Pet Insurance and Your Appointment

About Pet Insurance

As the cost of veterinary services rises, people are looking for alternatives to help them pay for their pets’ care. Pet insurance is something to consider, especially if your pets are young.

Most plans reimburse owners for a part of, or sometimes the whole, veterinary bill when pets are ill or injured. Some plans even help when pets die or get lost or stolen. Many companies offer pet insurance. They each have multiple plans to help owners afford the best medical care for their pets. Many plans allow owners to choose a deductible or coinsurance they are comfortable paying. This changes the monthly premium so all owners can be happy with the coverage that works best for them.

Here are some possible choices owners may have when it comes to picking insurance for their pets:

• How much they can afford to pay each month.
• Whether preventative medicine is included in the plan.
• Whether pre-existing conditions are covered. This means if a pet is diagnosed with a condition before their owners get insurance, does the insurance have to cover the bills to pay for that condition?
• How much of the bill will be reimbursed. Some plans cover all or a part of the bill. Some cover only what they think should be charged instead of what is actually charged.
• If there are any limits to your pets’ coverage. Some insurance plans will only pay for a problem once or set a dollar amount per condition. Companies may also have yearly limits or even limits of how much they will pay during a pets’ lifetime.

Take your time to study each plan to find the perfect one for you and your pets. Talk to your primary veterinarian for recommendations if you don’t know where to start your research.

Payments and Reimbursement Claims

During your research, you may find that some pet insurance companies are able to pay your primary veterinarian’s office directly, in turn decreasing the amount that you have to pay out of pocket up front. Please keep in mind that this is not set up for every hospital and is an optional benefit for only some hospitals.

Generally with pet insurance, you as the pet parent are responsible for paying the final invoice in full. You should receive an itemized invoice from the hospital, which you would submit with a completed claim form.

Contrary to popular belief, majority of claim forms do not need to be signed by your veterinarian prior to submission. Most claim forms solely require the diagnosis that your veterinarian has listed in the medical record, the date of the visit to the hospital, the reason (i.e., illness versus accident versus wellness) and the total amount paid. If you have all the required details, you should be able to complete the form yourself.

Once you have you completed the claim form and submitted it, along with your itemized receipt, your insurance company will reimburse you an amount appropriate based on the terms of your plan or as previously agreed upon per a pre-authorization agreement. This is all between you and your pet insurance company.

Adjusted or Denied Claims

There are occasionally times that your claim may not be reimbursed for an amount that you expected for one reason or another. If this is the case, you will receive either an email or mailed letter explaining why your claim was adjusted or denied.

When your claim is declined for a pre-existing condition, this means that your insurance company has medical records in their system that says your pet had that diagnosis already listed from a previous visit, whether from your primary veterinarian or any other veterinarian that you visited before. If you feel this is an error, you can reach out to the hospital they state made the previous diagnosis to inquire as to when and why that diagnosis was made.

IMPORTANT: please do not request that the doctor change, remove or alter the diagnosis from that record so that your insurance claim can be processed, regardless if it was written on the record as a “rule out” or consideration. Legally, medical professionals are not allowed to change, alter or adjust previously written medical records. If there was an error made, your veterinarian should be able to write an amendment letter or contact the insurance company to remedy it.

For any other reasons that your claim by not be reimbursed for the full expectant amount, you will need to call your insurance company for a full break down as they will be the best equipped to discuss the reason with you. Of course, you are more than welcome to call your veterinarian’s office for an explanation, but ultimately the decision is in the hands of your insurance company.

Integrative Ophthalmology’s Role in Your Insurance Claim

We do our best to help support our clients with pet insurance so we ask that you let us know in advance if your insurance company requires that the exam and diagnostic fees be separated for invoicing purposes. Upon completion of your pet’s exam, we will provide you with a PDF (or printed by request) copy of your itemized receipt and send you an Exam Summary Letter (emailed to the primary Pet Parent on the account within 24 to 48 hours of the appointment) that contains the list of diagnoses that Dr. Park-Dorner has listed for your pet’s condition. With those two documents, you will have everything required to complete the claim form as required by your insurance company. Should they need additional medical details, you can provide them with the Exam Summary letter sent to you as it contains all the medical details we have sent along to your primary veterinarian as well.

Due to the influx of claim forms we received and questions regarding the results of the denials or adjustments, it was determined that the best way to avoid becoming a liaison between pet parents and their pet insurance companies was to have clients complete and submit their own forms. We accept payment in full from clients at the time of service and will provide itemized receipts for claim submissions, we do not accept direct payment from insurance companies.

Since that decision, we have found that our clients have more of a sense of control with regards to their claims and expectations with the insurance companies. We also found that it helped our clients keep track of their pet’s various diagnoses, which is great for everyone involved especially their pet.