Insurance Won't Pay Claim For Skin Condition

[Kirty]

I know someone who got a kitten and in the first week they brought it home, it peed on their bed. Quite common with baby kittens, they get a bit involved in a game and leave it too late to reach the litter box. Anyway, the owner made the mistake of mentioning it to the vet when the kitten had its next vaccination. They took out insurance around this time. Fast forward about 8 months, the cat got a urinary tract infection. They submitted their claim but it was rejected because the insurance company claimed that OBVIOUSLY when the kitten peed on the bed, it had a UTI then as well... Absolutely disgusting. I think people are better off getting an emergency credit card or putting some money away each week.

[pixie_meg]

I know someone who got a kitten and in the first week they brought it home, it peed on their bed. Quite common with baby kittens, they get a bit involved in a game and leave it too late to reach the litter box. Anyway, the owner made the mistake of mentioning it to the vet when the kitten had its next vaccination. They took out insurance around this time. Fast forward about 8 months, the cat got a urinary tract infection. They submitted their claim but it was rejected because the insurance company claimed that OBVIOUSLY when the kitten peed on the bed, it had a UTI then as well... Absolutely disgusting. I think people are better off getting an emergency credit card or putting some money away each week.

I used to think that an emergency credit card was better but when you think of the big bills it was worth it for us. It only takes one incident like with Kaffy Magee's Chase, a freak occurrence and you're up for thousands. sure you can pay by credit card but that still costs you more than insurance. It only takes my dog to be let out of the yard by accident and get hit by a car and that could be thousands too. You hear about someones dog costing them thousands fairly regularly on here, i'm paying about $380 per year in insurance for my boy and i'm sure i'll get half of that back on treatments through the year. Last year alone cost me about $1000 without insurance on fairly minor things. I've got a fast active dog so i'm not concerned about the routine costs, just the big things where he turned the wrong way and did his hip in or twisted a limb. A big dog equals bigger costs in antibiotics and other meds.

[Kirty]

The other thing to remember though is that you still have to pay for it up-front anyway, and then hope that your claim will be paid.

[QWERTYASDFGH]

Thanks Rubystar and Dyzney, that's what I was thinking.

[cavNrott]

No, not exactly... pre-existing is not the correct term in that situation. Pre-existing is an illness etc which was existing or arose prior to the policy ever existed on that dog, so prior to the dog being covered by this insurance policy.

If for example there are further ongoing complications with the same condition/illness (and your example of HD could fall into this category) in a following renewal period (let's say the next year) you will have to pay the excess fee again, if there is an excess fee with that particular policy. And as long as the policy holder did not allow the policy to lapse, the condition/illness will still be covered up to the agreed amount.

So, basically what I mean (if I have not explained it clearly) is that the condition/illness is still covered into the next policy period provided there is no lapse in cover, but the excess fee may need to be paid again to get on going treatment for an already claimed condition/illness

I've found this not to be the case with Bow Wow Meow (Petsure) Insurance. My dog who was 5 1/2yo and had never had a sick day in his life, ruptured a disk in his spine for which he needed immediate surgery. There has been no lapse or any late policy payments but upon renewal this year an extra condition has been added. It states that in addition to the $250 excess I pay I will be responsible for 60% of any claim relating to any spinal condition for this dog. I might add to even get them to pay out for the surgery took 3 months of me arguing with them.

Since then this dog has had pneumonia so I imagine when the policy is up for renewal there will be another condition that advises I'll have to pay 60% for any respiratory issues should they occur.

[lisazkiwi]

Arh - pet insurance.

There are really two options out there.

1) PetPlan

2) the rest (backed by same insurer - Holland?).

PetPlan is any condition for life. (you have to pay a % as the animal gets older - but atleast know is covered for life).

The others can add clauses as they see fit every 12 months (policy renewal). This throws most people (including me), as I assumed it was like human - once in all good.

[Starkehre]

No, not exactly... pre-existing is not the correct term in that situation. Pre-existing is an illness etc which was existing or arose prior to the policy ever existed on that dog, so prior to the dog being covered by this insurance policy.

If for example there are further ongoing complications with the same condition/illness (and your example of HD could fall into this category) in a following renewal period (let's say the next year) you will have to pay the excess fee again, if there is an excess fee with that particular policy. And as long as the policy holder did not allow the policy to lapse, the condition/illness will still be covered up to the agreed amount.

So, basically what I mean (if I have not explained it clearly) is that the condition/illness is still covered into the next policy period provided there is no lapse in cover, but the excess fee may need to be paid again to get on going treatment for an already claimed condition/illness

I've found this not to be the case with Bow Wow Meow (Petsure) Insurance. My dog who was 5 1/2yo and had never had a sick day in his life, ruptured a disk in his spine for which he needed immediate surgery. There has been no lapse or any late policy payments but upon renewal this year an extra condition has been added. It states that in addition to the $250 excess I pay I will be responsible for 60% of any claim relating to any spinal condition for this dog. I might add to even get them to pay out for the surgery took 3 months of me arguing with them.

Since then this dog has had pneumonia so I imagine when the policy is up for renewal there will be another condition that advises I'll have to pay 60% for any respiratory issues should they occur.

That is disgusting cavNrott. What a shock that must have been.

I hope this isn't the case with my insurance. I don't believe so, but I guess I would not know until I am in that situation. I feel I have asked them every question I can think of, and I still occasionally do call them up with more inquiries even though I have been with them for a couple of years now.

I am with PIA. Am currently waiting on a claim now.

How is Bronson's pneumonia now?

Edited October 26, 2010 by dyzney

[Winterpaws]

You should make a complaint to the ombudsman. It costs you noting to do so.

Another member also had issues getting a pet insurer to pay due to an interesting interpretation of an exclusion (same insurer as CavnRott...) and I beleive she finally had her claim paid after going to the Financial Services Ombudsman.

With these policies you absolutely have to check all your documentation when you receive it. PetPlan had put a broad lameness exclusion on Bundy (horse) because I declared a minor injury where a foreign body got under his skin above his hoof. I queried the exclusion and they did agree to remove it.

Check, check and double check. If your claim is declined, show someone who knows about insurance your paperwork and ask them to look at it for you.

Did your policy schedule state that all skin conditions would be excluded?

[cavNrott]

That is disgusting cavNrott. What a shock that must have been.

I hope this isn't the case with my insurance. I don't believe so, but I guess I would not know until I am in that situation. I feel I have asked them every question I can think of, and I still occasionally do call them up with more inquiries even though I have been with them for a couple of years now.

I am with PIA. Am currently waiting on a claim now.

How is Bronson's pneumonia now?

My own fault Dyz for not reading the PDS thoroughly. They do state :- We reserve our rights to change the terms and conditions of the policy upon renewal.

Their PDS also states:- The maximum we will pay for a single condition, a recurring condition or a chronic condition suffered by your pet is the maximum amount that was current in the policy period when the condition first manifested. Once this maximum amount has been paid we will not pay for any further treatment of that condition during the remainder of of the policy period or any other future policy period.

Bronson's pneumonia is 90% resolved. Thanks for asking.

[Starkehre]

That is disgusting cavNrott. What a shock that must have been.

I hope this isn't the case with my insurance. I don't believe so, but I guess I would not know until I am in that situation. I feel I have asked them every question I can think of, and I still occasionally do call them up with more inquiries even though I have been with them for a couple of years now.

I am with PIA. Am currently waiting on a claim now.

How is Bronson's pneumonia now?

My own fault Dyz for not reading the PDS thoroughly. They do state :- We reserve our rights to change the terms and conditions of the policy upon renewal.

Their PDS also states:- The maximum we will pay for a single condition, a recurring condition or a chronic condition suffered by your pet is the maximum amount that was current in the policy period when the condition first manifested. Once this maximum amount has been paid we will not pay for any further treatment of that condition during the remainder of of the policy period or any other future policy period.

Bronson's pneumonia is 90% resolved. Thanks for asking.

Yes, these policies can be frustrating and sometimes confusing.

Glad Bron is nearly all better now. take care.

[Mason_Gibbs]

I know someone who got a kitten and in the first week they brought it home, it peed on their bed. Quite common with baby kittens, they get a bit involved in a game and leave it too late to reach the litter box. Anyway, the owner made the mistake of mentioning it to the vet when the kitten had its next vaccination. They took out insurance around this time. Fast forward about 8 months, the cat got a urinary tract infection. They submitted their claim but it was rejected because the insurance company claimed that OBVIOUSLY when the kitten peed on the bed, it had a UTI then as well... Absolutely disgusting. I think people are better off getting an emergency credit card or putting some money away each week.

I used to think that an emergency credit card was better but when you think of the big bills it was worth it for us. It only takes one incident like with Kaffy Magee's Chase, a freak occurrence and you're up for thousands. sure you can pay by credit card but that still costs you more than insurance. It only takes my dog to be let out of the yard by accident and get hit by a car and that could be thousands too. You hear about someones dog costing them thousands fairly regularly on here, i'm paying about $380 per year in insurance for my boy and i'm sure i'll get half of that back on treatments through the year. Last year alone cost me about $1000 without insurance on fairly minor things. I've got a fast active dog so i'm not concerned about the routine costs, just the big things where he turned the wrong way and did his hip in or twisted a limb. A big dog equals bigger costs in antibiotics and other meds.

Pet Insurance has been so worth it for us - my dog has allergies and I had to save up the $3000 to get him tested, immunotherapy and ear issues - overall this year I have spent $5000 on him, now if i had saved it up and had no insurance I would be $4900 out of pocket but because I have insurance I was able to put my money into my credit card. I am with Petplan and they have been very good, paid for everything and lifted a exclusion on conjunctivitis and other eye disorders that we had for 12 months.

[bianca.a]

You should make a complaint to the ombudsman. It costs you noting to do so.

Another member also had issues getting a pet insurer to pay due to an interesting interpretation of an exclusion (same insurer as CavnRott...) and I beleive she finally had her claim paid after going to the Financial Services Ombudsman.

With these policies you absolutely have to check all your documentation when you receive it. PetPlan had put a broad lameness exclusion on Bundy (horse) because I declared a minor injury where a foreign body got under his skin above his hoof. I queried the exclusion and they did agree to remove it.

Check, check and double check. If your claim is declined, show someone who knows about insurance your paperwork and ask them to look at it for you.

Did your policy schedule state that all skin conditions would be excluded?

Skin Condition means any diagnosed Condition regardless of

cause or origin presenting in or affecting the skin (as an organ)Pre-existing Condition means:

DD any Condition(s) or symptoms or signs of thatCondition occurring or existing in any form prior to the

Commencement Date, or

DD a latent infectious or parasitic Condition that manifests

itself within a known incubation period following the

Commencement Date indicating clear evidence that the

Condition had existed or had been contracted prior to the

Commencement Date, or

DD any Illness or symptoms or signs of that Illness occurring or

existing in any form during the Waiting Period.

A Condition, Illness, Injury or disease may be considered

Pre-existing whether or not it:

DD was specifically diagnosed by a Vet,

DD was treated by a Vet,

DD is in remission at the time of application,

DD is seasonal in nature even if in remission at the time of

application, or

DD is currently or previously being controlled by medication(s).

in any way whatsoever.

Treatment means

From Medibank's PDF

On my certifcate of insurance there are no exclusions listed however when I called them to query the nil refund they said that she is not covered for any skin, ear infections or conjunctivitis conditions ( I listed the last two when I initally applied).

[Quickasyoucan]

I personally think that there will start to be more of a shake up of the pet insurance industry now that pet insurance is definitely becoming more mainstream.

When I first looked at insurance years ago it wasn't worth taking out as it automatically excluded all gastro-intestinal conditions (presumably as that was the number one reason dogs end up at the vets). Things have moved on since then, as more people take up insurance those that are not user friendly will lose out to those that are, the market will dictate that.

I do find it troubling that people are saying their premiums have suddenly risen exponentially after a claim. Just because it says they reserve the right to change premiums doesn't automatically give them the right to double or triple them because you have had a claim. They have to be reasonable. You certainly wouldn't expect your motor vehicle insurance premium to triple if you had one smash and made only one large claim.

Insurance is based on the premise that the vast majority of people pay smallish premiums and don't claim large amounts and compared to the few who claim large amounts, so basically our premiums are not just paying for us they are paying for other people's claims as well.

If my premiums suddently rose exponentially (say doubled or tripled) I would be asking to speak to a manager or referring it to the ombudsman.

[CharlieandGus]

This is very unfortunate and I agree that $800 seems a little excessive for hot spots! Some dogs are more prone to them than others and getting rid of them is a pain.

I am with 1300 Insurance and they have been fantastic so far. I had to put a claim in for my Golden Retriever who needed an operation on his hip, and that made me pretty happy (and my pocket happy too!) that I had pet insurance