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]

Thanks! Let me know if they say anything or delete your question. 

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

Good to know the answer to that one! I'll me waiting for answer too.

[Adrianne Matzkin]

This is the response they posted on their FB page

Petplan Pet Insurance (USA) 

Hi  - sure thing. At Petplan, we define a pre-existing condition as follows: A medical condition that first occurred or showed clinical sign(s) or symptoms before the effective date of your policy or that occurred or showed clinical sign(s) or symptoms during the policy waiting period. Simply put, if your pet has or had any condition, whether diagnosed by your veterinarian or not, before enrolling in a Petplan pet insurance policy, it is considered pre-existing. 

At Petplan, we recognize there are two types of pre-existing conditions: those which can be cured, and those which cannot be cured. Some examples of a curable condition include, but are not limited to: respiratory infections, urinary tract infections, vomiting, diarrhea and bladder infections. If your pet has experienced a curable condition previous to enrolling in a Petplan pet insurance policy, the condition, while pre-existing, may be eligible for coverage after an exclusionary period. Providing your pet’s medical history shows no further episodes of the condition subsequent to the initial episode, coverage for the condition may be restored. 

Unfortunately, some pre-existing conditions are not considered curable. Examples of incurable conditions include, but are not limited to: Orthopedic illness (such as hip dysplasia or injuries related to cruciates or patellas), allergies, diabetes, lipomas or skin lumps, hyper- or hypothyroidism, urinary or bladder crystals or blockages, and cancers (however, only the specific type of cancer your pet has endured. All other cancers, for which your pet has not shown clinical signs, would still be covered by your Petplan policy.).

[Allyson, Peri & Taquito]

So basically you need to buy pet insurance before your puppy even comes home.  Glad I bought Peri's so early, but it's hard to do that!!!!!!!!!!!!!!!!!!

[F, Calla & Luca]

It is good to get it immediately : )

[F, Calla & Luca]

Thanks Adrianne. It would be good to know what the exclusionary periods are and if they are reasonable.

[Amy, Cubbie & Ollie]

The exclusionary period for ear infections is 24 months.

[F, Calla & Luca]

That truly seems excessive.

[Sue & Lily Grace]

All this insurance talk about companies refusing to pay for common ailments that most puppies (dogs) have off and on without any specific diagnoses makes me think about a self funded bank account being the way to go. Monthly deposits and a little luck may be more prudent.

[Jane, Guinness and Murphy]

I thought of that too.  The problem is that some diseases are very expensive.  Our Guinness had Pancreatitis at age two which cost $3000 in Vet bills.  In order to cover that I would have had to be banking $125 per month from the time we got him, which is considerably more than what I was paying for insurance.  I was lucky that I had the insurance, because it is likely to reoccur.  If I had to take out insurance now, that particular condition would be excluded.

[Sue & Lily Grace]

I go back and forth with this issue. I had Insurance for Cassie and for two years and use was minimal. Very little of each vet bill was covered. It has been six years now and I don't remember the exact details. Well, to make a long story short I dropped it. At age three Cassie had her first of five surgeries for mast cell tumors and several rounds of Chemo. I always said Cas was my $25,000 dog and worth every penny. She was my movies, eating out, extras and vacations for three years and I would not ever change that.

I still wonder with the way it was diagnosed if all her treatments would have been covered. I am now waiting for an ALD to be born the end of August and am trying to decide which plan if level (if any) is the best way to go. I think Lucy and Sophie's Mom is right, we have to make sure all documentation is correct on our Dog's records.

[Amy, Cubbie & Ollie]

It isn't that petplan doesn't pay out for ear infections, it is just the issue of Ollie having been treated for his 1st ear infection before I opened his policy. If you get the insurance early, I think it is the way to go.