Using Your Plan

How Claims Work

When your veterinarian charges you for medical care received for your pet, you can use your pet insurance coverage to pay or reimburse you for a portion of the costs.

As noted, some providers will allow your veterinarian to submit your claim and collect only your share from you. Other providers will expect you to fully pay your veterinarian and then submit your claim for reimbursement.

In either case, if your claim is eligible based on your plan policies and coverage, the insurance company will process your claims and provide reimbursement to you or your clinic, depending upon which method your claim was filed. The amount you receive is based on the co-pay (or co-insurance), which is the percentage of the total cost of eligible conditions the insurance company will reimburse you for after the deductible is met. Some companies apply the deductible first and then calculate the co-pay (though some apply the co-pay first and then the deductible). For instance, if a policy has a 90% co-insurance, this means the pet owner is responsible for 10% of the eligible amount after the deductible and the insurance company is responsible for 90%.

Lastly, the amount you will be reimbursed within a year will depend on your annual policy limit, which is the total amount a policy will pay for all claims combined in a policy year. (If you have a limit, some plans provide unlimited coverage.) Make sure to read your policy carefully to understand if you have an annual policy limit or not.

Getting the most out of your plan

First and foremost, insure your pet early in life before any conditions exist that would be considered pre-existing and therefore excluded from coverage. And secondly, answer any questions as honestly as possible during the underwriting phase or enrollment. In other words, disclose any known conditions at the time of enrollment, if asked, so that you will know in advance what might be excluded.

Manage your own expectations. Read the Exclusions Section of your policy so you will know in advance what is not covered. All companies have exclusions for certain things – e.g. grooming, boarding, nail trims, etc.

Research in advance what process your company uses for filing a claim. As previously mentioned, most companies today are still on a reimbursement model. You pay for the care up front and then submit the claim for reimbursement. Companies strive to have a quick turnaround time on claims to get you paid as quickly as possible, understanding that you have already paid the costs out of your own pocket. With technology advancements, more and more companies are creating portals and apps for claims to be submitted electronically. Of course, there is always sending in a completed claim by “snail mail”, but this slows the process down.

Learn what information your company typically requires when you file a claim. Complete any paperwork in full to avoid having your claim pended as being incomplete. Also, to minimize delays, it is always helpful to submit medical records with a claim so that all the information is available to quickly process your claim.

If your company uses a paper claim form, take one with you on a veterinary visit so that if there is anything on the claim form that requires the clinic to complete, you are prepared.

Finally, be happy and content when you don’t have to file any claims because this means your pet is healthy. That is a good thing. Pet Insurance is not about getting money back or saving money at the vet. It's about having the security that you have a plan in place to cover those expenses that can be beyond your ability to pay. Remember, getting money back just means your pet is ill or has been injured. Just because you may go two or three years without an extensive or expensive claim, that doesn’t mean that you won’t have one next week. Stay prepared.