In February, 2015, I blogged about 3 insurance companies that I recommended to my clients. They were Trupanion, Embrace, and Pet Plan. I discussed some basics about insurance, and what you would want to think about or ask prior to picking a plan. Some have preventative/wellness policies, and some don’t. The information was obtained by personal research into the companies, experience with them through clients, and from testimonials reported by clients.
Since that time, policies have changed within the company, and not for the better. I recently had a long conversation with the company, on behalf of a client. She had been denied a claim for an emergency dental procedure for her cat. Their responses were alarming and enlightening. I considered contacting the company again, to further express my displeasure in their claims process. Instead, I decided to share it with all 3500+ of my subscribers and users. I encourage you to share this info and advise friends with this information.
First, Petplan does not offer wellness policies. This, being an illness claim, seemed to be straightforward. The client has been a long time PetPlan member, having insured all 4 of her pets for many years. Sophie, my patient, who previously had low level tartar, progressed quickly to a painful gingivitis situation, with suspected tooth root involvement in need of extractions. Her appetite had recently decreased significantly. I recommended a dental cleaning and with further examination under anesthesia.
The reasoning for rejection of the claim to reimburse for a dental procedure is that she did not have proof in writing of all her exams since being insured. I provided the two years of exams since I became her veterinarian. But the paperwork was not located prior to that time.. This may be that the prior veterinarian did not have it, or the client did not get a copy and save it. That is a valuable lesson for all of you, no matter what your type of insurance. But what gets me is that they said that she was not covered because she DID NOT SHOW PROOF OF A VETERINARY EXAM ONCE EVERY 12 MONTHS. It was a contingency to coverage. Also, any dental disease would be considered a preexisting problem. In her case, she was insured as a kitten, when she had no dental disease. But, lack of proof of a normal dental exam once insured would make her unqualified for a claim reimbursement.
SO, we are dealing with 2 separate issues that are alarming to me as someone who is in a position to recommend Pet Plan health insurance. First, even though they do newly insure adult animals, they will not cover a problem if it preexisted prior to insuring. So, good luck finding a middle to older aged dog or cat with no evidence of dental disease. Secondly, and more disturbing, is that this stipulation that they will not cover claims without proof of yearly exams, is news to me. Also, it is news to the client, who has been paying monthly payments for all of her pets for years. Talk about small print. I have spent countless hours in sessions with PetPlan representatives, asking every question I could think of, while being required to go through sessions of tutorials on the policies. Never was this stipulation mentioned to me. I referred to my notes on the sessions, and nowhere is this info. Encouraging yearly visits is logical, but real life, unemployment, unexpected bills, etc , happen. Sometimes, even the best of clients will find their pet a little overdue for yearly exams at times. Life happens. Sophie’s pet parents are arguably the most conscientious clients I can think of, and yet Pet Plan continued to collect their monthly payments for years, without reminders or notifications that they should be saving and reporting regular visits. When I inquired whether they would be refunding them for all those payments, they declined. When I inquired as to whether they would indefinitely decline claims because of the 2 lost years of records, they were vague. They said that it would not be an indefinite time period. When pressed as to when they would resume payments, they could not provide a clear answer.
I still recommend pet insurance, because I feel that it has improved from what it was 10 years or so ago. I have found that it enables pets to get more regular exams and thorough workups when indicated. It is not in the state that human insurance is, where procedure prices vary widely, and insured clients spend hours of time on the phone inquiring about denied claims.
I hope that pet insurance companies do not continue to go down this path, where pet parents might be forced to spend countless hours also fighting claims. If so, I feel, the companies will run themselves out of business. For now, I will only no longer recommend PetPlan.
Dr. Dawn
