# Frustrated: Pet Insurance Claim Denied



## ElkChaser (Oct 28, 2008)

*UPDATE....Frustrated: Pet Insurance Claim Denied*

I had my YLF Daisy bred in December. A week after we got her home from the breeding we noticed she had a bad smelling discharge. We took her to the veterinarian and she was diagnosed with an open pyometra. We chose to do an emergency spay and the final bill came to about $1,100. 

I have Petplan insurance and filed a claim with them. They originally denied the claim because the veterinarian we saw when Daisy was a puppy wrote in Daisy’s chart at all her puppy appointments that she recommended having her spayed. Daisy didn’t have anything wrong with her physically, the vet just strongly believed in spaying all female dogs. We had the veterinarian write a letter to Petplan stating Daisy was healthy at the time and we appealed their claim. 

Over 2 months later I get a letter in the mail today from them again denying my claim. They said they denied it because the vet did recommend having her spayed making this a preventable disease or illness which they will not pay for. 

This doesn’t seem right to me. I bought pet insurance to cover large medical expenses and when I try to use it I get denied. It gives me the feeling that no matter what type of claim I have they are going to weasel out of it. Also, is it normal for a veterinarian to note several times in a dog’s chart to have a healthy puppy spayed? Thanks for letting me vent.


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## PackLeader (Jan 12, 2009)

Similar thing happen to me. I now drive over an hour to the vets because the local one won't even let you in the door unless they are fixed.

They claim it's because of the grants or some funding they get requires it.


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## Guest (May 19, 2011)

That is a total and complete crock. There's got to be a way around it and your vet should be willing to help you. Your vet should write a letter specifically stating that they did NOT tell you spay her to prevent pyometra. They told you to spay her to prevent unwanted pregnancy -- and maybe they might throw in mammary cancer, but that might screw you for later if your policy covers it. This is really unfair.

That would be like if your vet recommended that you put your dog in a box and never let it out so it doesn't get hurt or sick... geesh. It's common sense.

Your vet should have never written that on their records OR they should have written that you were keeping her intact for future breeding...

How much was the claim for?


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## Guest (May 19, 2011)

ps -- also get out the fine print and see where it states that they have a case to deny your claim on these grounds, or did they provide that to you?


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## Jay Dufour (Jan 19, 2003)

Activist Vet......Thanks alot......


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## Thomas D (Jan 27, 2003)

Look at your appeal process in your policy. Some have 2 appeals and an arbitration (or outside vet) to look at the claim. Some give the opportunity to file a complaint thru your state department of insurance. Make sure all of this is done in writing and certified mail.

I notice Petplans website says you are bound by the state of Idaho and waive jurisdictional, venue and service of process.

Ther is also a website that reviews all pet ins plans. You can write a review of Petplan and what they did on your claim.


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## Jay Dufour (Jan 19, 2003)

Ask your vet to sign an affidavit that she blanketly advises ALL female patients to be spayed.......Not your bitch specifically.


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## Pinehill (Jul 14, 2010)

a great lesson for all of us- if you intend to breed, find a vet that breeds.


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## Hoytman (Jun 23, 2003)

What a crock.
My wife's and insurance agent and I go to the dog house everytime I say this (even though she agrees with me)but here goes...INSURANCE COMPANIES are a joke. My wife knows I'm telling the truth and witnesses it all the time...and the dang agent is the one who ends up getting the bad rap.

Unless there's an attorney from this forum, in other words like minded like us, you'll most likey get taken again if you try that route. 

I've had nothing but bad luck with insurance companies and attornerys.

I had a dog with the same issue, a 4 month old pup. Five hundred for the pup ($500), then found out had the same issue as your dog...$1500 dollars after the surgery we got one more week with her...and I'm out $2000 bucks. Yeah, we got a replacement but that's all that was offered and it didn't seem as if asking for a refund of vet bill's was going to happen...so, I was stuck with accepting the dog who ended up with severe hip dyslpasia.

Good luck my friend...good luck.


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## Cleo Watson (Jun 28, 2006)

I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.


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## Guest (May 20, 2011)

Cleo Watson said:


> I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.


That's a good point... See if credit your account (versus give you $$$)

I'm all about 99% of people spaying and neutering their dogs. But the other 1% shouldn't be penalized for the stupidity and neglect of the other 99%....


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## ElkChaser (Oct 28, 2008)

Kristie Wilder said:


> ps -- also get out the fine print and see where it states that they have a case to deny your claim on these grounds, or did they provide that to you?


Here is the part of the policy they are using to deny the claim. 

aa.The cost of any treatment a veterinarian normally
recommends to prevent an injury or illness, and any
costs that arise from an injury or illness with respect to
which you were advised by a veterinarian to take
preventive measures and did not do so.


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## ElkChaser (Oct 28, 2008)

Cleo Watson said:


> I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.


This was the first thing that came to my mind. It seems they are denying the claim almost solely on the veterinarian's recommendation of spaying put in Daisy's chart. I didn't know if it was standard practice for a veterinarian to note this in a chart or not. If it's not a standard practice I feel like I have a legitimate gripe with the vet.


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## Thomas D (Jan 27, 2003)

Have you seen the actual chart? If not I would get a copy and proceed from there. Also, consider a second opinion from another vet to help in the appeal process...if there is another available.


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## Guest (May 20, 2011)

If you cut her back leg off, she'll never have a broken back leg. If you cut her ear off and out, she'll never have ear infections. If you skin her, she'll never have a staph infection... I mean, c'mon. That's frustrating.

I have personally had almost all great experiences with my insurance companies. I'm sure, like most insurance companies, these pet ones are going to say no and then fight at least for a bit before they'll pay a claim... like healthcare... or auto...

-K


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## GoldDog (Feb 10, 2009)

Excellent point Kristie! 
I'm with Cleo on this one. The vet is going to have to take his fair share. See it all the time with engineers. Make a blanket statement like that and you have to live with the consequences!
Michael


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## Buzz (Apr 27, 2005)

I am surprised that they are taking this approach with you. Looking at the exclusions in my policy (yes it is a Petplan policy) it says:

V.	General Exclusions
The following general exclusions apply to your policy and coverage parts. We will NOT pay costs you incur for your pet in the following categories:

j.	Costs arising out of or related to: 
(1) Breeding.
(2) Pregnancy. 
(3) Whelping or nursing. 
Except costs of any complications arising from these procedures.


It seems that what you have is a complication, a condition that their policy claims is covered.

Funny that also listed under exclusions is:

u.	Elective or specialty procedures which are not deemed medically necessary, including but not limited to: 

(1) Docking of tails. 
(2) Removal of dewclaws.
(3) Removal of eyelashes. 
(4) Cropping of ears. 
(5) Spaying or neutering. 
(6) Cosmetic dentistry.

So it is elective surgery unless a vet says it is medically necessary!

This is what they are going on:

7. CARE FOR YOUR PET 

a. In order for your policy to remain valid you must take care of
your pet and arrange and pay for your pet to have the following: 

(1) An annual health check. 
(2) An annual dental exam. 
*(3) Any treatment normally suggested by a primary vet to
prevent illness or injury.*

b. If your pet has not been examined by a primary vet within the
twelve (12) months prior to the effective date of the policy you must arrange to have your pet examined at your own expense within the first 30 days after the effective date of the policy. The examination will be used as the basis for determining any pre- existing conditions.

c. To be afforded coverage for the diseases listed below, you must keep your pet vaccinated at your expense, as recommended by your primary vet. We will not pay any claims that result from or are related to any illness that is listed below that a vet- recommended vaccine would have prevented.

(1) Canine distemper. 
(2) Canine adenovirus 2 (canine viral hepatitis). 
(3) Canine parainfluenza. 
(4) Canine parvovirus. 
(5) Leptospirosis. 
(6) Rabies.

d. You must take your pet to be examined and treated by a primary vet as soon as possible and within forty eight (48) hours after your pet first shows clinical sign(s) or symptoms of an injury or illness.


They seem to be taking the position that your policy has been invalidated because you failed to provide treatment normally suggested by a vet to prevent illness or injury, yet they say that they will cover complications from breeding. No contradiction there!


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## J. Walker (Feb 21, 2009)

Cleo Watson said:


> I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.


I agree 100%. This problem lies right at the feet of the vet. This is your dog. It is not your vet's job to try to indoctrinate you or to notate a procedure you didn't even want done.


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## Buzz (Apr 27, 2005)

J. Walker said:


> I agree 100%. This problem lies right at the feet of the vet. This is your dog. It is not your vet's job to try to indoctrinate you or to notate a procedure you didn't even want done.


But if you read the policy, it doesn't say "treatment that your vet recommended," it says - treatment that a vet normally suggests. And low and behold the policy is supposed to cover complications due to breeding. What a crock. Time to change insurance companies. And to think I left another company at the first of the year in favor of these clowns.


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## JusticeDog (Jul 3, 2003)

Cleo Watson said:


> I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.


Nah..... PetPlan has unwritten rules per my experience(s) that they don't tell you about. 

In this instance, a letter from the vet indicating that she recommends spay for every female, not for anything to do with this dog would be helpful. I'd appeal it, and then file a complaint with the commissioner of insurance.

Been there, done that regards-


this is one reason why I've gone with Purina on my last two dogs.


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## wheelhorse (Nov 13, 2005)

Why don't you all just put the money you pay on insurance in your own medical savings plan for the dog? It's your money then and you get to use it like you want to. Easy peasy....


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## ElkChaser (Oct 28, 2008)

JusticeDog said:


> Nah.....
> In this instance, a letter from the vet indicating that she recommends spay for every female, not for anything to do with this dog would be helpful. I'd appeal it, and then file a complaint with the commissioner of insurance.


In the original appeal I had the vet send a legal letter to them stating that Daisy was healthy and that it was the vet's policy to recomend spaying all dogs.

You don't think I have any recourse with my vet? I really don't want to go after my vet but Petplan keeps telling me that because my vet recomended the spaying multiple times they won't cover it.


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## ElkChaser (Oct 28, 2008)

wheelhorse said:


> Why don't you all just put the money you pay on insurance in your own medical savings plan for the dog? It's your money then and you get to use it like you want to. Easy peasy....


I understand what you are saying but the policy only costs about $300 per year. The whole purpose of the insurance was to cover expensive medical emergencies so I wouldn't have to make a decision for my dogs life based on finances. This whole experience hasn't given me much confidence in the system.


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## JustinS (May 17, 2009)

I feel for you, I am sorry that they are being such a pain, hope they realize what they are doing is wrong, and cough up the money. Sad part is an insurance company never admits their wrong.


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## wvlabman (Nov 17, 2008)

Am I the only one that refuses to allow the insurance companies to get richer off of our dollars. I made up my mind a while ago that instead of giving an insurance company $25 a month per dog I would give it to myself. I decided to self insure so I opened a savings account and now have a monthly draw for each of my dogs....and the nice thing about it is I can decide if I want to deny my own claim or not. I understand that it is a gamble for a year or two until your account gains some ground. 

The one thing I learned many years ago was that the purchase price of a dog is the cheap part. If you add up food, vet bills and training gear the original price of the dog seems like peanuts.

By the way that is wrong what they are doing to you. And if the insurance company doesn't pick up the bill the vet should be liable for some of it.


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## md11pilot (May 14, 2006)

How did you pay the vet's bill? Cash/check or credit card? If the latter, call your cc company and "stop payment"/"dispute" the charge.


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## wheelhorse (Nov 13, 2005)

md11pilot said:


> How did you pay the vet's bill? Cash/check or credit card? If the latter, call your cc company and "stop payment"/"dispute" the charge.


Won't work if the op signed an estimate approving the surgery. Had that tried on me once. Not my fault that the insurance company wouldn't pay.

I hate insurance companies for humans as well as pets.


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## Colonel Blimp (Jun 1, 2004)

What *wheelhorse* and *wvlabman* said.

A policy that "only" costs $300 per annum and then doesn't pay out isn't IMO cheap; it's very expensive.

I put a rough equivalent of $70 aside each month in a small deposit account (this for three dogs) to cover vet bills including shots, Frontline, worming pills and all that stuff. If I need to spend a lump sum on something serious, I have the money saved in the account to do it. If it isn't required I've still got it.

Most policies have an excess of $55 before paying out on any treatment which by amazing coincidence is about the average charge for an examination and a dose of drugs. Very few policies will pay out for chronic conditions like HD; they'll pay for the exam (minus $55) X rays and what have you, but not for any serious post treatment, generally using a wriggle out like the one you have been sold. They won't pay for continued prophylactic treatment either. Some won't offer cover for working dogs.

All in all I regard dog insurance as one of the poorer investments we can make, so like the other guys, I avoid it and make other arrangements.

Regards

Eug


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## The Snows (Jul 19, 2004)

As Susan said "Been there, done that" with PetPlan. 

That is exactly why several years ago when we looked at what we were paying a month for two dogs and how our deductible kept increasing (with minimal claims) as did the monthly payments, we decided to cancel with PetPlan and take the same money and put it into a "dog health bank account". 

Due to the fact that fortunately we had no major issues for a period of time, and yes you are putting yourself at risk until you can build a bit of a cushion, we know we will never have a claim refused!


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## Sophie Gundog (Apr 28, 2010)

Wow , seems to set off a lightbulb moment when I had the first exam done at nine weeks I remember a full court press move to spay , wonder how much of that is now in her records, live and learn I guess ...


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## jeff t. (Jul 24, 2003)

The Snows said:


> As Susan said "Been there, done that" with PetPlan.
> 
> That is exactly why several years ago when we looked at what we were paying a month for two dogs and how our deductible kept increasing (with minimal claims) as did the monthly payments, we decided to cancel with PetPlan and take the same money and put it into a "dog health bank account".
> 
> Due to the fact that fortunately we had no major issues for a period of time, and yes you are putting yourself at risk until you can build a bit of a cushion, we know we will never have a claim refused!


Takes a long time to save up enough to cover an injury that costs greater than $10,000 to repair and rehab.


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## metalone67 (Apr 3, 2009)

How did the insurance company get ahold of her charts in the first place? I agree with the majority on here that the vet went over the top in putting multiple times that she should be spayed as if there was a problem from the start.


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## hotel4dogs (Aug 2, 2010)

I looked into insurance extensively, and ended up with Embrace on the recommendation of several other golden retriever owners.
I HAVE NEVER HAD TO FILE A CLAIM so I don't know how it will be. 
That said, the policy I took out on my youngest boy is what I consider "catastrophic only". I opted for a $1000 per year deductible. PetPlan, and most others, have a PER EVENT deductible, whereas Embrace has a per year deductible. After that, they will pay 80% of all vet bills up to $15,000 per year, the amount I selected. They will pay acupuncture and/or chiropractic, too.
It costs me $12 per month. To me that's a small cost to pay in case my boy gets cancer, as 65% of all goldens do, or breaks a leg, etc.
Yes, they have exculsions and caveats like all insurance, but I felt theirs was the best for my situation They have a 6 month orthopedic waiting period, unless you get a certification from your vet that the dog has been examined and found free of orthopedic issues. This is a brief office exam by a regular vet. 
They also will review your medical records, which you submit, and tell you whether or not anything will be considered pre-existing.
Now hopefully I will never have to find out how well they pay on claims.


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## ErinsEdge (Feb 14, 2003)

jeff t. said:


> Takes a long time to save up enough to cover an injury that costs greater than $10,000 to repair and rehab.


Exactly. I had bills over $11K for one dog. That's what I bought it for-the big claims. A spay charge is nothing compared to those kind of claims. Unfortunately so many vets are pro spay, and I wouldn't go to one that started pushing it because they WILL put it in the chart.


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## EdA (May 13, 2003)

wvlabman said:


> And if the insurance company doesn't pick up the bill the vet should be liable for some of it.


I would like to understand the logic that led to that conclusion. The veterinarian provided professional services how the bill is paid is the responsibility of the owner.


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## EdA (May 13, 2003)

md11pilot said:


> How did you pay the vet's bill? Cash/check or credit card? If the latter, call your cc company and "stop payment"/"dispute" the charge.


The op's dispute is with the insurance company not the service provider.


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## achiro (Jun 17, 2003)

Yeah, I'd try to stay on the good side of the vet while you try and get this taken care of. I would certainly talk to her/him and suggest strongly that they add a note of something like "as part of my normal consultation, I recommended spay/neuter" also stating something about that not being due to a health issue but as a normal suggestion to all patients owners. 
That could at least protect future owners from a situation like this.


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## jeff t. (Jul 24, 2003)

ErinsEdge said:


> Exactly. I had bills over $11K for one dog. That's what I bought it for-the big claims.


Likewise...Sinner's medical bills last year were nearly $20,000..Pets Best paid $14,000 of it.


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## Jason Glavich (Apr 10, 2008)

ElkChaser said:


> In the original appeal I had the vet send a legal letter to them stating that Daisy was healthy and that it was the vet's policy to recomend spaying all dogs.
> 
> You don't think I have any recourse with my vet? I really don't want to go after my vet but Petplan keeps telling me that because my vet recomended the spaying multiple times they won't cover it.


Knowing several people in the insurance claims career world and the SS disabilty and my own personal experiance with Life insurance, the claims adjusters first goal is to deny! 100% if possible. 

Here is why, most people if they get denied will just accept that and walk away, only about 60-70% of people will appeal, thus they just saved alot of money. 2nd most appeals are written by the policy holder, this is a big mistake, they will deny because you do not get your point across. A laywer will write your appeal for a nominal fee usually, Usually only a couple of hundred dollars. So at this point they are down to 50% or less of people who they may pay. 

It is beneficial to the company to deny first and see who will fight it. The basis for your appeal should be life threatening injury, along with studies that reccomend not spaying your female from Vets. Along with the studies on pyometra and causes. Call a lawyer and get them to file the appeal, a cover page from the law offices of **^* usually is a big motivator, cheaper to pay then to go to court. The lawyer can review your policy and tell you if it is worth it, or if there is no chance.


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## Leslie B (Jul 3, 2009)

ElkChaser said:


> Here is the part of the policy they are using to deny the claim.
> 
> aa.The cost of any treatment a veterinarian normally
> recommends to prevent an injury or illness, and any
> ...


So, if I don't build a good fence and my dog gets out and is hit by a car would it be "preventable"? Under this exclusion, any injury could be denied.


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## JusticeDog (Jul 3, 2003)

ElkChaser said:


> In the original appeal I had the vet send a legal letter to them stating that Daisy was healthy and that it was the vet's policy to recomend spaying all dogs.
> 
> You don't think I have any recourse with my vet? I really don't want to go after my vet but Petplan keeps telling me that because my vet recomended the spaying multiple times they won't cover it.


At this point, you need to file a complaint with your state's department of insurance. Send them all documentation. 

There is no recourse with your vet. Not many clients actually have insurance at your typical vet's office, and they are just not savy with the ways of underwriting, etc. 

Since I work for a Property & casualty insurance company, I spend a lot of time educating my vets so that claims don't get denied.


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## JusticeDog (Jul 3, 2003)

EdA said:


> The op's dispute is with the insurance company not the service provider.


 
True. And you agreed to pay your vet for services. You have a contractual relationship with the insurance carrier. The two relationships are separate and distinct under the law.


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## JusticeDog (Jul 3, 2003)

metalone67 said:


> How did the insurance company get ahold of her charts in the first place?


Pet Plan requires you send the records for the bill you are seeking reimbursement for............ some policies do not, unless they have a question, such as VPI.


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## ElkChaser (Oct 28, 2008)

I just got done speaking with a manager at Pet Plan about by my claim denial. He said that claim denial came down to the veterinarian’s recommendation in Daisy’s chart to spay her when she was a puppy. He said if the veterinarian hadn’t wrote that she recommended spaying Daisy in her chart they would have paid the claim. He said regardless that Daisy was healthy at the time or that the recommendation was based upon the veterinarian’s opinion that all female dogs should be spayed; it was still a recommended treatment that we didn’t follow. 

I feel that I need to contact my veterinarian and discuss this with her. I don’t know if it is standard procedure to recommend spaying and to note it in the chart, but you can see it was detrimental to my insurance coverage. 

The fellow I talked to did suggest that I request underwriting on my policy. He said this will tell me exactly based upon Daisy’s medical history what they will not cover or what they determine as preexisting. I would suggest anyone with a policy do this.


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## labsforme (Oct 31, 2003)

Sent you pm


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## Howard N (Jan 3, 2003)

Seems like they are not paying for a medical problem due to a political decision of the vet's.


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## ElkChaser (Oct 28, 2008)

Howard N said:


> Seems like they are not paying for a medical problem due to a political decision of the vet's.


That's what I told him. He told me legally it's a black and white issue to them. Because the vet reccomended the spay and we didn't follow it, they can't pay.


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## Eric Johnson (Dec 23, 2004)

At the time s/he made the comment, there was no medical reason to suggest spaying so the comment was out of line.

Since there was no reason for the comment in the "Dr's notes" other than as a social comment, the vet ought to be taken to small claims court if the vet won't forgo the payment on the bill. What would have been an appropriate note? How about, "Discussed the advantages and dis-advantages of spaying Fifi with Elkchaser." and then leave it alone.

In fact, there is now a growing body of literature that says that there may be medical risks (plus the obvious surgical ones) to spaying. See:

http://healthypets.mercola.com/site...angers-of-early-pet-spaying-or-neutering.aspx

and

http://www.naiaonline.org/pdfs/LongTermHealthEffectsOfSpayNeuterInDogs.pdf

Eric


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## Buzz (Apr 27, 2005)

ElkChaser said:


> I just got done speaking with a manager at Pet Plan about by my claim denial. He said that claim denial came down to the veterinarian’s recommendation in Daisy’s chart to spay her when she was a puppy. He said if the veterinarian hadn’t wrote that she recommended spaying Daisy in her chart they would have paid the claim. *He said regardless that Daisy was healthy at the time or that the recommendation was based upon the veterinarian’s opinion that all female dogs should be spayed; it was still a recommended treatment that we didn’t follow. *
> 
> I feel that I need to contact my veterinarian and discuss this with her. I don’t know if it is standard procedure to recommend spaying and to note it in the chart, but you can see it was detrimental to my insurance coverage.
> 
> The fellow I talked to did suggest that I request underwriting on my policy. He said this will tell me exactly based upon Daisy’s medical history what they will not cover or what they determine as preexisting. I would suggest anyone with a policy do this.



So if your vet had suggested shooting little Daisy, and you didn't, does that mean no further coverage would be available? Because you know, if Daisy were dead, she certainly couldn't get sick and incur medical expenses.


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## Howard N (Jan 3, 2003)

ElkChaser said:


> That's what I told him. He told me legally it's a black and white issue to them. Because the vet reccomended the spay and we didn't follow it, they can't pay.


He's lying to you.


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## Keith Farmer (Feb 8, 2003)

Contact the Office of Insurance Commissioner for your state.







.


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## Misty Marsh (Aug 1, 2003)

Keith Farmer said:


> Contact the Office of Insurance Commissioner for your state.
> 
> 
> 
> ...


I agree 100%, this is complete BS!! This company is like all other health insurance companies, deny claims, make money. Go above thier head and document everything, all e-mails, etc....


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## wojo (Jun 29, 2008)

Based on the comments on this thread, why would I buy insurance on my 8 dogs?
Anyone selling pet insurance care to wade in ?


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## Squirm88 (Oct 30, 2008)

wojo said:


> Based on the comments on this thread, why would I buy insurance on my 8 dogs?
> Anyone selling pet insurance care to wade in ?


Hi Ed! I have insurance on both my dogs. Not very comforting to know people are having a hard time getting reimbursed. 

The reason I have it is in case there is ever a big ticket item that needs to be covered. Something like a TPLO surgery + rehab or a snake bite requiring anti-venom that can cost $5,000+. These dogs do so much for us I would hate to have to limit medical care because of financial concerns. I may never have to file a claim but at least I have some peace of mind.

However, if I had 8 dogs I think self insuring would be your best option.


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## Ted Shih (Jan 20, 2003)

wojo said:


> Based on the comments on this thread, why would I buy insurance on my 8 dogs?
> Anyone selling pet insurance care to wade in ?


Because I have had a number of big ticket bills and Pet Plan Insurance has paid a big chunk of them.


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## JusticeDog (Jul 3, 2003)

Keith Farmer said:


> Contact the Office of Insurance Commissioner for your state.
> 
> 
> 
> ...


Keith is correct. You need to file a complaint with the department of insurance. Make sure you provide them with all the documentation. The skewed thinking is typical of the experience I have had with Pet Plan, and I'm corporate counsel for a Property & casualty insurance company - so believe me, I "get it." I have not had this experience with other pet health insurance companies.


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## JusticeDog (Jul 3, 2003)

ElkChaser said:


> I just got done speaking with a manager at Pet Plan about by my claim denial. He said that claim denial came down to the veterinarian’s recommendation in Daisy’s chart to spay her when she was a puppy. He said if the veterinarian hadn’t wrote that she recommended spaying Daisy in her chart they would have paid the claim. He said regardless that Daisy was healthy at the time or that the recommendation was based upon the veterinarian’s opinion that all female dogs should be spayed; it was still a recommended treatment that we didn’t follow.
> 
> I feel that I need to contact my veterinarian and discuss this with her. I don’t know if it is standard procedure to recommend spaying and to note it in the chart, but you can see it was detrimental to my insurance coverage.
> 
> The fellow I talked to did suggest that I request underwriting on my policy. He said this will tell me exactly based upon Daisy’s medical history what they will not cover or what they determine as preexisting. I would suggest anyone with a policy do this.


 
If the manager was a guy named "Fabrice" sounds like that.. spelling is different, I can understand why you are frustrated. YOu can send an email to the vet in charge...... he is better. But, as I had indicated earlier on 5-21-2011 you need to file that complaint with your state's insurance commission, otherwise, you are getting nowhere. Trust me. This will get you into the upper ranks, where you need to be. It's guaranteed to get the insurance company's attention.


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## JusticeDog (Jul 3, 2003)

Squirm88 said:


> However, if I had 8 dogs I think self insuring would be your best option.


Not really..... 8 TPLOs x $15,000 = YIPES!


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## ElkChaser (Oct 28, 2008)

JusticeDog said:


> If the manager was a guy named "Fabrice" sounds like that.. spelling is different, I can understand why you are frustrated. YOu can send an email to the vet in charge...... he is better. But, as I had indicated earlier on 5-21-2011 you need to file that complaint with your state's insurance commission, otherwise, you are getting nowhere. Trust me. This will get you into the upper ranks, where you need to be. It's guaranteed to get the insurance company's attention.


That was his name. Thank you for the advice. I figured somebody on RTF has had to fight this battle also. I will be filing a complaint with my state's insurance commission. 
Mike


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## Illinois Bob (Feb 3, 2007)

PetPlan denied a claim for root canal work on one of my dogs.They said it was peridontal disease.It wasn't and a letter from my vet backed it up.They overturned their decision and paid the bill.It bugs me to read this thread because it makes me wonder if that is just the way it will be with Petplan.Maybe they'll pay.Maybe they won't.So far they have paid all of my claims related to two dogs teeth issues.I wonder if it's just luck of the draw where the you might get a good employee handling your claim or one of not so good ones.Every company has both at sometime.Whatever the reason,it doesn't give me much confidence in PetPlan reading about others bad experiences with them.


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## jeff t. (Jul 24, 2003)

wojo said:


> Based on the comments on this thread, why would I buy insurance on my 8 dogs?


One of my dogs incurred nearly $20,000 of surgical & rehab expenses last year...Pets Best Insurance paid $14,000 of that total.

I'm grateful that I had insurance.


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## wojo (Jun 29, 2008)

Ted Shih said:


> Because I have had a number of big ticket bills and Pet Plan Insurance has paid a big chunk of them.


Based on your experience would you stay with Pet Plan? 

Thanks


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## Ted Shih (Jan 20, 2003)

wojo said:


> Based on your experience would you stay with Pet Plan?
> 
> Thanks


I have no issues so far. I am remaining with Pet Plan. 

I left Pets Best, because I bought a plan which guaranteed no premium increases. Pets Best changed carriers, guarantee left too. So, I left. Plus, there is a six month waiting period for cruciate injuries with Pets Best. None with Pet Plan. So I insure my puppies at 7 weeks.

But, everyone gets to make their own decisions

Ted


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## JusticeDog (Jul 3, 2003)

If you have not gone through the appeals process, go ahead and do it as well as writing to your state's insurance commission. Have your vet write a very clear and concise letter that she recommends spay and neuter for all pets, to prevent unwanted pregnancy not for the purposes of preventing pyometria. (Don't let her go into other health concerns that could cause you problems later as Kristie mentioned). 

Carbon copy the following: 
[email protected] 
[email protected] - This is Pet Plan's vet. 
[email protected]

As was stated earlier, in order to appeal a claim we will need two things.

*1. **A request from you in writing (email is fine) stating that you wish to appeal your claim.*
2. *Any supporting paperwork from your vet to support the appeal. *The claims department has some guidelines on what is best for you to request from your vet:
a. In all cases, the medical record is the legal document we must use in adjusting claims. If you feel there was a material error in the medical record, the record MUST be amended or annotated by the attending veterinarian: a statement contradicting the written medical record is *not* sufficient. 
b. In cases where you feel that the medical record is ambiguous or unclear, a written statement from the attending veterinarian is appropriate.
c. Communication from a veterinarian must either be on letterhead from the veterinary practice or by email where the email address domain is consistent with the hospital website (e.g. email must be from [email protected] where the hospital website is www.abcvets.com).
d. Communication from veterinarians must include their contact details so that we can clarify any details with them directly.

*Information can be faxed to 866.599.4654 or emailed to [email protected]. *All information should be clearly labeled with “Claims Appeals” and feature your pet’s name and policy number.

The Claims Appeal Committee meets every 2-4 weeks and you will be notified of their decision in due course. 

I have found in speaking to Fabrice on several claims that they have unwritten definitions of how they apply their policy. When you ask him to put it in writing or show you where those definitions are written, you get nothing. Ie: the definition of pre-exising is applied differently than what you may think. YOur case is a prime example. They also have a policy that you must prove that you have pre-paid your vet. They want to prevent animal abuse, but yet Fabrice likes to then hide behind the shield of being a property & casualty insurance company. I explained to him in no uncertain terms that the contract was with me. I owe an obligation to my vet; they owe it to me. The relationships are separate and distinct under the law. And, if my house burns down, I don't pay for it to be fixed, and then my carrier reimburses me. The carrier pays for my house. It's up to me to choose to re-build or live out of cardboard box. 

It's this type of behavior that has caused me to go elsewhere for pet insurance.


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## DeniseAnd (Jun 2, 2011)

URRRR dealing with these insurance companies is SO SO frustrating! I used to have insurance and after they denied most of my claims I was like FORGET IT! I switched to Pet Assure--it's a discount program where I get 25% off my bill every time I go to one of their vets. I'm simply saving money without the hassle. I couldn't ask for anything better.


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## EdA (May 13, 2003)

DeniseAnd said:


> I switched to Pet Assure--it's a discount program where I get 25% off my bill every time I go to one of their vets. I'm simply saving money without the hassle. I couldn't ask for anything better.


So someone else chooses your veterinarian?....I like choosing my own physician but maybe that's just me...

A claimant should not have to brow beat an insurance provider into
paying legitimate claims but from this discussion Pet Plan chooses to deny it's responsibility and create negative publicity for their product in a relatively small market which is not good business in my opinion.

This is only one dog related site and their stance has undoubtedly cost them business in the retriever community then multiply that by all the other dog regimens and denied claims.


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## DeniseAnd (Jun 2, 2011)

EdA said:


> So someone else chooses your veterinarian?....I like choosing my own physician but maybe that's just me...
> 
> A claimant should not have to brow beat an insurance provider into
> paying legitimate claims but from this discussion Pet Plan chooses to deny it's responsibility and create negative publicity for their product in a relatively small market which is not good business in my opinion.
> ...


No--they don't tell me which vet to go to. They have a bunch of in-network vets in my area and I choose the one I want to use. Also, I am not stuck with one vet. I could go to ANY listed on their website. (Which is great for when I travel.)


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## jeff t. (Jul 24, 2003)

DeniseAnd said:


> URRRR dealing with these insurance companies is SO SO frustrating! I used to have insurance and after they denied most of my claims I was like FORGET IT! I switched to Pet Assure--it's a discount program where I get 25% off my bill every time I go to one of their vets. I'm simply saving money without the hassle. I couldn't ask for anything better.


I'm curious...what will you do if your dog suffers an injury requiring a big ticket surgery and a rehab that is as expensive as the surgery...if not more so?


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## DeniseAnd (Jun 2, 2011)

FinnLandR said:


> So it's an HMO for dogs...?


Never thought of it that way, but yea! Works the same way!


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## DeniseAnd (Jun 2, 2011)

jeff t. said:


> I'm curious...what will you do if your dog suffers an injury requiring a big ticket surgery and a rehab that as expensive as the surgery...if not more so?


Well, whatever it is, I know it will be 25% off. That could be hundreds of dollars in savings on a big surgery. HOPEFULLY I'LL NEVER NEED IT!!!!!


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## EdA (May 13, 2003)

The following comes from Pet Assure's website

"Pet Assure members visit network vets who provide them a 25% savings on *in-house medical services only*. This includes the office visit, exam, shots, surgery, x-rays, and other procedures you perform in your office (if you are a mobile vet, at their location). Typically, this works out to approximately 12% of a client's annual billings. 
You do not need to give our members special pricing on: 
any products the patient will administer at home such as medications, food, and flea or heartworm preventatives
non-medical boarding and grooming
any outside services such as lab work or outside specialists (even if the service is performed in your office)"
Big ticket items are generally because of referrals to various specialists and the discount would only apply if those specialists were in network veterinary facilities


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## cjr (Oct 21, 2010)

> Well, whatever it is, I know it will be 25% off. That could be hundreds of dollars in savings on a big surgery. HOPEFULLY I'LL NEVER NEED IT!!!!!


Do you work for Pet Assure?


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## jeff t. (Jul 24, 2003)

DeniseAnd said:


> HOPEFULLY I'LL NEVER NEED IT!!!!!




Unfortunately, my experience has been that hope is not a good strategy when it comes to my dogs health.

When I first got started in retrievers, I was warned "it is harder to keep them sound and healthy than it is to keep them trained" .

So far, those words have been absolutely true.


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## DeniseAnd (Jun 2, 2011)

jeff t. said:


> Unfortunately, my experience has been that hope is not a good strategy when it comes to my dogs health.
> 
> When I first got started in retrievers, I was warned "it is harder to keep them sound and healthy than it is to keep them trained" .
> 
> So far, those words have been absolutely true.


I agree. That's why I first said that whatever I need will be 25% off. I can always hope never to need Pet Assure for something big, but if I do, I will be fine.


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## DeniseAnd (Jun 2, 2011)

cjr said:


> Do you work for Pet Assure?


A friend of mine works there and introduced me to it.


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## ElkChaser (Oct 28, 2008)

So, 2 days after my half hour talk with the manager at Pet Plan I get a call from one of their representatives. She says they want to pay my claim but needs to talk to my vet about her recommendation of spaying Daisy as a puppy. She said that if the vet recommended the spay specifically to prevent pyometra, they wouldn’t be able to pay the claim. I figured this was going to end the same way with me not getting payed. 5 days later the Pet Plan rep. called me back and said they were going to pay the claim. I about fell over. 

The whole process still doesn’t make any sense to me. In the appeal the veterinarian explained her recommendation of the spay and Pet Plan denied it. I don’t know what she would tell them differently in a phone call. I guess I was very convincing in my phone call to the manager in explaining their inconsistencies. I know some of you on RTF wrote to Pet Plan and told them of your disgust in the way they were handling my claim. I’d like to think it helped and for that I thank you. For everyone else who offered advice I thank you as well. 

Mike


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## Jason Glavich (Apr 10, 2008)

ElkChaser said:


> So, 2 days after my half hour talk with the manager at Pet Plan I get a call from one of their representatives. She says they want to pay my claim but needs to talk to my vet about her recommendation of spaying Daisy as a puppy. She said that if the vet recommended the spay specifically to prevent pyometra, they wouldn’t be able to pay the claim. I figured this was going to end the same way with me not getting payed. 5 days later the Pet Plan rep. called me back and said they were going to pay the claim. I about fell over.
> 
> The whole process still doesn’t make any sense to me. In the appeal the veterinarian explained her recommendation of the spay and Pet Plan denied it. I don’t know what she would tell them differently in a phone call. I guess I was very convincing in my phone call to the manager in explaining their inconsistencies. I know some of you on RTF wrote to Pet Plan and told them of your disgust in the way they were handling my claim. I’d like to think it helped and for that I thank you. For everyone else who offered advice I thank you as well.
> 
> Mike


Great News! Now hopefully they get the check processed quickly.


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## ElkChaser (Oct 28, 2008)

Jason Glavich said:


> Great News! Now hopefully they get the check processed quickly.


Check is in the bank. I made sure I deposited it before I posted about a resolution.


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