pre-existing condition for pet insurance

[Willow and J]

I want to hear from those who have pet insurance how their dog's pre-existing condition was defined and dealt with through an insurance company.

We have Petplan for three years and we haven't been able to use it once. I set my deductible wrong first two years and everything fell under the deductible, which I don't complain because 1) I was stupid and didn't understand Petplan's deductible is per visit 2) Willow's ailment wasn't severe enough to go over the deductible and 3) our vet doesn't charge that much.

But there has been 2-3 claims that I filed for and were all denied for "pre-exisiting condition". Willow came from the breeder with yeast infection in her ears, and because of that, Petplan considered all ear problems (not yeast infection but from unknown causes) or yeast infections (not her ears, but on her face, on her paws) pre-existing condition, which I don't agree but can understand to some degree. Treatment for itchiness whether it's her ears, paws, or whether it's yeast or unknown causes were all the same and relatively cheap - antibiotics, topicals, and steroids. So if they call all of these "pre-existing condition", then, okay, I can take it for now.

Several weeks ago, we went to a vet dermatologist because of persisting itchiness, and she's diagnosed with atopic dermatitis. And Petplan calls this a pre-existing condition too, and my claim was yet again denied. Previous visits relating to itchiness in various parts of her skin was suspected of allergy related symptoms, but there was no systematic diagnosis until now. Does this sound fair / usual to you that Petplan calls this a pre-existing condition too? Is this common across all pet insurance companies? Is there a pet insurance that would be more willing to cover in a case like ours ?

[Karen, Jasper and Jackdoodle]

In hindsight, I would have gotten insurance on him after the A.D. diagnosis in a New York minute. And if it cost $50 a month, it would have been the greatest bargain of all time. The costs of diagnosing and treating the A.D. were/are laughable compared to what it costs to diagnosis and treat the IBD or the ruptured disc.

[Willow and J]

I agree, and I do plan to keep Willow covered. But every time I renew it, I get to wonder if I should change the insurance company or keep on with Petplan. On the paper, their plan made most sense, so I kept it so far. At the moment, I'd expect the insurance to cover accidents, although I'd be really frustrated if they find clever reasons to not to. I'm hoping I don't have to find that out, of course.

[Lucy & AnnaBelle's Mom]

I don't personally feel like Pet Plan looks for ways to get out of paying.  There are some exclusions or some waiting periods that we all need to understand up front.  I think most of the surprises come when the vet has noted something in the record that we weren't aware was there and that causes something to be denied.  We have seen though in a case or two where it was then reversed after working with the Vet to further explain.  Not always, but sometimes.

[Rita and Fazzy]

We have PetPlan and just submitted our first claims for Fazzy, (7 months old) who, last Saturday night wouldn't get up and walk without crying and was very lethargic (after eating a cinnamon raisin bagel around noon - we took him to the vet at that point and they induced vomitting and gave sub-q fluids).  He had a play date that afternoon with his buddy and they played like football players.  After we arrived at the ER, they said that he had a slight fever and an hour later, it had gone up even further.  He stayed there for two nights, with them watching his kidney values (due to the raisins), and kept him on IV fluids, antibiotics, pain meds.  The shoulder pain is probably a combo of the roughhousing along with the subq fluids in the shoulder area (plus, he had been attacked by another dog at the dog park the prior Thursday, but we never found any bites)....and they were never able to determine the cause of the fever - but it spiked again the next night.  They discharged him after he had been normal all day.  We had a follow up blood panel and urinalysis 48 hours later just to be sure his kidneys were ok.  He's still on Clavamox and Tramadol, although starting to wean off Tramadol now.  So - about $2200 later, we'll see how PetPlan reimburses.  Should be fine, the only thing that he had been seen for prior was giardia when he first came home - and of course, puppy visits/shots.  If they reimburse as I expect they should, it's paid for itself many times over already in the first couple of months.  I do work for a major medical insurance company and I understand the pre-existing condition thing and how it works, and I paid really close attention to the wording on the deductible.  It's really hard to "get" if you don't pay close attention, unfortunately.  I reviewed several companies, and settled on PetPlan.  Allergies are a tough one - alot of things can be "related" to allergies and thus can be denied as pre-ex.  Insurance, human or pet, can work great for some people and not so great for others.  Good luck on this one, I would probably elicit your vets assistance to see if there is anything they can put in writing to "un-relate" these conditions - and then appeal the denial.  You probably won't get much of anywhere with customer service, you'll need to appeal - cust svc reps don't have alot of authority to overturn the determination of claims.   Ugh....  :-(

[Willow and J]

Thanks for this, and good luck with your case. Hope Fazzy will recover well and soon.

I'm on the highest deductible plan, so I won't get too much reimbursed even if they do accept my claim. I'd probably not fight for this particular case. I am, of course, grateful for the fact that I didn't have to face more acute and serious conditions that would have provided a chance to have my money back. The less I have to use the insurance the better. 

[Jane, Guinness and Murphy]

I thought it might be helpful to share Pet Plan's definition of "pre existing condition".

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.).

If your pet has or had a condition previous to your enrolling in a Petplan pet insurance policy and you are unsure if it will be considered a curable or incurable condition, you can request an underwriting review within the first 30 days of your policy. To request underwriting, please contact one of our Happiness Managers at 1-866-467-3875.

[Lucy & AnnaBelle's Mom]

If anyone is getting a policy on a dog that is not a puppy it might be worth getting your dogs records from your vet and reviewing them to see what all has been noted in the file so that you can work it out with Pet Plan up front on what will and what won't be covered.  There are also some other restrictions as an example Lucy had CCL rupture surgery last July.  Should her other knee rupture within a year they will not pay for that one.

[Karen, Jasper and Jackdoodle]

I really think that they are way off base with some of the conditions they list as "incurable". Many orthopedic conditions are absolutely curable with surgery. To say otherwise doesn;t make any sense to me. And lipomas???? A harmless lump of fat under the skin that can usually be removed but rarely requires it.

On the other hand, vomiting and diarrhea can be symptoms of extremely serious and incurable diseases like IBD. But that, they cover?????

[Willow and J]

That's why I think between itchiness and diarrhea, the only two things Willow had to suffer from in her 3 years of life, would basically rule out everything gastro-intestinal and dermatological. Broken bones would be the only thing they may not see as "pre-existing" and "curable", and if at least broken bones are covered, I still think it's worth keeping the insurance. But again, is Petplan the best for her is something I should investigate further.

[Jane, Guinness and Murphy]

Here's how the vomiting/diarrhea works....if your dog has an episode or even a couple of episodes of diarrhea before you apply for coverage they can apply an exclusionary period for that "illness".  If there are no more episodes in a defined period of time they remove that exclusion.  I guess the assumption is that if it's IBS or IBD there would be recurrent episodes and the exclusion would stand.  If your Vet happens to put in the records upfront that she is diagnosing IBS or IBD or suspects it then you have a "preexisting condition".

[Wanda reyes]

I've been with healthypawspetinsurance.com for18 months my goldendoodle Valentino is 27 months and I am so thankful he has been sick since he was a baby pancreatitis 2 times ear infections and now atopic dermatitis amongst other test for other things this company has covered about 10,000.oo dollars in test and mess etc I pay 10%and they cover 90% if it wasn't for them I wouldn't have Valentino I know God put him in my life because he knew I would take care of him but I. Have cried a lot of tears.This insurance is the best and I only pay 27.80 a month with a 200.00 deductible per year. The only problem is that now your dog has been diagnosed and it will be pre existing call me if you need more info 4077299534 my name is Wanda

[Karen, Jasper and Jackdoodle]

Wanda, this discussion is three years old. And this is a public forum, so you might not want your phone number here because anyone on the internet can see your post.