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HealthyAssurance by petMD

Healthy Assurance's mission is simple: To provide pet owners with unbiased, reliable, helpful, and timely information on pet insurance from a veterinarian’s perspective. And what better veterinarian to write this blog than Dr. Kenney, a small animal practioner and author of Your Guide to Understanding Pet Health Insurance

Why Insurance Coverage for Hereditary Conditions Is a Big Deal

Some pet owners who have investigated pet insurance have complained about what they felt were numerous exclusions or loopholes that would allow a pet insurance company to easily deny claims. This has led them to conclude that pet insurance isn’t worth it. One of the exclusions they frequently mention is coverage for hereditary conditions.
 

These are conditions that have a proven or suspected genetic basis or cause. Many times these conditions are commonly seen in certain breeds; for example, hip dysplasia in some large breed dogs, luxating patellas (dislocating kneecaps) in some small breed dogs, idiopathic epilepsy (seizures) in Beagles, polycystic kidneys in Persian cats, or cardiomyopathy in Ragdoll cats. (Here are a couple of websites that list hereditary conditions in dogs and cats.)

If you are considering the purchase of a policy from a company that doesn’t cover hereditary conditions, ask for a list of conditions that aren’t covered – preferably in a sample policy. Some companies will furnish you with a list of conditions they consider hereditary, and if it isn’t on the list, it’s covered. They may even offer limited coverage for the conditions on the list. Others may not have a list available for viewing and say they rely on lists of hereditary conditions in current veterinary textbooks, etc. You might be surprised how long some of these lists can be.

You should also inquire about whether congenital conditions are covered. These are problems that the pet was born with, such as a congenital heart defect or liver shunt. Some companies won’t cover congenital conditions (even if they cover hereditary conditions) because they consider them pre-existing, since they had the problem from birth — i.e., prior to your purchasing a policy. However, there are companies that will cover congenital problems as long as they weren’t known about or diagnosed by a veterinarian prior to the effective date of your policy.

For example, if you take your new puppy in for a wellness examination and vaccinations and on physical exam your veterinarian hears a heart murmur that the puppy has likely had since birth, it won’t be covered if you later purchase a policy. However, if you purchase a policy and several months later the puppy starts showing signs of illness and a liver shunt is diagnosed (which is congenital — the puppy was born with it), that would be covered because symptoms developed after you purchased the policy.

While coverage for hereditary conditions is a significant factor when selecting a policy for your pet, coverage for congenital problems is just a bonus because a pet is much more likely to develop a condition considered hereditary than it is to be born with a congenital problem.

From a veterinarian’s perspective, I believe coverage for hereditary conditions is essential. I have seen instances where the insurance company considered a condition hereditary and the veterinarian did not, but unfortunately the insurance company’s opinion is the one that counts and the claim was rejected. In order to avoid this situation, buy a policy from a company that covers hereditary conditions, preferably up to the full per-incident or annual maximum.

By reading a sample policy, you should be able to determine if hereditary conditions are covered and if there are any limits or restrictions on coverage.

Dr. Doug Kenney

 

Pic of the day: Upsidedown Kitten by pinguino k

Kitten upside down, healthy kitten, herditary conditions, pet insurance

 

Comments  12

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  • Excellent Information
    05/26/2011 07:59am

    Thank you for the excellent information, Dr. Kenney. Good to know.

    I have an HOCM kitty and was told it is a congenital problem, but the murmur wasn't heard until his second checkup. The cardiologist indicated this problem will definitely surface eventually. However, it may show up immediately or it may take years.

  • 05/26/2011 10:15am

    The main purpose of insurance is to spread risk amongst a larger group. Most people do not understand they will pay far more in premiums than they'll ever receive in payments. Purchasing insurance for a pet of a breed with a higher likelihood of illness may be prudent, but unless the premiums for high-risk patients are also higher, the company will have to raise premiums for all insured pets or go out of business. Shar-pei puppy? The owner should pay a hefty annual premium, much larger than the premium paid for Jack Russells, Labradors, poodles, etc.

    Many of my patients are insured, some for value, into the hundreds of thousands, and some just for major medical/surgical. Insurance companies won't touch any horse over the age of 16-17 (can't remember the precise cut-off). Though most of my patients live into their 20s and 30s, they're routinely dropped from all policies. Insurance companies won't cover lameness issues on the same leg, even if the horse had a chip removed from a hock as a yearling then strains a high suspensory as a 10-year-old - two completely unrelated problems, IME. OTOH, few insurance companies will insure a HYPP+/- or +/+ horse, nor should they be required to do so.

    Some of my clients self-insure. It's not hard to come up with a figure: $10,000 for colic surgery. Some of my clients can't afford insurance premiums, which add up quickly with multiple horses. I tell them to start a small emergency fund and give target numbers ($500 for minor emergency; $1500-3000 for moderate emergency). It's better than nothing.

    Overall, I'm dubious of the insurance industry. It certainly hasn't done wonders for human medicine cost-containment, a huge issue in veterinary medicine.

  • 05/26/2011 07:52pm

    The first thing people need to realize is that insurance companies are in the business to make money. They hope people happily pay the premiums and never need to file a claim. (I've been paying car insurance for a whole lot of years and have had one claim. The company and I are both pleased with the situation.)

    What I think critter insurance is really for, is to take the sting out of the HUGE bill that comes all at once that most people can't handle.


  • 05/30/2011 04:24pm

    Equine DVM,

    Insuring horses is not something I know much about, so thanks for your comments.

    You are exactly right that overall, more pet owners will have to pay more in premiums than they will ever receive back in benefits for the insurance company to stay in business and make a profit.

    However, for those who have pets that get seriously ill or injured or have frequent visits to the vet, most of the time they are glad they have the insurance. Of course, they really don't have a crystal ball to see the future and know whether their pet will be mostly healthy or not. That's why as you alluded to, insurance is really a way to minimize risk until they are (if possible) self-insured. Many pet owners are okay knowing that they may pay more in premiums than they get back in benefits if it serves it's purpose.

    I really don't see pet insurance as being a way to contain the costs of pet healthcare. The costs of pet healthcare is going up with or without pet insurance. I believe that is why more and more pet owners are looking at pet insurance to try and bridge the gap between the quality of healthcare now available for their pets with new technology and specialization, etc. and what they can actually afford.

    I'll be writing in the near future about the differences (thank goodness) between our human health insurance and pet insurance.

  • 05/30/2011 01:56pm

    I practice in Canada and have found that people are overall naive about the extent to which their pet is covered. This may be an unfortunate consequence of our "socialist" mentality, the expectation that it's all taken care of once a policy is purchased, but I don't know if this is really that different from clients' expectations in the US. I never take the initiative to suggest insurance, but when asked, I urge people to obtain a list of breed-related exclusions before they buy a policy.

    On another note, much depends on how the claim is submitted. If your vet is sending a claim for treatments that cover both pre-existing and new (or otherwise billable) conditions, it's very important to attach a number to every item on the bill, the numbers corresponding to medical problems, and thereby separate what's covered from what's not. The insurance company will not bother to do this (ultimately only the treating vet can tell which problem this or that item covers), and may refuse to pay anything if it sees the mention of a pre-existing condition anywhere on the bill. I've learned this lesson the hard way :-)

  • 06/02/2011 10:27pm

    I have an accident/illness policy that does not cover routine and preventative care.
    I once had a portion of a claim denied because the insurance company felt the procedure was routine/preventative and did not believe that it was diagnostic. I didn't fight too hard because I'm generally pleased with the company, it was a fairly small charge, and I have been reimbursed for claims in excess of what I've paid in premiums.
    Later, when my dog needed to be anesthetized for something (throat culture maybe?), I asked to have his teeth cleaned at the same time. I also requested that the insurance claim form be detailed enough to demonstrate the anesthesia was needed for the illness. If the insurance company considered the anesthesia to be part of the dental cleaning (which is not covered) most of the claim would have been denied.

  • 06/03/2011 07:49am

    Thanks KLD for offering this bit of advice that coincides with that of Dr. V.

    One thing that I like about writing blogs is that not only do I get to share what I've learned, but I also learn a few things myself along the way. I want to take this time to thank all the readers for sharing their experiences.

    This is a lesson for pet owners and veterinarians alike. So, pet owners - you need to let your veterinarian know about categorizing procedures performed with specific problems if the claim involves more than one problem. I guess another way to do it is file a separate claim form for each problem.

    Veterinarians have a lot yet to learn about pet insurance and pet owners may be much more pet insurance savvy than the veterinarian and his or her staff. So, feel free to let your veterinarian/staff know about this bit of advice. It sounds like it may avoid part of a claim from being denied coverage and quite possibly save time from having to clarify later which procedures were done because of which problem, etc.

  • 05/30/2011 03:49pm

    Dr. V,

    Thanks for the information about how it is done in Canada. I'm sure that there are readers of this blog that have pet insurance and live in Canada. I'm especially appreciative when other veterinarians comment because the premise of this blog pet insurance from a veterinarian's perspective.

    I've always been intrigued by differences in pet insurance in the USA and other countries. I just don't know enough yet to write about it. I know that there are a lot more pets insured in some European countries than here. Please continue to comment about any differences you see and deal with in Canada.

    I found your comments about filling out a claim form interesting. From my experience in doing so for my clients, I just list the problems and let the insurance company sort it out as far as any pre-existing conditions and other exclusions.

    I too believe that it is extremely important for pet owners to fully understand the policies that they buy. There are a lot of policies sold that I wouldn't necessarily buy, but that's okay as long as the pet owner understands any shortcomings of those policies so that they aren't surprised when they file a large claim.

  • 05/31/2011 03:56am

    Re. submission of claims: I don't know if my comment suggested that the insurance company would try to weasel out of paying, but that was not my intent at all. Such an attitude is counterproductive, and just puts you in a bad mood if nothing else :-) The issue is not separating pre-existing conditions from new ones (of course that's the company's job and they know which ones are which), but showing that this or that lab test or treatment is under this or that problem. It's not uncommon for pets to present for more than one problem, or for owners to wait with submitting a claim if multiple tests and treatments are being done. That way we end up sending a rather long bill for services related to various problems, some covered and some not. For example, a dog with pre-existing hypothyroidism had a seizure for the first time, and bloodwork to determine or rule out possible causes of seizure did include total T4 (mostly because it's included on a geriatric panel, and I just didn't give it any thought at the time, and it was a good idea to measure T4 anyway to see how well the dog was controlled for that problem, etc.). The claim was denied in its entirety as whoever processed it (likely not a veterinarian) assumed the bloodwork was a followup on hypothyroidism, not workup for a newly emerged condition. Once that was cleared up, the claim got resubmitted and the client got reimbursed for the seizure workup portion, but now I don't take chances and itemize everything on the bill. The company is actually very appreciative of this as it makes their life easier, speeds up the processing of the claim, and the client gets their money back faster.

  • 05/31/2011 07:18am

    Thanks for the explanation, Dr. V. This is a good tip for those of us who fill out claim forms. And reimbursements do get delayed sometimes only because of a lack of information or clarification on the claim form. Anything we can do to prevent this from happening will help our clients.

    I wonder if there are any pet insurance representatives that would like to chime in on this point?

  • this is my fear
    06/01/2011 03:44pm

    Great blog about insurance Dr Kenny. I have two bullmastiff's and according to what I read online these dogs are genetically inclined towards all kinds of horrible diseases. Both were from rescue, my male is now 10 years old and my female is 5.
    Both dogs are doing well with no genetic diseases so far. My male is pretty big for a bullmastiff, looks more like a bulldog on steroids. ( you can see his picture under breeds\bullmastiff on this site under the name Rock J Dog and you will see what I mean)
    I have yet to find an insurance company that does not exclude hereditary disease. Guess I will have to dig further.

    I did have insurance for a short time but cancelled it. Right after that my male bloated so I did not collect any claims. I am not sure if it would have been covered.

    One other thing I noticed is my vet did not seem to be to savvy about insurance. They are a fairly busy hospital and have five vets so it made me feel pet insurance was a bit sketchy if these vets did not seem to know much about it.

    I wonder if it is the norm for most vets not to be too savvy about pet insurance yet. No vet I have been to ever asks me if I have insurance. Try going to a doctor for humans: thats the first thing they ask about. Perhaps it is because human care is about 10 times more expensive but still I wonder why it is not discussed more.

    It made me also wonder how well insurance companies accept or fight diagnosis from the vet.

    If a vet were to botch an operation or care of a pet there is really little an owner can do. The Veterinary Medical Board ( many cases can be found via google) usually sides with the vet even in extreme cases where mal-practice is evident.

    I am not trying to stear this discussion towards medical care provided by bad vets but the point is if there is little recourse towards an obviously bad vet what protection does one have against a pet insurance company?

    The other thing I wonder about is how well do the medical reports have to be documented? I notice with people doctors everything is reported and written down but with pets it does not seem to be as inclusive.

    As the Equine Doctor mentions many pure breeds that are predisposed to hereditary disease can drive premiums up. Will there ever be a way for insurance companies to promote a standard that asks breeders to test and try to elimate hereditary disease in their stock?
    I am not sure if such a thing is even possible and I may have misstaded some things here. This is from a pet owners perspective so if I misstated any thing forgive my ingnorance.

  • 06/01/2011 10:28pm

    Great comments and questions Rockjdog! I will address some of your questions in coming blogs.

    I think all but about 2 or 3 companies in the U.S. offer either limited or full coverage of hereditary diseases. Unfortunately, many pet owners who are looking at pet insurance don't realize this because, for whatever reason, they don't look at every company that sells insurance in the U.S. or their particular country. More on this June 9th.

 

 

About Healthy Assurance

  • Dr Kenney, DVM
    Lisa Radosta, DVM, DACVB

    Doug Kenney practices small animal medicine and surgery at Houston Levee Animal Hospital in Cordova, Tennessee. He has a special interest in wellness care...

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