MAKING AN INSURANCE CLAIM

If you have a valid pet insurance policy for your pet then you may be able to claim back the cost of your recent veterinary treatment.

Is your pet actually covered?

 

Before you make a claim, you need to check that your pet is actually covered!  This may sound silly but people often get caught out.  It is worth while checking  that:

 

  • Your pet has been insured with the current insurance company PRIOR to the illness/injury occurring.  Most policies have a period of time after taking out a policy that won’t cover you for illness. (This is to prevent people taking out insurance only when their pet becomes ill!)

 

  •  Your policy doesn’t have any specific exclusions.

 

  • If you have changed your insurance provider, they are unlikely to cover the cost of a claim if it can be in any way related to a previous problem that your pet may have suffered from. This often will catch people out as you would be surprised what insurance company will class as “pre-existing”.  (For example if you dog had diarrhoea three years ago, and then you try to make a claim for recent diarrhoea on a new policy, they may not cover it!)

 

  • Have you kept up with your premium payments?

 


Is your pet actually covered by your pet insurance policy?

Before you claim

 You need to check if it is worth while making a claim – you need to take into account your excess amount and also see if you are required to pay any percentages of the final fee.  Smaller amounts often are not worth claiming for as it will be less than the costs involved.

 When to make a claim.

 
If you think you are going to make a claim, then it is worth checking it your insurance company has any specific requirements of “time-scale”.  We see some companies that set time limits – such as “ you have to notify us within 6 weeks of an illness/injury occurring ”.   This can catch people out if a problem escalates over time and turns into a condition that you DO want to claim for.  Therefore it is worthwhile being very aware of what your policy stipulates, so you can act in good time if necessary.

Sometimes, if you are not sure if you are going to make a claim, it is handy to let the insurance company know that the pet is ill and a claim MAY be coming so they can record it on their system.

Pile of money with a blurred clock in the background

What can I claim for?
 
For most insurance policies, you can make an individual claim for veterinary treatment for each specific illness or injury.  Each cost associated with the specific problem is added together and this is the TOTAL CLAIM .  You will then get reimbursed with the TOTAL CLAIM , less the EXCESS/PERCENTAGE FEE and any EXCLUSIONS .
 
Usually you only pay the Excess ONCE, per condition per policy year.  So in other words if you make repeated claims for an ongoing problem over the year, you should only pay the excess once.  Once your policy renews you may have to pay the excess again.

What gets excluded?
 

Again this varies but it can often involve:


  • Illnesses that have already been excluded or that were present before you took out (or changed) policy provider.

 

  • Prescription diets often are not covered unless in certain circumstances.

 

  • Routine treatments such as flea treatments/wormers etc

 

  • Problems that are associated with pregnancy such as caesareans etc.

 

  • Dental treatments such as cleaning or routine extractions (unless caused by trauma) are often not covered.


  • Any fees incurred for completing or submitting the insurance claim.


 

Again – you need to make sure that you have read through your policy documents.

Glasses lying on a policy document

Direct  Claims.
 

Many insurance companies will offer to “pay the vet directly”.  As a practice we DO NOT ROUTINELY allow direct claims unless by prior agreement with the vet in charge of your case/pet.  PLEASE DO NOT ASSUME WE WILL DEAL DIRECTLY WITH THE INSURANCE COMPANY as this often causes awkward situations.

We will only agree to DIRECT claims with:
 

  • Certain insurance companies

 

  • Unavoidable large bills

 

  • Clients who have shown good payment history/trust previously.



We will NOT consider DIRECT claims for:


  • Problems associated with whelping or kittening


  • Long term chronic condition claims


  • Where doing a direct claim has NOT been agreed by the senior clinical team.


 

Sadly this has come about due to poor claim handling by many insurance companies and a significant amount of insurance fraud that we have to endure.



There is an administration FEE for making a direct claim with the insurance company.  Most insurance companies won't cover this cost. 

How to make a claim.
 

As we have said, it is best to notify your insurance company as soon as possible that you are going to be making a claim.  With certain companies we are able to the claim electronically. However with most others, you will need to either download or get them to send you a claim form.

Let us have the claim and then we will complete the details and contact you to let you know when it is ready to collect.  We are not allowed to send the form off for you, and so you will need to collect it.


Due to the high levels of paperwork involved for insurance claims, we usually suggest a turn-around time of a minimum of 14 days, but a busy times this can be longer.  We don't currently charge for completing Insurance Forms .

 

It is better to make the claim at the conclusion of treatment and just do a single final claim, however we do appreciate that with some cases, the financial amounts can add up in the interim, and so please feel free to ask us to do a claim at a suitable point.

Common Pitfalls

Foot about to slip on a peeled banana skin
Often, making a claim may not be as straightforward as originally thought.  Here are some of the more common situations that we have found over the years.
Not all types of policy are equal.  There are generally three types:

  •      Life Policy– this is where you are covered for any condition for as long as you:
    • Keep paying the premiums
    • Keep with the same insurance company
    • Don’t reach your upper financial limit on the policy which may be annual or over the life of the policy.
  • Time Limited (Annual Policies). These pay for any condition up to the limit of the policy with the remainder of the policy year – irrespective of length of time.  Upon renewal any condition claimed for during the previous year will be excluded from the next year’s policy.
  • Fixed Value Policy – will pay up to a predetermined amount per condition.  Once this amount is reached then the condition is excluded from the policy.  This can either be limited to one year, or sometimes within the lifetime of the policy.
Many people incorrectly assume at as they have got an insurance policy then they are fully covered, but with the Time Limited and Fixed Value policies this cover may not be suitable.
Insurance companies can often try to “split” claims for slightly different conditions, and this can mean you have to pay more than one excess.  A classic example is if your pet comes in for an operation and has two types of lumps removed (eg  1x cyst and 1x fatty lump) they may interpret this as two separate conditions even though they were done at the same time and under the same anaesthetic.
When we send a claim away, all insurance companies request a FULL history to be sent as well so they are able to see if the animal was unwell before the policy was taken out and to see if the condition has occurred previously. 

This is done to check that the claim doesn't fall into their exclusion criteria.  This can be particularly problematic if the pet hasn't got a Life-Time Cover type policy.

If you have changed your policy provider then it is possible that if you claim for any condition that you pet may have suffered from (sometimes very tenuously) previously, then you may find you are not covered. 

This is often found with skin disease, gastrointestinal disease and orthopaedic problems.  We generally advise that it is not a good idea to change policy providers.

Referral to specialists can, in certain complicated instances, lead very quickly to situations where the costs exceed your policy cover.

 This needs to be taken into account if your vet is discussing referral options with you.

The Claim Process - made simple!

Bilton Vets Flow Diagram to show how to make a claim
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