Your Pet Insurance Guide

Trupanion Offers No-Limits Policies

Trupanion recently removed the $20,000 lifetime limit on their policies. There is also no per-incident or annual limit. This makes them unique among pet insurance companies. The other unique thing about Trupanion is that the premiums don't increase as your pet ages. Premiums may increase due to inflation over the years.

Pet Insurance Coverage For Prescription Diets

This is a topic that not many people think about. While it isn't a big factor in the grand scheme of things, some companies do provide some coverage for these diets. These diets are usually more expensive than your pet's usual diet.

What is a prescription diet? It is a diet usually available only from your veterinarian for a specific medical condition. There are several companies that manufacture prescription diets like Hills, Iams, Purina, and Royal Canin. Examples of these diets are K/D for kidney failure, S/D and S/O for dissolution of struvite stones, H/D for heart failure, etc. Studies have shown that some of these diets prolong a pet's life while also providing a better quality of life.

The following companies offer no coverage for these diets:

• Purina
• ASPCA/Petshealth
• Pet's Best
• VPI
• HealthyPaws

The reasoning for not covering the diets is that if your MD recommended a low salt diet or low fat diet, you would alter what you eat, but your health insurance policy wouldn't pay for it.

The following companies offer at least some coverage of these diets up to the per-incident, category, or annual maximums for the policy:

• PetFirst - standard plans don't cover prescription diets, but an optional rider can be added for $5 per month to cover these diets. This will cover 25% of the cost of a prescription food up to $250 annually.
• 24 PetWatch - covers 25% of the costs of prescription diets up to 6 months.
• Embrace - doesn't currently cover prescription diets, but will be adding it to their wellness program sometime this year. Details aren't available yet.
• PetPlan - covers any food that is prescribed for the dissolution of kidney/bladder stones for up to 6 months. Other prescription diets aren't covered.
• Trupanion - provides probably the broadest coverage. They will cover foods prescribed for chronic conditions e.g. kidney failure, heart failure, diabetes, allergies, etc. up to 25% of the cost of the food. Diets for weight loss aren't covered. They cover diets to dissolve stones while the patient is symptomatic, but they don't cover a maintenance diet after the stones are dissolved. The decision to provide long-term coverage for prescription diets is decided on a case by case basis depending on the condition being treated (whether it has resolved or is on-going) and in consultation with the veterinarian recommending the diet. 

2010 VPI Hambone Award

Last year, I encouraged readers to vote for the pet of their choice to receive the annual VPI Hambone Award. I must say that the pet I voted for won last years award. Each month, a pet is nominated by employees of VPI -- selected from the thousands of claims that they receive. It is usually a pet that found itself in an unusual and sometime humorous situation requiring a visit to the veterinarian for treatment. For example, the award is named after a dog that was trapped inside the refrigerator and ate a ham leaving just the hambone.

The time for voting on this year's award is August, but you can get a head start reading about the nominees. Enjoy!

Why Buy Pet Insurance?

I ran across an article written by Laura Bennett, the CEO of Embrace Pet Insurance Company, that gives interesting insight on her journey from purchasing pet insurance for the first time to actually starting a pet insurance company.

Interestingly, two of the responses to the article were from people who have had pet insurance for a number of years and had negative impressions of the industry. They had purchased a policy from a company that provides limited coverage and/or excluded conditions that many of the newer companies now cover.

You must do your research and know what to look for and what to avoid when deciding if you want to purchase pet insurance, and if so, which company and policy is best for your pet.

The one thing that I keep saying over and over that Laura agrees with is that the pet owner's decision shouldn't be whether to open a pet health savings account or purchase pet insurance, but the wise pet owner will do both. A savings account and a pet insurance policy serve two distinctly different purposes.

I might add that in addition to savings and a pet insurance policy, a major credit card or CareCredit would be helpful in paying your pet's healthcare expenses.

Buy Pet Insurance Early

I recently posted about this subject. Yesterday, I was reading a forum post from a pet owner that had bought pet insurance and when she filed her first claim, the company requested her pet's medical records. After reviewing the medical record, the company denied the claim stating it was for a pre-existing condition. Needless to say, the pet owner wasn't very happy.

Embrace pet insurance has a Medical History Review that can give pet owners peace of mind that there won't be any surprises pertaining to pre-existing conditions when you file a claim. Other companies may be willing to do the same thing if you ask. If the company informs you that there are pre-existing conditions that won't be covered, and that is unacceptable to you, you can cancel your policy early on and sometimes receive a full refund (if the company has a e.g. 30 day money-back guarantee and you haven't filed any claims). Remember though, even if one or more conditions are excluded from coverage, there are still potentially hundreds of other conditions that will be covered under the policy. So, you'll have to decide if the pet insurance is still worthwhile to you even if there are excluded conditions.

I found another example to illustrate the importance of buying pet insurance early. It also emphasizes that you never know when an expensive illness will strike (even chronic kidney failure rarely seen in a young dog). It also contradicts what I see some people repeat over and over online that "pet insurance isn't worth it." It comes down to the pet owner doing enough research to buy a good policy from a good company. 

***When I include examples from specific pet insurance companies, it is not intended to be an endorsement of those companies. I have endeavored to remain as neutral and unbiased as possible, but will from time to time point out both good and bad when I see it. My goal is always to educate pet owners about how pet insurance works and help them select the best company and policy for their pet. 

Good Information from Trupanion website

As I've stated before, pet insurance companies use their website to promote their product in the best light and sometimes even compare themselves to competing companies. However, some websites also provide very good educational material for pet owners in an effort to help them understand how pet insurance works. When I find such material, I'll pass it on to you - but, that doesn't mean I endorse that particular company, but simply that they have provided something that every pet owner should know and understand about pet health insurance. Here are several pages from the Trupanion website:

Cost of Claims

Truth About Profits and Costs of Claims

Alternatives to Pet Insurance

PurinaCare Comes Through With Big Claim Reimbursement

I am including a recent blog post on the PurinaCare Blog that is very interesting.

There are at least 3 things that pet owners can learn from this true story:

• You never know when your pet could be facing a serious life-threatening (and therefore expensive) crisis. Here is the story of a dog that had a relatively routine surgery that ended up with unexpected complications. What would you have done if your pet faced this sort of crisis with a bill of over $18,000? Would having a pet insurance company help with a substantial part of the bill make a difference in your life or that of your pet?
• Perhaps you can see the importance of recognizing the differences in pet insurance policies. PurinaCare has an annual maximum limit of $20,000 with no "per-incident" limit. If you have pet insurance now, check your policy and see what the insurance company would have paid on this claim and what you would have had to pay. If you don't yet have pet insurance, but you are contemplating it, let this be a lesson that you should get the highest annual maximum that you can afford, and beware of policies with a per-incident maximum.
• Since most pet insurance policies require the pet owner to pay the veterinarian in full and then seek reimbursement from the insurance company, even if you had pet insurance, would you have been able to do that in this case? I suspect that paying $18,000 out-of-pocket is out of reach for many pet owners. You would have to have money in the bank or available credit. Many pet owenrs coordinate a pet insurance policy with a CareCredit card that provides them with no interest payment options. When the pet insurance company reimbursement arrives, they can then pay off the credit card. Some companies will pay the veterinarian directly if the pet owner pays the veterinarian the deductible and co-pay and for any non-covered expenses. But, your veterinarian and the pet insurance company must agree to this type of arrangement. Be sure and ask a pet insurance company if they have provisions to do this in case of a large claim like this one. You might also ask your veterinarian if they would be willing to accept payment from your insurance company if such a situation as this case occurs. However, it is unlikely that your veterinarian or the insurance company will be willing to do this with smaller claims.

Pet Insurance Ebook Informs Pet Owners

The Ebook, "Your Guide To Understanding Pet Health Insurance" is now available. There is a video giving pet owners a glimpse inside the book. The book contains numerous clickable links to pet insurance company websites as well as a step by step guide (with links) on how to research each company. 

Two years of research have gone into this book, and I'm grateful for all the help that colleagues (fellow veterinarians) who are on the staffs of several pet insurance companies, company CEOs, and other special contacts at companies have given me. Their help has been invaluable to helping me understand pet insurance in general, and their company in particular. I told each of them on the front end that this book is an unbiased look at the pet insurance industry and several of them have told me personally that I achieved that goal.

Another Ebook I've written entitled "The Wise Pet Owner" which advises pet owners how to save money on their pet's healthcare expenses is a free bonus item when you purchase the pet insurance book. Again, it is written from a veterinarian's perspective because I (as do other veterinarians) see pets every day who are suffering and sometimes who die needlessly from accidents or illnesses that could have been easily prevented saving family members much grief and also money.

Perspectives On Pet Insurance

I just read the first chapter of a new book by Andy Andrews entitled "The Noticer." It is a book about an old man who finds people going through hard times and offers them advice. He "notices" things about their plot that they can't see and offers them a perspective that changes their attitude and ultimately their destiny.

You ask, "What does this have to do with pet insurance?" Well, nothing really except a line jumped out at me that is the inspiration of this post.

"Experience isn't the best teacher. Other people's experience is the best teacher."

If you are like me, before you buy almost anything of significance, you look at as many customer reviews as you can. Here you will read about the experiences of people who have actually purchased the product and/or dealt with the company. You will learn things by doing this that you won’t learn on the company’s website or even reading my book. I would advise you to not purchase a health insurance policy for your pet without looking at some reviews. Also, be sure to read the comments that follow the reviews. I found an excellent website to do this. Watch this short video.

When choosing a pet health insurance company, you are starting a relationship that you need to be comfortable with. Sometimes the service you receive and the trust factor is more important than the cost factor. Because pre-existing conditions are not covered by any insurance company, it is best if you make the right choice the first time rather than being dissatisfied and switching later to another company after you’ve filed several claims and your pet then has one or more conditions that won’t be covered.

Lessons From Trupanion Pet Insurance Website

I'd like to share with you an updated video from the Trupanion website. I believe you'll gain a better understanding of pet insurance and how it works. The video is best viewed full screen. Thanks for watching and let me know if you have any questions or comments.

Wall Street Journal Interview about Pet Insurance

Dr. Kenney was interviewed by Anna Matthews of the Wall Street Journal about Pet Insurance. She has written a very good article that pet owners should read. To hear the interview, click on the audio in the article.

The Importance of Hereditary Condition Coverage with Pet Insurance

I just got back from a Continuing Education seminar where one of the speakers talked about liver diseases. There are several congenital and/or hereditary liver diseases that veterinarians see in practice that are expensive to diagnose and treat. Sometimes, even surgery is required to correct/treat the condition.

Not all insurance companies offer policies that cover congenital/hereditary diseases. Some companies offer limited coverage. There are several that cover hereditary, but not congenital diseases, and some companies cover both.

In my book, I outline all these differences and go more into detail as to why such coverage is important - from a veterinarian's perspective. You should make this important factor a key point when doing your research to find the best company and policy for your pet.

I was also reminded of something that I'll recommend to you. Perhaps your veterinarian already recommends it to you. When you take your pet in for an annual or semiannual wellness examination, it's a good idea to do some basic blood tests that can help uncover e.g. liver disease (even though your dog or cat may appear in perfect health to you) before it advances to the point that the prognosis for recovery isn't good. Sometimes our pets don't show symptoms until a disease is advanced and a good wellness program can detect disease even before your pet appears ill.

I'll give an example. Chronic hepatitis in dogs is more commonly seen in certain breeds, and some of those breeds have actually been identified as having a genetic basis for the disease. If you have one of those breeds and your pet's insurance policy excludes hereditary conditions, you'll end up paying for the diagnosis and treatment out-of-pocket - yourself.

One way to detect chronic hepatitis early-on is by detecting an elevated liver enzyme (ALT) usually between the ages of 2 and 5 years old. Chronic hepatitis isn't the only problem that can cause the ALT to be elevated, but it is a red flag that warrants further investigation. In some dogs, if the condition is not recognized until the dog is showing symptoms, the prognosis is unfavorable for response to treatment.

Is Pet Insurance Worth It? TV Station Investigates

A Fox News station spent the night at an emergency center in Las Vegas to determine if pet insurance would be helpful when paying for a pet's healthcare expenses - particularly since emergency care generally costs more. See what they determined here.

New Software Could Benefit Pet Owners

There is a new software that helps pet owners store their pet information. You can keep track of expenses for your pet's healthcare and pet insurance premiums. You can store vital information about your pet e.g. your veterinarian's name, address and phone number, insurance policy number, examination and vaccination dates and reminders, microchip number. You can keep track of when to give medications and mark that you gave them,etc.

This is an Apple OS X application, but is also available as a downloadable app for your iPhone or iTouch.

For more information go here.

Is Your Veterinarian A Reliable Source Of Pet Insurance Information?

Linda Markland, a tenured technician at Veterinary Pet Insurance (VPI), came by my office last week for a visit because they are familiar with my book. Dr. Carol McConnell and others were kind enough to share some of the insights they have into pet insurance when I was doing the research for the book. It was the first face to face visit I've had with a representative of VPI although they are good about calling or e-mailing me about interesting articles or podcast they discover from time to time about pet insurance. I was fortunate enough to form relationships albeit via e-mail and by phone with company CEOs, veterinarians, and others at most of the insurance companies who I continue to contact trying to keep up with changes as they occur. To all of them, I am extremely grateful.

Linda had spent three days in Memphis visiting several practices and even giving them seminars about pet insurance. I asked her what she learned. She told me that veterinarians in general don't know a whole lot about pet insurance and sometimes this includes even the companies that they recommend to their clients, whether it is VPI or another company.

This confirms a suspicion that I've had and even wrote about in my book. Insurance companies are very willing to send brochures to veterinary hospitals about their company to give out to pet owners. Many veterinarians don't know much about pet insurance and it's nice to have something that they can put into the hands of clients who inquire about pet insurance. Some veterinarians will even openly recommend pet insurance to their clients and give out the brochures, but really not know much about the company itself.

On the other hand, I believe that there are some veterinary hospitals whose staff has been adequately trained by the pet insurance company they recommend and can answer accurately specific questions pet owners ask. 

I've had veterinarians tell me that they don't have the time or inclination to learn everything they can about pet insurance - that's the pet owner's responsibility because they are the ones who ultimately decide if they want pet insurance and which company they will purchase it from.

If your veterinarian gives you a brochure from a pet insurance company, be sure to determine if it is a wholehearted recommendation and why they recommend that particular company. Then, go do your own research and see if you come to the same conclusion before purchasing a policy.

Another Factor To Consider When Purchasing Pet Insurance

A reader of my book and blog contacted me recently while doing her research before purchasing pet insurance. She had already done an amazing job researching in order to make a wise purchase. She brought up a consideration that, frankly, I hadn't given much thought to. As it turns out, it just might be important to some pet owners.

She lives in California and has a 7 year old dog. After she narrowed down her search to 3 companies, she looked at how much her premium would increase as her dog aged. This is what she discovered:

Company A    Company B    Company C

Age 7 $45.01 $45.66 $35.75

Age 8 -9 $51.04 $66.93 $35.75

Age 10 $52.00 $101.57 $35.75

All three of these companies were favorable when compared to the important factors I outline in my book, but this was an eye-opener.

Company C doesn't raise premiums as the pet ages, so this could be an important factor for some pet owners. You should always be careful when a company advertises that their premiums don't rise as your pet ages. There is one company (not Company C) that keeps premiums level, but as the pet ages, the deductible and co-pay rises effectively increasing your out-of-pocket costs.

Which company did she ultimately go with? She was very tempted to go with Company C because of the no increase in premiums, but to get that premium she would have to get the $500 per-incident deductible. She ended up going with Company A and a $200 per-incident deductible.

So, when getting a quote from a company, you might inquire what the premium would be if your pet were older (use several different ages).

Pet Health Savings Accounts

While doing some research this weekend, I came across several companies that offer Pet Health Savings Accounts. It works somewhat like my own Health Savings Account my wife and I have with two exceptions. First, it isn't tax deductible. Secondly, it isn't tied to a high deductible insurance policy. Unfortunately, some of these companies are positioning themselves to compete with pet insurance companies for pet owner's dollars. 

I believe that a savings account and pet insurance should compliment each other, not compete against each other. The idea behind my HSA is that with my savings I can pay for minor medical issues, medications, etc. and the insurance policy will cover catastrophic medical issues. If I remain healthy, then my savings increase year by year. If I have a major health issue that I can't cover out-of-pocket, then my insurance will cover that. 

I try to put the maximum that is allowed into the savings account every year, and since my deductible is high, most years my insurance never comes into play. Does this mean the insurance is a waste of money (I pay quite a bit for it)? No, because all it takes is one year when you wind up in the hospital with a major illness or surgery to find out how necessary it is to have. 

For those people who advise starting a savings account, but not buying pet insurance leave the pet owner exposed to not being able to cover a major medical expense should it occur before their savings account builds up. And believe me - as a veterinarian, I see it happen.

Theoretically, as your savings build up, you can afford to raise your deductible and lower your insurance premium. This is what I've done over the years with my own health insurance. As premiums rose, it became almost cost prohibitive to keep maximum coverage. This usually meant changing to a higher deductible. The amount you choose for your deductible makes the biggest difference in the premium. What's interesting is to go to the websites of companies that allow you to choose your own deductible and notice the difference in the premium as you change this one variable when obtaining a quote. When choosing a higher deductible, make sure you can cover it out-of-pocket.

So, I prefer to advise the balanced approach. Pet owners should have a savings account, credit card, and pet insurance. Since pet insurance is indemnity insurance, the pet owner usually pays the veterinarian and then receives reimbursement from the insurance company within a couple of weeks after filing the claim. Having a credit card allows the pet owner to pay the veterinarian and then usually receive reimbursement before the credit card bill becomes due. As I said earlier, the savings can help pay for the deductible, co-pay and anything not covered under the terms of the policy.

Pet Insurance Research Guide

I get daily Google Alerts on pet insurance. A frequent question being asked by pet owners, especially those with new pets, is, "What is the best pet insurance company?" Veterinarians have told me that their clients tell them that they don't know how to do the necessary research in order to pick the best company or policy for their pet. Therefore, they ask their veterinarian for advice on picking a company. Some veterinarians may be knowledgeable enough to do that, but many aren't. They may have some brochures that a company sent them to give to clients, but not actually know much about the company.

Although I've written a book to help pet owners learn more about pet insurance and even have some tools in the book to help them research pet insurance companies, I felt like I needed to actually demonstrate how to do the research. Therefore, I've written a  Pet Insurance Research Guide that you can get by clicking the link in the sidebar of this blog. It has live links that will help speed up your research. You can download it to your computer.

I would appreciate feedback from those of you who use it. A discussion on how to find the best company and policy will benefit all pet owners. What criteria do you think is the most important to you and why?

My book has much more detailed information and explanation about each company and its policies. Therefore, the Special Report isn't meant to take the place of the book, but to supplement the book. It can be confusing trying to sort through all the details about each company and policy. I've tried to do a lot of that for you in the book. 

You need information about all the companies - not someone's opinion about which companies are the top 3 or top 5.

Pet Assure

Pet Assure is advertised as an alternative to pet insurance. You would be surprised, however, how many times I see it called an insurance company on the internet - sometimes by websites, e-books, etc. who profess to be advisers on pet health insurance.

Pet Assure is a company (club) that has a network of participating veterinary hospitals that offer their services at a discount (25%) to members of the club. Usually, the pet owner pays an annual membership fee to belong to this club and be eligible for the discounts. It is not insurance. There are no deductibles or co-pays. Pre-existing, hereditary, and chronic conditions are eligible for the discount. You receive the discount when paying your bill at the veterinarian’s office. 

Even though they advertise that there are no exclusions, services and products that aren’t eligible for a discount are any medication you are sent home with, food, flea and tick or heartworm preventatives, boarding or grooming, outside lab tests, referral to a specialist, and any product or procedure that is already discounted. The annual membership for a dog is $99 and $59 for a cat. They do have a family plan where up to 4 pets are covered for an annual membership of $149. 

The main problem with a network such as this is that it requires the veterinarian/hospital to discount their services. Therefore, there are often a very limited number of veterinarians participating in a given city or community. In other words, the veterinarian that you prefer and have an established relationship with may not and/or will not participate in such a network. 

You can read the reviews on Pet Assure as compared to insurance companies. You will even find some of the people who wrote the reviews referring to Pet Assure as insurance. For some pet owners - especially those with several pets, and if there are participating veterinarians in the area that they like, Pet Assure may be helpful. As with insurance, know that there are things that aren't eligible for the discount and that your savings are limited to 25%

Is Pet Insurance For You?

I want to post today about the limited reach of pet health insurance to pet owners as it exists today. This isn't talked or written about very much. Pet insurance is essentially a reimbursement plan. An insurance policy is a contract between the pet owner and the insurance company. This means that you must pay your veterinarian in full for the bill, then file a claim with the insurance company and wait for reimbursement. This has led many to ask, “If I can afford to do that, then why do I need insurance?” In these cases, the insurance reimbursement will help pay off the credit card debt or replenish the bank account.

Thus, the pet health insurance model of today implies that only pet owners who can afford to pay for a large bill out of their own bank account or with a credit card and then wait for reimbursement need apply. In my opinion, this leaves a large percentage of pet owners who cannot afford to pay a large, unexpected veterinary bill out of the loop.

Some of the insurance companies have provisions to pay your veterinarian directly after you pay the deductible, co-pay and for any non-covered procedures. The drawbacks to this are that your veterinarian may not agree to such a provision because he or she is used to being paid at the time the procedures are done. Veterinarians also fear that if they start filing claims on behalf of pet owners and waiting for reimbursement from insurance companies that extra staff may be needed. This will increase their overhead and they will have to raise fees to cover this expense. They see human doctors who have a whole office devoted just to handling insurance claims and they want no part of that. They are also concerned that if they have to wait on reimbursement from the insurance company (MDs have to wait weeks to months sometimes) that cash flow will suffer significantly. In fact, some practice management experts have stated that such a scenario is undoable for most veterinary practices. The other problem is determining in a timely fashion if the disease or problem they are treating is even covered and if so, how much the pet owner will end up having to pay and how much reimbursement they can expect from the insurance company.

Therefore, veterinarians generally prefer the status quo - present day model. Veterinarians are also wary of any model that may resemble “managed care” (networks e.g. HMOs, PPOs, Medicare or Medicaid) that has plagued other healthcare professions. There is a whole chapter in my book on the importance of veterinarians and pet owners avoiding managed care.

Several insurance companies are working to improve their ability to verify coverage and shorten turnaround times between filing a claim and receiving reimbursement – sometimes as short as 24 hours. The filing of claims and receipt of reimbursements are done electronically, therefore, it involves virtually no paperwork and minimal staff time. I know of one company who is working with at least one veterinarian to test such a system. I was told that the veterinarian files all claims – large and small – for pet owners and the reimbursements are deposited directly into the hospital’s bank account.

If insurance companies can reliably put such a model in place, it should overcome most of the objections that veterinarians have with it and put pet insurance within the reach of pet owners who can afford a monthly premium, but can’t come up with thousands of dollars on the front end should their pet develop a serious medical or surgical problem.

Just because your veterinarian agrees to file the claim on your behalf doesn’t mean that you will walk out without paying anything (like you may be used to doing at your own doctor’s office). You will still be responsible for paying your part (deductible, co-pay, and any non-covered expenses), and the insurance company will pay its part directly to your veterinarian. In my mind, this is how it ought to work to allow more pets to be covered. Some of the insurance companies are now offering larger deductible policies and these may be more acceptable by the veterinary community in such a model because you will be paying (and they will be receiving) a larger portion of the bill on the front end (like a deposit).

Until such a model is commonplace, you can ask your veterinarian if he or she will allow you to pay the deductible and co-pay and file a claim on your behalf. If it isn’t an emergency, some companies will pre-certify a procedure and let you and your veterinarian know the approximate expected reimbursement. Your veterinarian would need to send an estimated cost of the diagnostic and treatment plan to the insurance company (the final bill may vary from the estimate). However, you should only expect to be able to do this with large, unexpected bills, and you will have to get the cooperation of both your veterinarian and the insurance company.

Interesting Stat on Pet Insurance Reimbursements

I just finished reading the March issue of Veterinary Forum Magazine. Tucked in the corner of page 24 was an interesting statistic. Pets Best Insurance reviewed its reimbursements over $500 and found that:

• 54% are for regular veterinary care
• 35% are for specialist care

• 11% are for emergency clinic care

What this means is that almost half of significant veterinary bills occurs outside your regular veterinarian's office. Many clients don't even think about having to visit anyone but their regular veterinarian, but odds are at some point you will have to take your pet to an after-hours emergency hospital. Since the best techniques for handling some problems require greater expertise or more advanced technology than your regular veterinarian may have, at some point you will also likely be referred to a specialist. For example, some invasive tumors are best managed by having a CT scan or MRI done in order to plan the surgical procedure and insure that all the tumor is removed. Some complex medical problems are best handled by internist who see and manage these problems much more frequently than your regular veterinarian, and many times the pet should have 24 hour (around the clock) monitoring and treatment to have the best chance for a successful outcome.

It used to be that veterinary schools were the only alternative when such procedures needed to be done and clients had to drive hours to the nearest school. Now, most major cities have one or more specialty hospitals. Here is Memphis, we are fortunate to have several board-certified surgeons, internists, an opthamologist, a dermatologist, an oncologist, and a physical therapist. Because they have more advanced expertise and have access to more advanced technology, their fees are higher. Most major cities also have one or more emergency hospitals where pet owners can take their pets when their regular veterinarian is closed during evenings, weekends, and holidays. The emergency hospital's fees are also likely to be higher than your regular veterinarian's fees.

This should at least make you think about the benefits of having pet health insurance for your pet when you are faced with having to visit a specialty hospital or an emergency hospital and a significant veterinary bill.

One of the good things about pet health insurance is that pet owners who have insurance can go to any veterinarian, hospital, specialist and be reimbursed for covered medical expenses. They aren't limited to doctors or hospitals in a "network." This is an important reason that veterinarians and pet owners alike should avoid joining networks typical of the HMOs, PPOs, etc. that is typical of the "managed care" model that plague most human healthcare professions.

Exclusions - Pt. 4

There are miscellaneous exclusions that aren't as important in the big scheme of things as hereditary or chronic conditions or wellness care, but pet owners are occasionally caught by surprise if they aren't aware of them.

For example, most companies won’t cover behavioral problems, breeding or pregnancy–related expenses, cosmetic or elective procedures like tail-docking, ear trims, declawing, etc.(not an exhaustive list). I had a client who purchased a policy and when his pregnant dog developed problems, he was very upset because it wasn’t covered. It was clearly stated in the policy, but he likely didn’t even read the policy until his claim was rejected. This is the reason you should research and ask questions before purchasing a policy. One of my goals in writing about pet health insurance is to give readers a heads up on what to look for and what to ask about. Ideally, you should print a copy of a company's policy that your are interested in, carefully read it - highlighting anything you don't clearly understand, and then contact the company to get an explanation. You should never purchase a policy without reading it thoroughly.

Is Wellness Care Coverage Worth It?

Pet owners should purchase pet health insurance to cover those unexpected accidents or illnesses where the cost is unknown -- potentially hundreds to thousands of dollars. Coverage for wellness care where the procedures and costs are predictable should be a secondary concern. Since wellness procedures and products can be planned for and saved for, not all insurance companies offer wellness care benefits. Following your veterinarian's recommendations about wellness care is extremely important to your pet's overall health and well-being. Wellness care prevents disease and allows early detection and intervention that saves lives, reduces suffering, and saves you money because prevention inevitably costs significantly less than treatment.

What are we referring to when we say wellness procedures and products? 
- Wellness examinations by your veterinarian 
- Vaccinations for infectious diseases as indicated 
- Intestinal parasite testing 
- Heartworm testing 
- Feline leukemia and AIDs testing 
- Spay and neuter 
- Blood and urine testing for early disease detection screening -especially for senior pets 
- Heartworm preventative medication 
- Flea prevention and treatment medication 
- Dental prophy 

Wellness care procedures and products should not be expensive. However, I know from experience as a veterinarian that many clients don't opt for some of the recommendations I make for their pet. Perhaps cost may be a factor for some clients. It has been my experience that clients are interested in coverage for wellness care. Companies that offer wellness care benefits don't always cover everything in the list above. Pay close attention to what they do cover. Some companies offer different levels of wellness coverage. Some companies advertise almost double in benefits compared to what you pay in premiums. Realize, however, that you likely won't get everything on the list every year. For example, you will only get your pet spayed or neutered once. Some practices are now recommending vaccinating for some diseases every three years instead of annually. The bottom line is that you likely know about what you pay for wellness care annually. I would go through the list above and write down the cost of each procedure or product. If you don't know, call your veterinarian and get an estimate. Then, it is simply a matter of adding up the benefit reimbursements that you would receive for those procedures and products and subtracting the additional premium you pay the company to cover those things and see if you would come out ahead. Sometimes it is hard to estimate accurately.

If a company pays wellness benefits according to a defined benefit schedule (usually listed on their website), it is relatively easy. But, if a company pays according to a schedule of what is usual and customary for your region of the country (usually not listed on their website), it is harder, if not impossible, to determine if you'd come out ahead. The company may not be willing to tell you what the benefit would be for each procedure or product in the list above until you actually file a claim. Sometimes wellness care benefits are subject to your deductible and co-pay. If you haven't used your deductible yet for an illness or injury, your deductible will be subtracted from your wellness benefits. Likewise, if your deductible was applied to your wellness claim, then you wouldn't have a deductible if you filed an illness or injury claim (assuming it is an annual deductible). It is also hard if the company includes wellness care in their accident/illness coverage for one premium (not as a separate rider for an additional premium). You don't know how much of the premium is going for the accident/illness coverage and how much is going for wellness care coverage. In these cases, you may have to actually purchase the wellness care at least one year and see if you think you come out ahead.

In fact, wellness benefits may definitely be worthwhile if purchased for a new puppy or kitten. Some companies now offer generous benefits to cover the complete puppy or kitten vaccination series. This is also the best time to get your pet neutered or spayed which is also covered in most policies as a wellness care benefit. You may also be reimbursed for heartworm preventatives and flea control products. If purchased as a rider, you can always drop the wellness coverage later. If it is included in the policy (not a separate rider), you must be careful and inquire whether changing to another policy (without wellness benefits) later on will affect your accident/illness coverage -especially how pre-existing conditions are handled.

Pet Health Insurance - Exclusions - Pt. 3

A chronic condition is a disease that will need long-term (ongoing) treatment after it manifests itself and diagnosis and treatment is started. Many chronic diseases (e.g. diabetes) can be treated and controlled for several years, allowing the pet to live a relatively normal (symptom free) life. 

Why is coverage for chronic conditions an important factor to consider when purchasing pet insurance? Because every pet, if they live long enough, will develop one or more chronic conditions that will require ongoing treatment - sometimes for years. Some pets can manifest symptoms of a chronic condition relatively young in life e.g. allergies.

How do companies handle coverage for chronic conditions?

• Some don't cover chronic conditions.  For example, if your dog develops diabetes two weeks before your renewal date, the diabetes is only covered for two weeks because when you renew your policy, the company considers the diabetes a pre-existing condition.    
• Some cover chronic conditions, but have limited coverage. Some cover the condition up to the per-incident maximum (total). The per-incident maximum isn't reinstated annually. Pets Best is an example of a company that does this. Lets assume you have their Basic policy which has a $2500 per-incident maximum and your pet develops diabetes. If you spend $1000 this year on diagnosis and treatment, then in the following years, your pet would have $1500 total coverage left for the treatment of the diabetes. Once you've spent $2500 on the diabetes, there isn't anymore coverage for it.  PetCare covers chronic conditions up to the category maximum (total). Embrace limits coverage of chronic conditions to 25% of the annual maximum in the years following the initial diagnosis and treatment. ASPCA has recently added a chronic conditions optional rider that has its own annual and per-incident maximums and deductible. These limits are less than the normal illness limits in the policy.
• Some cover chronic conditions just like any other illness. Therefore, coverage for all injuries and illnesses (including chronic) combined are covered up to the full per-incident and/or annual maximum which is reinstated every year upon renewal. VPI, PetPlan, and Purina are companies that do this. Trupanion covers all injuries and illness (new or chronic) up to their lifetime maximum.
  

You need to know how each company handles coverage for chronic conditions as you choose which company to purchase a policy from. From a veterinarian's perspective, I consider it an important factor because many of the problems that I diagnose and treat are chronic conditions.

After I finish this series of posts on exclusions, I'll try to put it all together in a summary post that will be a very useful tool for you to use in your research. Right now, I'm giving the details of the exclusions I feel are important. Please offer your comments or ask any questions that may come to your mind and I'll try to answer them. 

Pet Health Insurance - Exclusions - Pt. 2

Hereditary conditions are another important exclusion (from a veterinarian's perspective) that some pet insurance companies have in their policies. Some companies totally exclude coverage for any disease or conditions considered hereditary. Others have limited coverage (maximum dollar amounts) that they will pay for some inherited diseases. Others cover inherited conditions just like any other illness in their policies.

Some companies have a list of hereditary conditions available for viewing on their website or in their policy that they don't cover. Generally, if a disease isn't listed, it's covered. Others don't have a published list, but say they use current veterinary texts to determine whether a condition is hereditary or not. 

To realize why I think this is an important factor to consider when choosing a company to insure your pet, take a look at these lists of conditions that are considered hereditary for each breed. The length of the lists may surprise you.

Dogs

Cats

Pet Health Insurance - Exclusions - Part 1

The one exclusion that's virtually universal among pet insurance companies is pre-existing conditions. This means that any problem that your pet has shown symptoms of prior to purchasing an insurance policy or that manifest symptoms during the waiting period prior to the effective date of the policy won't be covered. Waiting periods for accidents and injury usually vary from none to 5 days. Waiting periods for illnesses usually vary from 15 to 30 days. At least one specific problem I know of - anterior cruciate rupture - has a 1- year waiting period with most companies.

Insurance companies go by when you first noticed symptoms, not necessarily when it is diagnosed and treated by a veterinarian. When you apply for coverage, most companies will ask you questions about your pet's medical history. Some may require a copy of your pet's medical records and/or a physical exam by your veterinarian. Some pet owners may be tempted not to tell everything - thinking that if the insurance company doesn't know about a problem, then it will be covered. More than likely, if the insurance company doesn't ask for a copy of your medical records when you apply for coverage, they will when you submit your first claim. If the insurance company finds out you've not been truthful with them, they will cancel your coverage (it's in the fine print of almost any policy). 

If you indicate a previous problem, the company may tell you that specific problem won't be covered and for how long. Some policy language states that if a previous problem hasn't manifested symptoms in 180 days, then it will be covered.  However, if the problem is considered chronic, it likely won't be covered at all. In fact, some chronic problems e.g. Cushings Disease or Diabetes may disqualify your pet from any illness coverage. In this case, your pet would still be eligible for accident/injury coverage.

Therefore, the best time to get insurance for your pet is while he or she is still young before any problems appear. If you know that your pet has had previous problems and you've told the company about it and even submitted past medical records, try to get the insurance company, when they issue a policy, to state in writing what problems aren't covered and for how long. Hopefully, this will prevent surprises from denied claims down the road.