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. 

[Adrianne Matzkin]

I schnoodle sat for my nephew, Marty. He was part of my sister's family for a month when he came to stay with us. That weekend the 13 lb schnoodle thought he was big enough to get in between Charli and Mickey wrestling. He broke both bones on right front forearm. The bill for 2 vets (my local vet and the orthopedic vet) was over $1,000 that 1 day. I don't know what the other visits cost but she will get back 80% minus the $200 deductible.  My sister wouldn't have had any time to save money for this accident. I am thrilled that she took my advice and got him insurance the day he came into their lives!

[Lucy & AnnaBelle's Mom]

One lesson that I think that we all need to take from this if we have insurance is that we need to be certain that our Vet's are documenting the records correctly and thoroughly.  As an example if Amy's Vet had better documented the first ear infection, this one may have not been questioned.  I know that at the Vet we go to we are probably their only client that has insurance.  In our area it is just unheard of!

Another point, I think this might be one of the first issues I think we have had here with PetPlan.  For the most part I think they have paid very well, and quickly, claims that have been submitted by our members.  However, I have had some arguments with them over rate increases being what I considered a little excessive, and they haven't ended in my favor. 

[Amy, Cubbie & Ollie]

Unfortunately, it can be hard to find the cause of the ear infection. Ollie came to us with the infection, so our vet didn't have any info to go on. He got this most recent infection even though I keep his ears, clean, dry, and hair free. She couldn't pinpoint a cause which was frustrating.

[Christine & Camus]

I have Pet Plan and they denied all of Camus' allergy medication because the vet mentioned something about possible allergies in one visit before I got the insurance.  This was before I took him to an allergist for testing this month. So I have not submitted his testing and  antigens for $726.00!  I think it was very unfair since the comment was just that - a comment not a diagnosis. Needless to say I am not please with their decision.

[Heather]

This makes me nervous... I submitted a claim for allergy testing 2 weeks ago and the website still just says initial documents received. I've also had a claim in for vomiting and diarrhea for 3 weeks that they haven't touched yet, but they'll probably deny it since Rook had been treated for vomiting before the insurance kicked in. I just really hope they pay the allergy stuff - the results came back that she is allergic to a lot of stuff and is going to need immunotherapy. The only other claim I've filed with Petplan, for puppy teeth that needed to be pulled, was paid within a few days of submission. Has anyone else had to wait a long time for a claim to be processed from them? And if so, did it end up getting approved?

[Christine & Camus]

I have had a couple of claims that took longer than usual, but the denials came through very quickly. No check to cut so fewer steps was my guess.

[F, Calla & Luca]

Is there a waiting period after which they will pay at least for the medication.

[Christine & Camus]

The initial denial came through for medication (hydroyizine) did not mention a waiting period. That was before he was tested.

[Amy, Cubbie & Ollie]

My DH and I were just discussing whether to ask our vet for a referral to a specialist so Ollie can get tested for allergies. I guess I better see if there was ever a mention of allergies before I even bother submitting a claim for the specialist. Thanks for the heads up.