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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

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  6

Leave Comment
  • Older Critters
    05/19/2011 07:29am

    There hasn't been a youngster adopted into my home since I was a child. Usually it's a neighborhood stray that knocks on my door (sometimes literally) asking for a home. Age is a guestimate and pre-existing conditions are only what is found on the first trip to the veterinarian.

    Is that handled any differently than a critter just starting out in life? Are the premiums higher since there is no known history?

  • 05/19/2011 04:20pm

    I don't know of any instance where the premium would be higher because of an unknown background.

    Some companies require that an examination by a veterinarian has been done in the previous 12 months when applying for a policy. If not, you will need to have the pet examined as part of the application process or within 30 days of getting a policy.

    Anytime a pet owner acquires a new pet, an appointment for an examination should be scheduled as soon as possible anyway. You want to know what the health status of the new pet is (especially if you already have pets) and also follow your veterinarian's advice on any preventative measures to keep your new pet healthy. The insurance company would then rely on your veterinarian's best estimate of the pet's age.

    As I wrote in the blog post, the goal of both the pet owner and the insurance company should be transparency. Ideally, you need to be on the same page from the get-go about any pre-existing conditions.

    Some pet insurance companies may allow you to estimate the pet's age and apply for insurance and not require an examination. When you file your first claim, they will likely require a copy of the pet's medical record anyway. If your veterinarian estimates the pet's age differently than when you applied for the insurance, the policy may be adjusted based on this. Any problems found on the examination by your veterinarian will be revealed by your pet's medical record and may be covered, or depending on the problem, be considered pre-existing by the insurance company.

  • Very interesting
    05/19/2011 11:41pm

    Our pets are older (both of them way over 10 years), and even if they qualified, I think the premiums would probably be too high. But these are informative articles. After Mr. Kitty got an abcess on his rear, we talked about possibly getting insurance on our next pets; wonder if indoor/outdoor cats qualify?

  • 05/20/2011 01:17pm

    Only one company that I know of has a policy designed just for indoor cats. So, pet insurance companies don't generally discriminate against indoor/outdoor cats or just outdoor cats. In fact, pet insurance would be even more important for an outdoor cat because they can get into more trouble than indoor cats. Fortunately, pet insurance for cats is less expensive than for dogs.

    You also want to be sure to follow your veterinarian's advice about wellness care - especially in an outdoor cat that may come into contact with stray cats, etc. This would include annual or semi-annual wellness examinations, spaying or neutering, vaccinations, regular parasite screens, testing for FeLV and FIV, heartworm and flea/tick preventatives.

    Although I'm not a big fan of wellness care coverage, it is something you will want to look at as part of a pet insurance policy on an indoor/outdoor or outdoor cat and decide for yourself if it's worth it.

    Read a sample policy to determine what preventative measures you are required to take to maintain coverage.

  • Full disclosure
    06/02/2011 11:04pm

    I was frustrated with my insurance carrier (company 1) because they were raising the annual premium every year. I researched other companies and decided to make a change to ‘company 2’. During the application process I disclosed everything and offered to send records. The company 2 rep said they never ask for records. HAH. When I filed the first claim, company 2 requested medical records. This was an inconvenience for the vet’s office because my pet’s records are the size of a phone book. I don’t remember all of the details, but the claim did not include any excluded conditions. The harassment from the company 2 adjuster was too much, I canceled the policy and returned to company 1.
    A year or so later, I was in the waiting room at the vet’s office. I overheard one of the staff on the phone with company 2. The part of the conversation I heard went something like this: “Yes, I sent the records. I sent them twice. I sent all of the records. There were 5 pages. Five pages are all the records. I sent all the records. The client tells me we are her pet’s only veterinarian. I sent the records – twice. There were 5 pages. I sent everything. The client tells me we are the only vet her pets have seen. I don’t know what else to say.”
    As a client, I really don’t want to put my vet’s staff through this ordeal. The insurance has to work for both of us.

  • 06/03/2011 08:10am

    Thanks KLD for sharing your experience with this. You did the right thing is offering to send your medical records during the application process. As you found out, they will request them anyway when you file your first claim.

    So, request (insist on) a medical records review during the application process. Ask what they require to determine on the front end if there are any pre-existing conditions. If the company still says its not necessary, find another company. Ideally, you want something in writing when you actually receive your policy about what conditions are excluded from coverage.

 

 

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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