. Our golden retriever chipped a canine, but his insurance plan doesn’t cover dental issues. However, it does cover accidents and traumas. The specialist vet we took him to labeled the cause an “accidental trauma” on the form, and our claim was accepted.

If there is no chance of your claim being accepted, it might be worth looking into other financing options to cover the costs of your pet’s care. Here are a few options:

• Open a pet savings account
• Get a medical credit card
• Get a pet loan
• Look at your car insurance, which may cover pets for car-related accidents

The bottom line

Pet insurance is meant to give you peace of mind, but to get that peace of mind, you must familiarize yourself with the intricacies of your pet’s insurance policy.

When your pet needs urgent veterinary care, the last thing you want is to worry about the administrative hassle of filing a claim. If you don’t know much about your policy’s reimbursement rates or procedures, now is a good time to get the details.

If rejected claims become a pattern with your insurer, it might be time to explore other financing options and compare rates from the best pet insurance companies.

Frequently asked questions

• How long do I have to wait to be reimbursed?

  Reimbursement timing for pet insurance claims varies by insurer, but it typically takes a few weeks after they receive your complete claim.

• How long after buying pet insurance can I file a claim?

  Most policies have waiting periods (weeks or months) before covering certain conditions. Waiting periods can often be waived, but it’s best to check your specific policy details for exact wait times.

• How long after an incident do you have to submit a claim?

  The deadline to submit a pet insurance claim varies by company, but it’s generally within a few months (often 60 days) of the vet visit. Check your policy for specifics.