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Written by leading veterinarians to provide you with the information you need to care for your pets.

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

What to do About Pre-Existing Conditions

A common reason that pet insurance claims are denied is because of a pre-existing condition. This is a problem or disease that your pet may have shown symptoms of or been diagnosed with before you purchased the policy, or that came to be during the waiting period before the policy became effective and coverage actually began.
 

However, each company’s definition of a pre-existing condition may vary, so it's important to read a sample policy or ask a company representative prior to purchasing an insurance policy.

For example, ruptured cruciate ligaments in a dog’s knee are considered by some companies to be a "bilateral condition" – a problem that occurs on one side of the body that is prone to also occur on the opposite side of the body. Therefore, if one side is affected prior to your purchasing a policy, issues with the opposite side will still be considered pre-existing, even if they occur after you purchase a policy.

Pre-existing cancer may also be an issue for you. For instance, if your pet develops cancer such as a mast cell tumor prior to your purchasing pet insurance. Some companies exclude coverage for any type of cancer, while other companies may exclude coverage for only mast cell tumor and cover all other forms of cancer.

And still other companies may cover a problem that occurred previously if it was "cured" and was not considered a chronic condition (no symptoms or treatment within the last 6 to 12 months).

So by purchasing a policy soon after getting a pet, preferably as a puppy or kitten, and before any known problems develop, you decrease the chances of having a claim denied because of a pre-existing condition. However, many pet owners interested in purchasing pet insurance have pets that have already been to the veterinarian several times with problems.

Recently, I corresponded with someone who was getting a new policy for his 10-year-old dog, who had been relatively healthy with the exception of a couple of problems. He went through the process I’m about to describe with satisfactory results.

During the application process, you will usually have to answer several questions about any previous problems your pet may have had. You should be completely honest when answering these questions. Knowingly misleading the insurance company about your pet's previous problems is considered fraud and the penalties range from the policy being canceled to possibly even being fined and/or imprisoned. Depending on your answers to these questions, the insurance company may issue a policy on your pet with no exclusions, or they may request further information from you and/or request your pet’s medical records for the past 12 to 24 months.

Even if you aren’t required to send in medical records during the application process, you will likely be required to send in medical records when you file the first claim. If you have forgotten to mention something during the application process, it may become evident when the company reviews the medical record and a condition could be considered pre-existing and excluded from coverage.

Therefore, during the application process, I recommend asking the insurance company if they will let you know in writing during the underwriting process if there are any conditions that will be excluded from coverage, and for how long because they are considered pre-existing. Most of the insurance companies will do this if you make this request, and it is worth asking about so that there aren’t any surprises down the road. The last thing you want to do is pay several months/years of premiums only to find out that a claim is denied because the insurance company considers a condition pre-existing before you bought the policy. They will usually require a copy of your pet’s medical record for review.

The goal is transparency on your part to reveal any known prior medical problems to the insurance company, and transparency from the insurance company to reveal (when the policy is initially written) if any pre-existing medical problems are excluded from coverage. If one or more conditions are excluded from coverage and you elect not to continue coverage, you can usually cancel the policy for a refund of premium as long as you haven’t filed a claim.

Another benefit of sending in your pet’s medical records during the application process is that when you do file your first claim, any questions about whether a condition is covered can be decided quickly and the reimbursement process will be expedited.

If your pet is older when you apply for a policy, the insurance company may request your pet’s medical records to review and even require a physical exam and/or lab testing to make sure your pet doesn’t have a chronic condition that would preclude coverage for illnesses.

Hopefully by following this process with your application, it will eliminate being frustrated with one of the more common complaints about pet insurance.

I would be interested to learn about any exclusions that were added to your pet’s policy during underwriting because of one or more pre-existing conditions. Also, have you had a claim denied because of a pre-existing condition?

Dr. Doug Kenney

Pic of the day: X-Ray of Jespah's knee after by jespahjoy

x-ray of dog knee, dog x-ray, cruciate ligament

Comments  4

Leave Comment
  • pre existing condition...
    11/08/2014 08:10pm

    I have a young dog ( right @4yrs.) and she has fluid in her knee due to a small injury at an unknown date. She has been on join meds. for 2 months and we are not seeing the improvement we would like. Not knowing if we are going to need more in depth treatment, we started looking into insurance. SUPRISE we are having a hard time finding a plan that will cover her. Is there any direction to go in? My vet has provided me with recommended insurances, but informed me most insurances will give me a hard time. Does anyone know of an insurance, or any programs even, that can help cover expense's, should we need them. Again she is a young dog and we are worried of quality of life in the future. Any suggestions help!

  • Not likely to be covered
    11/09/2014 07:31pm

    Has the problem with the knee been definitively diagnosed? No insurance company will cover the current problem. Depending on the cause, other conditions of the knee may or may not be covered in the future. The insurance company can only tell you this if a diagnosis is made.

    So, even though insurance may not cover the current problem, it may still be worthwhile to get it for other conditions your pet could develop during her lifetime. I don't know why a knee condition would necessarily disqualify her from coverage to other illnesses or injuries.

    Be sure to ask for a medical record whenever you apply for pet insurance so it will be known going forward what will and won't be covered.

  • Health Insurance issue
    06/24/2016 10:43pm

    Hi, My dog has always been a problematic dog when it comes to health issues. when he was a puppy, we found out he had an undescended Testicle. he's broken a tooth, he also has a huge eating disorder in the fact that he eats everything! (hair, parts of his chew toys, cloth on the tennis balls, even the blankets in his own cage which i put him in to limit the things he eats when i'm gone) so he's already had a GI foreign body removed which was the size of his ENTIRE stomach fully expanded. it contained mostly hair, pieces of cloth toys, a couple tampons! ew! and some other cloth type things. he's fractured his leg (which was my fault :( i was running with him as a puppy, he darted at something, the leash got wrapped around my legs and i tripped and ended up stepping on his foot under hard ground! it was terrible!) anyways, he's always had health issues so i found it very beneficial to get health insurance on him. He's only 2 years old!

    I've been insured for about a year and just updated my policy to nationwide's newest policy which covers 90% of all costs! i finally saw their list of exclusions for my dog and among them were a couple that he's NEVER been diagnosed with. they're excluding rhinitis/sinusitis/canine upper respiratory infection (based off the fact that he had a symptom of reverse sneeze, which is an error on my vets end and i'm working with them to amend their records) and Gastroenteritis (based off the fact that he came in with a symptom of vomiting and constipation.) I don't know much about Gastroenteritis. so when i asked my insurance why they're excluding it they said it was because he had a symptom of vomiting and constipation. i replied with "so he's never been diagnosed with Gastroenteritis, correct?" and the lady i spoke with responded "vomiting is diagnosed as Gastroenteritis" not knowing much about that stuff i relented and got off the phone. i then proceeded to call my vet and get more information on their end. i explained the situation above and my vet agreed he was never Diagnosed with any of that stuff. and that vomiting is not diagnosed as Gastroenteritis. that i needed to speak to a supervisor at my insurance and that my vet is 100% willing to talk to them and explain that he was never diagnosed with those things. i was reading somewhere that pet insurance isn't a form of health insurance like most people think but it's a form of property insurance which probably plays a role in what right i have. i guess i'm wondering what my rights are. is nationwide pet insurance aloud to exclude all of those things based off of 2 symptoms he's had (which is so very vague!). when he was never diagnosed with any of the things they're excluding. I live in Texas (not sure if the state laws affect it or not) but to my understanding and what my vet said was that they couldn't exclude those from my policy based on symptoms. i've tried searching everywhere to figure it out but i'm having a hard time finding the information. i called TDI (texas department of insurance) to get a better understanding but as i called a little later in the day and it's friday the guy who specializes in this had left early and wont be back till monday. any information what so ever will be extremely helpful! These are big guys and i want to be as informed as possible when i call them back and try to dispute their exclusions.

  • 06/25/2016 02:47am

    Tayler,

    Some insurance companies have a formal appeal process you can go through if you have a claim denied or to dispute exclusions, etc. You might check on this.

    You also have the option of seeking coverage from another company. Not all companies may exclude the same things. If you haven't filed a claim and especially if it's been less than 30 days, you can often drop the policy and get your money back.

    Always ask for a medical record review after signing up and if you don't like the results, try another company.

 

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...

    Extended Bio

 
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