How to File a Pet Insurance Claim- If you have pet insurance and you’re considering filing a claim but you’re not sure how to get started, this article is for you. In this article, we will outline the step-by-step guidelines on how to file a pet insurance claim.
In the meantime, having a sick or injured pet can be heartbreaking and also expensive. Pet insurance can help with the cost, but you will need to pay the bill in full and then file for reimbursement.
However, to increase your chances of being reimbursed, it is important you know the process and parameters of filling a claim with your insurer. This will enable you to know whether your claim qualifies for reimbursement. Read on for steps and guidelines to follow.
How Do Pet Insurance Claims Work?
There are mainly two claim reimbursement structures. If your policy works on reimbursement, you have to pay the vet bill up front and get the insurance company to reimburse you. Here are the two structures along with their pros and cons:
Direct Pay
This process is quick and easier. It doesn’t require you to pay huge vet bills out of your pocket. However, not all insurers or policies offer direct pay, and not all vets accept it.
Reimbursement
This is when you take your pet to the vet pay the bill and submit a claim to the insurer. It offers flexibility in choosing a vet.
However, the downside is that you have to pay the bills out of your pocket, and this can be a financial burden, especially considering how much it costs to insure a pet.
How To File A Pet Insurance Claim
In this section of the article, we have outlined the steps and guidelines on how to successfully file a pet insurance claim. Check out the steps below:
Conduct a Direct Pay Pre-Check
If your insurer offers direct payment to the vet and you want to use this option, confirm beforehand that the vet’s office accepts direct pay from your insurer.
If the vet does not accept direct payments but you proceed with the visit, you will be switched to the insurer’s reimbursement plan.
Know Your Waiting Period
Most pet insurance policies have a waiting period of 10 to 30 days, and this is from the date the policy starts until coverage begins. You must be past the waiting period before seeking regular care.
If you are dealing with an accident or severe illness, the waiting period may not matter, and your pet will not be covered for this event.
Review Your Policy Coverage, Terms, and Conditions
It is important you know whether the treatment your pet needs is covered by your policy and also all pertinent terms and conditions.
- Preexisting Conditions Exclusion
Most insurance policies do not cover congenital defects, hereditary conditions, or any issues diagnosed and treated before the policy’s effective date.
- Other Exclusions
Policies typically exclude coverage for preventive treatments or wellness care, dental services, vaccinations, flea prevention, spaying or neutering, and behavioral training.
However, some plans offer a wellness rider that can include these services.
- Deductible
This is the portion you pay out of pocket before the policy’s coverage begins (after the waiting period). Some plans feature a per-incident deductible, while others have an annual deductible.
- Co-Pay
After meeting the deductible, you may be responsible for co-insurance or a co-pay. For instance, if your reimbursement rate is 80%, you will need to cover the remaining 20%.
- Coverage Limit
This refers to the maximum reimbursement amount provided by the policy, either per incident or within a policy term.
Obtain a Claim and Fill it Out
Most insurance offers claim processing in several different ways. Most insurers use online claim forms or a mobile app. While others allow you to download and print out the claim form.
You will need to familiarize yourself with the process used by your insurer by going through it.
After which, you will need to gather all the necessary documents needed. Ensure you complete the claim form by describing the treatment and also follow the instructions completely.
Submit the Claim
After you have completed the claim form and gathered all documentation, you will need to submit your claim online through the mobile app, email, fax, or regular mail.
Ensure you follow the instructions for including invoices and medical records depending on the process you use.
Confirm Claim Submission
Ensure your insurance company has received your claim. Notifications may be immediate if submitted online or via a mobile app, but it could take 48–72 hours.
For first-time claims, the process may take longer, as the insurer reviews your pet’s medical history.
Wait for Claim Processing
Claim processing times vary by insurer. While some process claims in 24 hours, most take 15–30 days. For first claims, additional time may be required for reviewing your pet’s medical history, while future claims follow standard timelines.
During the review process, the insurer might request additional information, which could reset processing timelines.
Respond promptly to avoid delays. If direct deposit is available for reimbursements, enrolling in it can help you receive payments faster.
Receive Claim Decision
Once your claim has been reviewed, you’ll receive notification of approval or denial. This notice will include the reimbursement amount.
Approved claims may result in a mailed check or direct deposit if previously set up.
Accept Payment or File an Appeal
If approved and you’re satisfied with the reimbursement, your process is complete.
For policies with direct vet payments, you’ll be informed whether your veterinarian has been paid and if there’s a remaining balance. If you disagree with the decision, you can proceed with filing an appeal.
File an Appeal or Escalate Complaints
To appeal, begin with your insurer by following their appeal instructions, usually found on their website under “Appeal” or “Claim Review.” Be prepared for this process to take up to 30 days.
If the appeal doesn’t resolve your issue, contact your state insurance commissioner’s office for assistance.
You can find their contact details through the National Association of Insurance Commissioners or your state government website.