You don't have to worry about this! With pet insurance, you can go to any licensed veterinarian. You pay the veterinarian for services (as you normally would), then submit that bill with a claim form to the pet insurance company. Any reimbursement you're eligible for will be paid directly to you by the pet insurance company.
This is different from human health insurance, where the insurance company pays the doctor directly (not you). That's why for human health insurance, you need to confirm whether your doctor works with a particular insurance company. In this way, pet insurance is simpler than human health insurance.
You might be wondering which is better to get on your policy: a per-incident deductible or an annual deductible. The short answer is that neither is really better. They're both designed to share costs between you and the insurance company. The important thing is to choose a deductible amount that you're comfortable paying if the need arises. However, if you can predict the future:
The reimbursement rate is the percentage rate at which the insurance company covers eligible expenses (after the deductible is applied). Most pet insurance policies have reimbursement rates that range from 70–90%. Higher reimbursement rates will cost you more in terms of monthly premium (just like low deductibles do). Here's an example of how it works if you have a policy with a $500 deductible and an 80% reimbursement rate:
Item Description | Amount |
---|---|
Total claim submitted to insurance | $3,000 |
Deductible you're responsible for | - $500 |
Eligible expense for reimbursement | $2,500 |
Reimbursement to you from your insurer | X 80% |
Total Paid by Insurance | $2,000 |
Total Paid by You | $1,100 |
A word of caution here: some pet insurance companies reimburse based on a fixed schedule of costs (you may see it referred to as the "usual and customary charges for the treatment"), rather than the actual vet bill you submit. We don't recommend that type of pet insurance policy; you'll be better off on reimbursements when they're based on your actual vet bills.
Some pet insurance policies will limit the amount paid in claims for your pet. (There are also policies with no limits). Generally, there are five different types of limits on payouts:
A word of caution here: some pet insurance companies reimburse based on a fixed schedule of costs (you may see it referred to as the "usual and customary charges for the treatment"), rather than the actual vet bill you submit. We don't recommend that type of pet insurance policy; you'll be better off on reimbursements when they're based on your actual vet bills.
We're also not fans of policies with maximum payouts per incident. An incident could be a single life-threatening event (e.g., cancer or a car accident) that requires expensive, lifesaving care. A per-incident limit is typically lower than an annual or lifetime limit, so the per-incident limit might actually defeat the purpose of pet insurance, which is to allow you to make decisions about lifesaving care without worrying about the cost.
On the other types of payout limits—annual and lifetime—we think they're totally fine as long as they're high enough to cover a worst case scenario (which can run upwards of $20,000 for certain conditions). There are also plans with no limits on payouts. These plans provide the greatest peace of mind (and are still reasonably priced).
You'll probably see these terms referred to when you're shopping for pet insurance. What do they mean?
Some conditions might be both congenital and hereditary. The tricky thing about congenital and hereditary conditions is that they may not appear for years. So you wouldn't know your otherwise healthy pet has one until it shows up—and treatment is often expensive. For this reason, we encourage pet insurance buyers to consider only policies that cover congenital and hereditary conditions.
But wait—you might think that you don't need this coverage if your pet's breed isn't prone to these types of conditions. It's true that certain breeds have higher risks for these conditions; however, that doesn't mean that your pet, if not one of these breeds, is risk-free. Also, policies that exclude coverage for congenital and hereditary conditions give the insurance company more "wiggle room"—it gives them the ability to determine that a certain health condition, where the cause is unknown and difficult to determine, is congenital or hereditary. That means your claim would be denied.
To avoid these situations, and to make sure your pet is covered, we recommend getting a policy that covers congenital and hereditary conditions, without limit.
Pre-existing conditions are any health conditions that first occurred before the pet insurance policy's start date (aka effective date). Anything that is documented on your pet's medical health record before you get pet insurance will likely be considered a pre-existing condition and will be excluded from coverage (meaning any claim you make on that condition will be denied).
We think this is a fair exclusion. Why do we think that? Because an insurance system that covers pre-existing conditions couldn't last for very long! That would allow people (or pet owners) to wait until they get sick before they got insurance—and then cancel it after they recover. If everybody did that, no insurance company could afford to exist. Insurance works because not everybody needs it at the same time (this is because of the "law of large numbers"). Sick pets (and wrecked cars and damaged homes) can be covered by insurance because people with healthy pets and no car accidents and undamaged homes are also paying into the insurance pool.
Because pre-existing conditions are always excluded, you should get pet insurance as soon as possible for your pet. The longer you wait, the greater the chance your pet experiences a health issue that would be excluded from coverage.
If your pet needs to go to the vet for medical treatment, then you'll make a claim for reimbursement of eligible expenses. Here's what you should know about the claims process:
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Yes, we have to include some legalese down here. Read it larger on our legal page. Policygenius Inc. (“Policygenius”) is a licensed independent insurance broker. Policygenius does not underwrite any insurance policy described on this website. The information provided on this site has been developed by Policygenius for general informational and educational purposes. We do our best efforts to ensure that this information is up-to-date and accurate. Any insurance policy premium quotes or ranges displayed are non-binding. The final insurance policy premium for any policy is determined by the underwriting insurance company following application. Savings are estimated by comparing the highest and lowest price for a shopper in a given health class. For example: for a 30-year old non-smoker male in South Carolina with excellent health and a preferred plus health class, comparing quotes for a $500,000, 20-year term life policy, the price difference between the lowest and highest quotes is 60%. For that same shopper in New York, the price difference is 40%. Rates are subject to change and are valid as of 2/17/17.
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