PetPlan Denied My Claim -- Pre-existing Condition **UPDATE**

[Amy, Cubbie & Ollie]

I recently filed a claim with PetPlan for the treatment of Ollie’s ear infection.  The total treatment costs amounted to $332.82 and I have a $200 deductible with  a 10% coinsurance.  I wasn’t expecting a huge payment from them, but every little bit helps.  Well, I just got a letter in the mail from PetPlan stating that they will not pay out on this claim because it is a pre-existing condition. 

 

When we adopted Ollie last summer (June 2011) he had a double ear infection that was likely caused by the extreme amount of hair in both of his ears.  We opened the policy in September 2011.    The ear infection related to this claim occurred in February 2012 which is over 6 months since his first issue.  I guess I just don’t see how an ear infection can be a pre-existing condition.  To me, it would be the same as me getting a head cold in November and one in February.  Those are 2 different things.  I could get a cold a couple times a year or I could go years and years without a cold.  It isn’t a condition, it is just a cold. 

 

The General Exclusions sections of the policy states that they will not pay costs incurred on “any injury or illness that is the same as, or has the same diagnosis or clinical signs or symptoms as any injury, illness, or clinical sign your pet had before the effective date of this policy.”

 

Has anyone else ever been denied by PetPlan claiming a pre-existing condition?  I am trying to decide if I should give them a call or just let it go.

**UPDATE**

I spoke with PetPlan and found out that the ear infection is a pre-existing condition since Ollie had one before I started the policy and there was no diagnosed cause of the infection.  There was no diagnosed cause to this most recent infection either.  If the vet were able to determine that causes and if there were different then they would have paid out on this claim.  PetPlan did tell me that if he goes 24 months without an infection, then they will pay out on the next ear infection claim after that 24 month waiting period.  So, if I go to a different vet for any ear infections during the next 2 years and don't notify my regular vet would that constitute insurance fraud?  It just seems silly that he has to be symptom free for 2 years before they will pay.  Sigh...another lesson on why it is so important to get insurance as soon as you get the pet. 

[Jane, Guinness and Murphy]

I would not let it go.  It makes no sense to me that an ear infection is a pre-existing condition unless there is some underlying cause, which would be highly doubtful.  I would at least talk with a Manager.

[Laurie, Fudge, and Vern]

I never let stuff like this go. A follow up phone call or letter would be my next course of action. Good luck!!

[F, Calla & Luca]

Sounds like a good idea. A reminder about how many of us have pet plan, customer satisfaction, etc. wouldn't hurt.

[Lucy & AnnaBelle's Mom]

While I also would give it a try, I'm not surprised to hear this.  It seems that ear infections are a favorite pre-existing condition that they like to exclude!  It seems many dogs that get one get many.  Not always the case, but lots of times it is the case I guess.  Hey, maybe we will get lucky and the PetPlan ninja's will see your post and jump in here and prove me wrong!

[Amy, Cubbie & Ollie]

PetPlan ninja?  lol

[Jennifer and Jack]

They have never done that with Jack per se however I have the gold plan and they always used to pay for any hospital stay I had. I just submitted a claim for my heart for one thousand dollars in care of dog while I was in hospital. I am hoping they say it is ok and not a pre existing condition.

I don't see how an ear infection is but I know if the puppy had any symptom documented as an illness prior to insurance date they at least try to say it.


I will be happy to bombard them with emails of my displeasure if you want.

[Sherri, Sophie, Winston, & Kitty]

oooohh, maybe someone from PetPlan will join DK and try to fix it! lol!

[Heather & Brinkley]

VPI saw my complaint about them after I posted my frustration with a denied claim.  Because it had been at lest six months since Brinkley's last bought with a GI issue, they contacted my vet for all of the vet records, did a review and removed the "pre-existing" condition regarding GI issues.  While they were at it, they also removed the ear infection pre-existing condition.  Then they resubmitted my claim, and reimbursed me.  I know these are two different insurance companies but see what their policy is regarding this and see if you can do the same thing.  

Good luck!!

[Sue, Murphy and Bella ()*o*()]

It does seem as though the big companies are watching and waiting for their names to come up, but we have discussed Petplan many times and I don't remember anyone of their representatives jumping in as yet.
I knew when I started my policy with Murphy that it would need to be 2 years of no ear infection diagnosis before they would consider it as not being pre-existing. I too have the Gold Plan and have a claim in as we speak for his recent trip to the vet. With medications and recheck it came to $220.00. Not a lot, but I hope to get some back after my $50 deductible. I will keep you all posted.

[Amy, Cubbie & Ollie]

Thanks everyone for the feedback.  I'll give them a call in the morning and let you know what I find out. 

[Adrianne Matzkin]

Absolutely contact them. It wouldn't hurt to let them know that you are a member of a social site with over 9000 doodle families that love petplan .......... 

One ear infection a year should not be a pre-existing condition. It isn't like he had surgery for a chronic problem. 

[Kaytlin and Cooper]

I would fight it. this ear infection is not related to the past ear infection