A pet health insurance policy is a contract between the pet owner and the insurance company. You pay your veterinarian and then mail a claim form along with a copy of your receipt to the insurance company. The insurance company will process the claim and mail you a reimbursement check minus the deductible, coinsurance and any procedures that weren’t covered under the terms of the policy.
One reason many veterinarians are a little wary of pet health insurance is they don’t want it to become like human health insurance, where a whole department is needed to handle billing and insurance claims. They would rather not have to deal with a pet insurance company directly. Your veterinarian may have to fill out and sign a claim form for you, but this usually takes only a couple of minutes. The more time veterinarians or their staffs have to devote to insurance claims, payments, etc., the higher the cost of veterinary services will rise because their overhead expenses will be higher. So far, insurance companies have endeavored to keep the claim process simple.
Most veterinarians I've talked with are reluctant to deal with the insurance company directly for the reasons stated above. Also, most insurance company representatives that I've talked with prefer that all financial dealings remain between the insurance company and the pet owner. In fact, some pet insurance companies, as a matter of policy, won’t pay the veterinarian directly.
What if you don’t have enough cash or available credit to pay a $3000 bill and then wait for reimbursement? Sadly, the short answer is that pet insurance may not do you or your pet any good in this situation, even if you had a policy. For a previous discussion related to this, see Which Is Best — Pet Insurance Or Savings Account?
However, unless the procedure/treatment is an emergency, some companies will give you and your veterinarian an estimate of the expected reimbursement if your veterinarian will send the company an estimate for the procedure (pre-certification). If the insurance company is willing to make a direct payment to your veterinarian and your veterinarian is willing to accept reimbursement from the insurance company, you will pay your veterinarian out of pocket for the deductible, coinsurance, and any procedures that aren’t covered when the procedure/treatment is performed.
For example, this kind of arrangement could potentially be used if your dog is diagnosed with a ruptured cruciate ligament and surgery is the best option for full recovery. Surgery could wait a few days until the insurance company verifies that the condition is covered and can give your veterinarian the expected reimbursement amount based on the estimate provided.
You would then pay your veterinarian out-of-pocket the part of the bill not reimbursed by the insurance company, either as a deposit prior to the procedure being performed or upon your dog’s discharge from the hospital. Your veterinarian would fill out and fax a claim form along with a copy of the invoice to the insurance company. Depending on the insurance company, the reimbursement will usually be received within two weeks by check, or arrangements can be made to receive it by direct deposit within a few days – or possibly even the same day the dog is discharged from the hospital.
Realize that this type of arrangement may be new to your veterinarian because he or she may not be familiar with pet health insurance and is probably used to being paid by you when the procedure is performed. This request should only be made when the bill is large, and for an unexpected event for which you aren’t able to cover totally out of pocket and then wait for reimbursement. You should not expect your veterinarian, nor will he or she likely be willing, to accept this type of arrangement otherwise.
I invite both pet owners and veterinarians to comment.
Dr. Doug Kenney