Arghhh--Pet Plan

[F, Calla & Luca]

I received some insurance reimbursement for Luca's tail. I spent $843.70 and other amounts not included on bandages and vet wrap for bandaging I did myself. My deductible is $200 and my copay is $20%.  I received $381.18 today. Why you might ask, I did. Well, Luca was seen Feb 22 and that was $117.22 for the initial visit, bandaging and medication. But my plan renewed on 3/9. So Pet Plan paid me nothing for the first evaluation. Then Luca had his surgery in 3/11 and they started the deductible clock again.

Had I opted for surgery right away I would have been paid more. But had we been able to save the end of Luca's tail it would have cost Pet Plan less altogether.  I think this repayment  is grossly unfair and I  will speak to a supervisor on Monday. I did mention to the fellow that I was speaking to that I belonged to a website of 10,000+ members and that many of us had PetPlan. If the supervisor doesn't help my son just reminded me that My writing to CEO's has been effective. To be continued.....

Update:

I did not get anywhere with the supervisor. I did email the CEO. I doubt that will help but we'll see. Meanwhile, lest you feel sorry for Petplan:

http://www.ft.com/intl/cms/s/2/5f54f7d4-6b08-11e2-9670-00144feab49a...

[Joanne ~ Spud*]

Yes, but what you are missing is... this was a condition that started a month earlier. Wouldn't that fall under a pre-existing condition geared toward the pet owner this time?

She was just continuing the policy. Not taking out a new policy. 

Makes sense to me that this accident occurred prior to expiration and renewal.   This was not her first year either. She has had this pet on insurance for 5 years~ no claims.

That is the argument.  This was a condition that began before the policy expired and took place during renewal.

As far as preexisting, the insurance company can deny anyone for preexisting, why is she getting denied for preexisting in reverse.

Get it?

[F, Calla & Luca]

It really wasn't being denied for being pre existing but the deductible that was applied again, J.

[Joanne ~ Spud*]

A true. It's late. Yawn.

[nate]

This has nothing to do with pre-exisiting conditions.

You seem to not understand this particular situation or how insurance policies work.  

PetPlan policies very openly work like this: your policy renews every year and has a per-incident + per-year minimum, and a yearly payout maximum.  If care for a single injury spans multiple years, it is subject to the deductible again on the subsequent years. However, it also has a new yearly maximum for claims.

Her incident spanned 2 policy coverage years.  The first 117 was for services provided on Feb 22 ( Year 1  ) ; The Plan renewed on Mar 9 ; Surgery Occurred on Mar 11 ( Year 2 ) and cost $726.  The Year-1 services were below the deductible , so nothing was paid out.  The Year-2 services were paid-out after the deductible was applied  (726 - 200  = 526 ) which @ 80% insurance should be  $420 ( which is $40 short of the check, so there is something we're missing or they're not covering ).

If she paid more attention to her policy earlier, she probably would have noted the date sooner and could have planned a surgery for the 8th with the vet ( if it were advisable).  Then 100% of all the bills would have happened in Year 1 and everything would be subject to the same deductible.  

Her argument was that, if she had another plan, either:
1. This would be in a calendar year, so the clock for a deductible would reset on Dec 31 OR

2. There would be a lifetime deductible per-incident, not a per-year deductible per-incident.

My response was that the plans which offer lifetime deductibles cost substantially more , so even if she chose a competitor, she saved money.

[F, Calla & Luca]

Pet plan also figures the payout calculation in a way that works out to less. They first deduct the copayment, then subtract the deductible, which is less than the other way around. I had questioned this when my other dog had some x-rays and a consultation a year or two ago. But truly I did not plan my dog's care based on insurance but on how things evolved for him. And my vet only does surgery one day a week and I know and trust her so I would not have scheduled surgery on a day she was not operating. My first concern was doing the most appropriate thing for my dog and not planning around insurance deadlines.

[nate]

"They first deduct the copayment, then subtract the deductible"

WTF?  That is sketchy!

I'm glad that you're puppy is fine!

[F, Calla & Luca]

I understand what you are saying and generally agree. I am I assure you that I am very happy that Luca is fine now and he has no worries related to this I assure you.