Hey guys! I just got a dog from the shelter and im a little confused on pet insurance. Its a lot different than human insurance it seems lol. Im aware that you have to pay the cost upfront and will be reimbursed by the insurance agency. By “upfront cost” is that the deductible??? Or is it the full price of the visit? My deductible is currently 250. My dog has his first vet visit soon. Should i be prepared to pay the whole bill or just the deductible?
Posted by Content-Command-1703
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It depends on the pet insurance policy. For most policies, the deductible is the amount that you have to pay out-of-pocket before the insurance kicks in. It is usually a total amount for the year, not an amount per visit.
Lets say your policy has a $250 deductible, then pays 80% coinsurance after. If you go to the vet for the first time in a year and have something covered by your policy done, and the total cost is $200, then your insurance would take 80% of that ($160) and that is the amount they would cover. But since your deductible for the year is $250, they wouldn’t pay anything out yet and you would have to pay the vet the full amount.
Then a couple months later something happens and you go to the vet again. This time the bill is $300. 80% of that is $240, which is what your insurance will cover. You have $90 ($250 – $160) remaining for your deductible, so they subtract that from the $240 and they reimburse you $150.
Pet insurance almost always reimburses you after you submit a claim. You will pay the vet directly, then submit a claim to the insurance carrier. Most also require that you send them the SOAP (Subjective, Objective, Assessment, Plan) from the vet so that they can verify the services performed are covered under your plan. You will have to ask the vet for the exam/SOAP notes after.
Keep in mind that most pet insurance doesn’t cover routine, preventative care without purchasing a special rider or add-on. Read over your contract, but I wouldn’t be surprised if nothing in your first post-adoption vet visit is covered (meaning that you will both pay for it directly and it won’t count against your deductible).
There are also exclusions for pre-existing conditions, and some policies require an initial exam visit to determine if there are any existing conditions. In other words, you might bring your dog in for an exam after the adoption, find out they have a heart defect, and your insurance may never cover any treatment related to that defect. Again, you have to read your policy carefully.
Pet insurance can be great, but there are also a lot of companies with a bad reputation. The adjusters will look for ways to avoid paying out, and the agreement/contract you sign often has a lot of fine print in it. If you are not comfortable reading that fine-print, then I would cancel the policy and just put some money aside for unexpected vet visits.
That said, I’ve had Fido insurance for 5 years for my dog and have generally had a good claims experience the handful of times I’ve used it.