You did your research and decided on an accident-and-illness plan. You chose the insurer, plus the amount of co-pay, deductible, and premium you wanted to pay.
Now, several months later, your cat or dog is sick, and you’re scared. You take your pet to an emergency animal hospital and have your fur baby diagnosed and treated. After a moment of sticker shock, you pay the bill and head home.
Now it’s time to file a claim. The process is pretty straightforward with most companies:
- Initiate your claim promptly; some insurers have time limits.
- Download a claim form online or use the insurer’s app, if available.
- Fill in what you can and have the vet complete any missing information.
- Provide a copy of the vet’s itemized invoice as requested by the insurer (photo, digital, or physical copy).
- Submit the claim digitally, by fax, or by mail.
- The insurer reviews the submitted claim and requests additional information as needed.
- Turnaround time is calculated from when the insurer has all the required information.
- The insurer calculates what portion of the invoice it will reimburse, based on the coverage you selected (plan, co-pay, deductible, and any limitations in your policy).
- The insurer sends you a check or direct-deposits the reimbursed amount in your bank account.
How May the Process Vary by Company or Policy?
Some insurers deviate somewhat from that process. For example:
It prides itself on the simplicity of its claims processing: open its app, select ‘Claims,’ write what happened, and add a photo of your invoice. The company takes it from there. (Online, email, fax, or mail submissions work, too.)
The vet’s staff member will complete the downloadable claim form, not you. The detailed invoice must indicate it has been paid. Embrace runs a paperless operation, so fax, scan-and-email, or upload everything through its website. For invoices expected to go over $1,000, you can request pre-certification and have Embrace pay the vet’s portion directly. Turnaround time: 10-15 business days. Read our full-review of Embrace.
With Figo, everything can be handled through the ‘Figo Pet Cloud.’ Log in, go to Claims, answer online questions, upload a copy of your itemized bill, and submit the claim. Faxed or emailed submissions will slow Figo’s targeted 7-10 day turnaround time. Read our full-review of Figo.
No claim forms here; just send a photo of the invoice through its website or app. Turnaround time: often two business days; ten days on first claims. Read our full-review of Healthy Paws.
Some of its plans reimburse based on a convoluted benefit schedule (not the vet bill), with caps for each condition or service. The payout is confusing, so study the policy carefully. Turnaround time: up to 30 days.
What Are Some Issues That You Might Face During the Process?
Having the insurer request more medical records will slow things down. Get a detailed list and submit everything, then ‘bird dog’ your claim online and by phone.
‘Pre-existing condition’ is an insurer’s favorite reason for denying a claim. Re-read the fine print in your policy. If you disagree with the decision, be ready to fight for coverage.
Also, monitor renewal dates very carefully, so nothing expires, allowing the insurer to claim that previous illnesses are now pre-existing.
What Can You Do If Your Claim is Denied?
While U.S. statistics are not available, 37% of claims are denied in the U.K., and the U.S. should be similar.
First, find out why the insurer denied the claim and identify its appeals process. Sometimes it is a misinterpretation. Whether that or the ‘pre-existing’ excuse, it will be up to you, with your vet’s help, to prove the company wrong. It won’t be easy but will be worthwhile.