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. 

[Amy, Cubbie & Ollie]

Yes, I called and spoke with a representative but I didn't necessarily call to argue, I was sort of just trying to understand why they considered the ear infection to be pre-existing.  I am going to talk to my vet on Friday and see if she feels that the 2 infections were related or if they had different causes. He had a double ear infection when we adopted him and I think that it was because his ears were packed full of fur and dirt which certainly wasn't the case with this last infection.

[Amber (with Maggie)]

I had VPI. Recently I cancelled because every claim I submitted, they only covered a very small fraction of the cost. My vet charged approx 500 to have my dog fixed and they only covered 75 dollars of it. After 1.5 years of this and paying 56 dollars a month for the premium rate, I decided to start my one savings account for my dog and automatically sending 100 per month to it. At least I won't deny my own claims!

[Karen, Jasper and Jackdoodle]

This is a good idea, but if a catastrophic situation arises, (and we see that they do arise), there would not be enough money in the savings account for at least several years. Jack's endoscopy last fall cost $3000, and that was after I had spent $1000 on other testing (X-rays, ultrasound, bloodwork) and meds in the previous two weeks.  

At $100/month, it would take almost three and a half years to have enough set aside to cover the diagnosis for one illness, and there are ongoing expenses for the treatment of the disease itself.

Penny's Beemer needed over $7000 worth of hip surgery. It would take almost 6 years to have saved up that much.

When a dog swallows a sock and needs testing and/or surgery for an obstruction, that runs thousands of dollars, and it can't be put off.

Anyway, you get the point.

I am wondering if these companies don't offer a major medical type of policy which only covers the big ticket stuff, and not the routine things like ear infections and giardia. That might work out better for many people.

[F, Calla & Luca]

My plan has a $200 deductible yearly and covers 80% of expenses other than routine care. It seemed to be to be a good compromise to keep the premiums down. This year it was about $320/ dog.

[Jennifer and Jack]

F my Gold plan with zero co insurance and fifty dollar deductible is only $420 a year or about that.

[F, Calla & Luca]

That's interesting. I may change the plan but my two are also older than your Jack. Also what is you maximum limit. I decided I preferred that very high but I don't remember exactly what it was.

[Amber (with Maggie)]

My expenses came to 3,000 last year. I was reimbursed 320. This is because they have a certain amount they say is the national average cost and they will pay a portion of that. I live in an expensive area...but they really should have covered more than 75 they covered to get her fixed (of 500).

I get the point. I just went to Asia for adominal myomectomy for fibroids and laproscopy for endrometriosis...if I was in the US they would have given me a hysterectomy and it would have been 100,000. I did not have insurance and so it would have been only 50,000. It was 2100 for an international hospital with 5 day hotel like stay and endoscopy (my colonoscopy was only 250...so the 5,000 I paid for one in the US in 08 was an interesting difference), and surgery and anethesiologist and all medications and 4 doctors and blood work and ultra sound (75 dollars) and sonogram (75 dollars).

 

I won't fight with insurance companies about the big stuff if they are nickle and diming me on the small stuff. I will go to the local vet community and sign up for their local insurance (which has amazingly good ratings).

 

I get the picture...I really do. 1,200 a year and if all goes well that will not be needed since she has a life time gaurentee by the breeder for any lifetime illnesses due to her own breeding) should be good enough to cover most things. If not, there is always a low to zero interest credit card or taking her to the local Davis vet school.

[Karen, Jasper and Jackdoodle]

The breeder guarantees are great, but they only cover up to the purchase price of the dog; in many cases, only up to 50% of the purchase price of the dog. In the case of Penny's $7000+ bill for Beemer's HD, even the full $2000 purchase price still leaves a vet bill of over $5000.

I have no insurance, and am paying all of JD's expenses myself. The alternative would be to put him to sleep, which is what would have happened if I'd had him 20 years ago when I simply could not have done it. He has two immune-mediated diseases, sees two specialists, and I don't even know what the annual costs are any more because I know that if I sat down and figured it all out, I'd panic, lol.

But I do worry about the dogs whose owners would not be able to cover a catastrophic illness or incident without insurance.

[F, Calla & Luca]

A lifetime guarantee. That's very unusual. I also know that people go abroad for health care. That is good if all goes well. But I would worry about the what ifs while in a foreign country far from home.

[Amber (with Maggie)]

I think readers are missinterpreting my deciscion as what I am telling other people to do. I am doing what works for me and my finances (14,000 a month is a fairly normal income) and I stay with insurance companies who do not fight about every dollar (although 320 for 3000 in medical bills for a dog is pretty bad...I only had a 250 co-pay and paid to have everything they could cover, covered...so the actual monthly payment was 53 per month).

Out of the country medical, if you do the research and know people in the country you can live with or have them help research...really is a great idea. My sergeon is famous in her country for trying to save women's internal girl parts. She teaches state of the are techniques to physicians around the world. I would suggest that over some hack job the local mall franchise hospital hires who only does the work the insurance pays him to to (i.e. hysterectomy is default for a woman my age and is 100% easier to do).

I wouldn't tell someone else "not" to get insurance...just question in detail what they will and wont pay for and what their price "limit" is for each thing they are "happily" agreeing to cover.

I have never in my life put down an animal because it cost too much to keep alive. I have, however, put down animals who have reached end of life because there was no cure for what they had (cancer, lymphoma, spinal injury that cause full paralysis including bowels and a horse who had broken her leg and twisted her back) and they were in pain.

Good luck with followup on this insurance claim for ear infections...hope they come around and pay for it.

 

[F, Calla & Luca]

I realize you are just saying what works for you and we are just cautioning others that it may not work for them. Having family abroad certainly helps for research and support.

[Adrianne Matzkin]

I just asked on their FB page the companies policy on why an ear infection is considered a preexisting condition when there hasn't been one in a year.  Interesting to see if they delete my question or actually answer it.