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. 

[Heather]

Uh-oh, now I'm worried... Last Tuesday I submitted a claim for a specialist for vomiting and diarrhea that hasn't been paid yet. I thought maybe it was just the holiday, but now I'm worried they won't cover it, as Rook had been treated for vomiting before we got the policy. :(

[Amy, Cubbie & Ollie]

you can go online and check the status of your claim.

[Heather]

Yeah, I have, but it's been on "received claim, initial documents complete". The one other time we submitted a claim (for puppy teeth extraction), it was paid within a few days.

[annmarie sparks]

I would call them and follow up...I know a few plans have a 12mo waiting period for pre-existing like UTI's....I was thinking of signing up with petplan but checking out other companies as well. I will keep checking to see your outcome as it may deter me from signing up with them.

HOWEVER. sometimes persistence pays off.....and maybe have YOUR VET WRITE A NOTE that does help at times GOOD LUCK and hang in there!! 

NOTE: there are DIVERSE reasons for Ear Infections.....and ask them is this the case for all ear infections and how so? as per se: sarcoptic mange can lead to 2ndary infections wh/then means ear infection which is different than say a dog that swims alot and moisture builds up etc.

[Karen, Jasper and Jackdoodle]

I would protest this, it seems crazy to me.  What about a dog who had giardia as a puppy before the policy was in effect, and then gets it again two years later? Would they call that a "pre-existing condition"?

[Amy, Cubbie & Ollie]

They said that there are different waiting periods for different issues, so i'm not sure what the waiting period is for something like giardia.  I might talk to the vet on Friday when I'm there and see if she thinks the 2 infections are related and maybe get her to write them a letter if she feels that they are totally unrelated.   

[Jennifer and Jack]

Sigh.....seems like they got off on a legality! I think that is insane ..we use a weekly medication wash in Jacks ears which I am hoping helps cut down his yeast ear issues.

Maybe you can look into a wash....

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

So I guess this also means that after they pay for (IF they pay) Murphy's recent ear infection, tha it will be another 2 years before they will pay for another one? Geez.

[F, Calla & Luca]

No if they pay then they should pay thereafter I would think. It would be an ongoing not pre-existing condition I'd think.

[Jennifer and Jack]

F is correct! I have a huge claim in with them I am wondering how it will go. I have always had great experiences with them

[Amy, Cubbie & Ollie]

Ollie's first ear infection occurred before I got him insured so as long as Murphy didn't have an infection before you got him insured then you will be fine for any ear infection claim. They only denied my claim because Ollie had an ear infection before I got his policy.

[Adrianne Matzkin]

Amy - you spoke to them today and they still are denying the claim?