PetCare insurance

today i called them to ask about how i would go about having the temporary exclusion on my policy for diarrhea removed. I figure i better hurry before he comes down with some diarrhea thing, which i'm not expecting but you never know.

Just thought i'd pass along a few things from this phone call.

One, it took pretty long for someone to answer. I dial extension 333, that's the underwriting department. Maybe i should've just spoken to whoever picked up the phone on the main number, maybe they could've answered my questions. I was on hold for about 15 minutes at least. i guess they are growing as a company.

I first got my policy around the end of January last year, you're supposed to wait a year to ask to have a temporary exclusion removed. Zack's medical records continue to show him being treated for the diarrhea into the first week of March. But she said i could request removal of the exclusion now. She said there is a form they will fax me by tomorrow, and i have a vet fill it out and send it back to them.

I have a vet appointment for Saturday for a general check up. I'll send that to PetCare as well. I also have a complete blood count with extensive thyroid panel from November and parvo and distemper titers from November, everything came back normal/adequate, which i'll send them.

Their claim form has a checkbox on the vet's portion that says "all vaccinations are up to date." Or maybe it says "all necessary vaccinations are up to date." I asked her what their position on titers instead of boosters was (other than for rabies vax). She said they accept titers instead of boosters. So i take that as a sign that the insurance industry is coming to accept the new thinking/research findings on the reliability of titers as evidence of immune response. I kind of expected her to say they required triennial boosters, imagining they would be conservative but she was clear that titers are acceptable for their purposes (basic healthcare requirements).

Thanks Judy for the info. Do you know if they consider lepto as a mandatory vaccination? I have not decided if I am going to give to Lily. One Vet does not give it and another Vet recommends it if you live around a lot of wildlife, which we do. He said he can give it to her at her 6 mo. check up so she wouldn't be getting it with all her other vaccinations. He did say that they only had 4 cases of it last year. My Lhasa had a bad anaphylactic reaction to it the first time she had it. I had to rush her to the ER because she couldn breath and her muzzle and tongue were swollen 3x their size. It was very scary and I didn't think I was going to get her there in time. I ran every red light on the way. After that, he would give her bynadryl first and she was fine. He stopped giving it to her when she was about 9.

I am scared now not to give it to Lily becasue I do have a lot of wildlife. I was wondering too if PetCare could deny any of my claims because she has not had it. I have 3 claims outstanding.

While many have had great success with PetCare insurance, I am alittle disenchanted to say the least. I know some of this is my fault in not understanding how this insurance works, so i'm thinking maybe there are others who can benefit from what I have learned....

Petcare does not underwrite your policy until the first claim is made, in my case it was 5 months after I had given them a full years premium. At that time they re examin every visit to the vet with a fine tooth comb. Now while they do state this in black and white, not speaking insurancese,,,I didn't know what meant..my bad. I sent them my money and Molly's records and even followed up with a phone call asking if everything was okay, and went about thinking that Molly was covered for everything.
Had I been on notice of all of the exclusions they would come up with..I probably would have cancelled right away (or is that what they worry about...hmmmm). Temporary exclusions are fine and dandy except that they last a year from the date of your policy and then and only then they will revisit the issue. I feel like I gave them $444 and I am only covered for a portion of what I thought I was.

I am still awaiting a decision from PetCare regarding the exclusion they put on Molly's syringomyelia....I received my acutal Document of Insurance...Unlike the document of insurance I thought I had received when I gave them $444 last September.

Here is a list of exclusions they have now (5 months later, I might add)

Excluded from Coverage

1. Bilateral Conjunctivis, Corneal Ulcer of Feb (06) and Associated Conditions-Temporary (My cat scratched her one eye not both eyes)

2. Bilateral Patella Luxation and Associated Conditions-Permanent..(Molly has grade 1, so I wasn't suprised with this)

3. Elevated Kidney Enzymes and Associated Conditions-Temporary..(Lab error, discovered and corrected next day..that would have been in the records as well)

4. Full Anal Glands 2/06 and Associated Conditions-Temporary..

5. Hot Spot of 9/05 and Associated Conditions-Temporary...(dry skin on one leg...treated with antibiotic)

6. Lump on head and Associated conditions-Temporary...(pimple on head, I was a new cavie mom and panicked over a pimple, what can I say)

7. Retained decidous tooth, related extract 11/05 and Associated conditions-Temporary....(baby tooth pulled...come on :sl*p: )

8. Skin/interidigital irritation/licking March 06 and Associated Conditions-Temporary...(don't even know what that one is???)

9...last but not least Syringohydromyelia/Hydrocephalus, blah blah blah-Permanent..(fingers crossed, jury still out)

Unfortunately for me...and I don't mean to be so long winded...everything I have learned about being a dog owner (first one) and more importantly a Cavalier owner...I like many others learned the long/hard way.

Insurance probably is a great thing, if you understand everything your getting which I guess is my message.

If I had known before.....what I know now.....get insurance the minute you get your puppy...and get the highest level of coverage you can afford...Molly's MRI/Surgery will probably run a total of $4000.

Molly, Wow....That is a lot of exclusions. Are all of the exclusions things she was treated for before the insurance was in effect?

I had never had a dog before and took Molly to the vet alot her first year, just like I took my first daughter to the pediatrician every time she sneezed, 21 years ago. icon_whistling

Yes all of those exclusions with the exception of the SM where things noted before the policy to effect.

did you sign molly up for the policy after a year? I don't understand the part about 'you are not underwritten until you file your first claim" and want to understand how that happened, and how someone could avoid that happening. From what you said, let me know if this is right, you signed up for the insurance after you had had molly for a while and after she had been to the vet for various things. then you signed up for the insurance and there was a 30 day waiting period before illnesses would be covered. After that 30 day waiting period, when you should've been covered for anything not previously noted, you took her in and SM was suspected, she was MRI'd and SM was diagnosed, you filed a claim and they turned it down, even though it was never noted before the end of the 30 day waiting period. Is that what happened? And they turned it down because you hadn't filed any claims yet so you weren't undrewritten yet, and they decided not to cover it and to exclude it permanently. Is that what happened?

i dimly remember seeing something in my policy about not being underwritten until the first claim was filed, and like you I didnt konw what it meant and i forgot about it because it seemed clear enough that they were saying you are covered after the 30 day waiting period for things not noted before that.

So i don't get how that works, and i think anyone getting pet insurance would need to understand that. Especially, people want to be covered for SM and i dont'[ understand how this happened to you. Good luck with your appeal. I saw the other post you wrote about this, i think you said you have a couple of vets advocating on your behalf. Hopefully they have made a good case. If you get turned down, maybe you can make a complaint to the state agency that regulates them. When i was having a problem with a permanent exclusion on all heart problems, i let them know i was at the point of filing a complaint because it was so unreasonable for them to have that exclusion. I dont know if that helped or not, the underwriting manager quickly got the exclusion removed. I didnt' say it in a threatening way. i just said i didn't know what else to do at that p9oint, and that's why i contacted her.

i'm so sorry you are going through this, on top of molly having SM. i hope you win and am sorry it's had to be such an ordeal. Surely other poeple can learn from what happened to you. i'm not yet sure what happened to you, hhow it happened that you weren't covered for something that wasn't noted until after the 30 day wait. I am going to read my policy and find out what that means--obviously it's really important and it went right by me when i saw it the first time.

i hope you get good news about the appeal soon.

Was scrathing or any symptoms that could be SM symptoms mentioned to the Vets before the 30 day waiting period? If anything that could be associated with SM was in her file prior to the 30 day waiting period, it is my understanding that they could say that it was pre-existing. i.e. that she was showing symptoms prior to being covered.

shay--i really sympathize with you, what a hard dilemma, just to have seen another loved pet have such a bad reaction and almost suffocate, but to be concerned about the real risks of the terrible disease of lepto. If you decide to vaccinate, as you know, there are things you can do to minimize the hypersensitivity and hasten recovery. jean dodds told me a couple of things i could give zack when i get the rabies, she wrote them down, i dont' remember right now but will look them up.

i don't know what petcare's policy is about coverage and vaccination, i've been wondering. It might help to call them and ask, you don't have to say you already have a policy, you just want info, or you can say you want to know how your policy works. i'm guessing if she got lepto, it might not be covered because of no vaccine, if the risk is considered something you should've taken into account. but whether they'd deny coverage for unrelated things because of no lepto vaccination, i dont' know. I haven't gotten the rabies yet and i've wondered whether, if they didn't see it in the records, they would deny a claim, but that hasn't happened so far.

I don't think the rules are hard and fast on those things, it's more on a pet by pet basis, and has to do with what the treating vet recommends.

let me know if you find anything out.

Well I am going to rant on your post - so I apologize now!! I have had it with insurance companies and have decided to forget it all together. My puppy was felt to have had a flow murmur at 6 wks - 3 of 4 puppies in litter were the same. But when all the puppies were seen by individual vets (each different) not one vet felt a murmur existed. The fact 3 suspected murmurs at 6 wks were not detected in any puppy at 8 wks either proves they were innocent flow murmurs which are not related to heart disease or mis-interpreted by the breeder's vet.

So after reading your post, I posed the question to each main pet insurance company, would they reinstate a dog for heart related illnesses if the murmur remained undetected for a set time period - 1 yr, 2yr, I'd even accept 3 yrs. I dont feel its fair to be not allowed protection on heart related illnesses down the road as a senior at 8 or 9 yrs because of a suspected flow murmur by one vet at 6, gone by 8.

If an insurance company is this hard set - my thoughts are they will fight for their life to stop claims with any excuse on other issues. Which diminishes the peace of mind aspect they claim to provide.

I got Molly in July 05 and decided to get insurance in 9/06 basically because that's when I found this website and started reading about all of the illnesses. There was nothing in her records regarding SM or related symptoms at that time. When she was just a pup she had a skin staph infection on one of her legs that was it.

Molly was seen by my vet on 12/22/06 because I suspected SM. When she had her MRI in January 07, (some 4 months after policy was paid for) the MRI Vet noted that I had said I had noticed scratching in Sept. (I honestly don't remember saying that. I might have, or might have said a couple of months now that I knew she had SM and started to think back to when she was scratching, I actually thought she didn't like her new collar).

Anywho that now has become the smoking gun that excludes SM. The million dollar question (or should I say $3000 question) is, which scratch when, was the definitive scratch, since she was neither seen or diagnosed by a professional. There was NOTHING in her file prior to my giving PetCare a years worth of premiums regarding scratching or SM. I am not a professional and I find it interesting that they have had no interest in speaking to me, yet they are taking my off handed comments as a definitive diagnosis. So this is where we are.

When they say they don't underwrite the policy until the first claim is made, basically as I understand it now, they are not guaranteeing coverage on anything, nor are they even taking a close look at your records until you ask them for money. At that point they can go back and decide what they will cover and what they won't based on your records prior to the first date of your policy. I am not arguing that they don't have the right to do that, but I would much more appreciate knowing from DAY 1 what my exclusions are then some 5 months down the road.

You never know if having this information may or may not influence your decision making on types of treatment etc.

I had no idea Molly would not be covered for the MRI, in fact I was singing PetCare's praises to everyone I knew. Had I known, I still would have had the MRI done, but might have looked alittle further into a more affordable one.

Yup Molly's Mom, you just verified it for me - they will fight tooth and nail, it would be safer for my dog that I put the money away each mth. That way I may not have enough for everything, but if I am like you, that is a good amount to have banked when the time comes if I need it.

Oh boy....I wonder if they have ever paid an SM claim. Dogs scratch for a million reasons. I really got the pet insurance for SM and MVD. Now I just don't know if it is worth it. I am anxious to see how they pay the 3 claims I have submitted. I will keep you posted. If you have to fight every time you file a claim, it's very discouraging. I have found with most insurance companies, they will fight to the death, hoping you will just finally give up. They make it so difficult for the insured, especially the elderly, most do finally give up. They either, don't have the resources or the inclination (many are ill) to keep at it. In helping my Mother with the new prescription benefits enacted last year for seniors, I'm not sure a rocket scientist could have understood it. I was a Human Resouces Manager for 20 + years, and now an HR Consultant, and have dealt with benefits for years. I had a hard time understanding it. How did they expect seniors (no knock on seniors, my Mom is very smart) to understand it. When you called either Medicare or the insurance company, they couldn't even answer your question, because they didn't understand it! Very sad.

I just got off the phone with PetCare, and Judy, the regular claims line hold is just as long as the underwriting department. Still no word on my resubmission. I call every day and they tell me to call back in a couple of days. I seem to talk to the same person everytime I call so i'm thinking not a huge office. The Chief Vet is only there on Tuesdays. My claim has been reviewed by the chief but now goes back to underwriting before I get my decision. My husband thinks no news is good news, I'm thinking the opposite.

Shay,
I don't see how they could deny a claim for SM if there is absolutely no paper (or verbal trail) of anything could be related to SM before the policy was in effect, but if they play six degrees of separation that might get tricky.

If I knew then what I know now (it's that always the case ) I would have insured her the day I brought her home. I got the insurance mainly because of luxating patellas (which I didn't think made it into her charts but apparently it did) and MVD. I think for me since they may not cover SM and Patellas are definately excluded, I may just bank the yearly premiums and put it towards a mvd fund. I will wait to see how PetCare handles this first. Or I might look into Petplan, at least they underwrite from day one so I would know what my coverage is.

For now I am just anxiously awaiting Feb. 21, :drivecar: which is Molly's surgery day. Hoping and praying that everything will work out okay and then we can begin the process of healing and moving on :dgwlk:

Bev,

How did you get a list of exclusions? Is it on one of the documents or did you have to ask for it? I can't remember seeing it on anything they've send me for Spencer's policy.

When planning for Spencer's patella surgery last year I found that you can find out ahead of time if they'll approve stuff. Ask them for the pre-approval form and then have your vet complete it and fax it in.

Whitney

Oh Bev...I am saying a prayer for Molly and you that everything with her surgery goes well. Please keep us posted on the insurance dilemma and especially about Molly's surgery. I'm pulling for her. :flwr:

I didn't know you could get pre approval :sl*p:

I did call in advance of the MRI and ask if they cover MRI's but it was just a general question.

As far as the list of exclusions, I just received them yesterday almost 5 months to the day I paid for the policy....

Wow, insurance for pets is just like insurance for people. :x I do think that if your dog is not 100% healthy at the time you apply for insurance, you will be fighting battles for everything whenever you submit a claim.
I tried PetCare insurance, but found that they will not cover Riley for the important things that i originally wanted insurance for! Unfortunately, 2 days after we got Riley our vet discovered an innocent flow murmur and he was only 11 weeks. So, PetCare will not cover his heart at all.
Anyway, I decided to cancel the policy and have begun to put the money I would have spent on insurance premiums into a "health fund" account for Riley. Given that the insurance would only have "reimbursed" me anyway, I still would have had to spend my money on his health care up front. This way I don't have to deal with being on hold, lots of paperwork, and frustrating Exclusions. :bang: I will make sure that I do the best to take care of my furbaby without insurance.

OK PetPlan insurance members, I emailed (I like everything from regarding any contract in writing) about the Flow murmur detected by the breeders vet. This is Petplan's response
"We would go by the medical records received for treatment done while under your care. There would be no way of knowing what puppies had the murmur or not under the breeders care because they are usually list as puppy # 1, puppy #2 etc. "

If they are being 100% honest, that is great news. However, should I be worried about a loop hole in the fact I mentioned the murmur at 6 wks to them in writing or to my vet so she could check it out? How I hate we cant trust them - I dont have issues like this with my house/car insurance - I know when I make a claim I am covered, this has me all bent out of shape because of what Molly is going through. It makes me think they will come back at me in 5 yrs due to heart etc.. I'm I over analyzing and others have no issues making claims etc with PetPLan?

I have concerns about SM, questions about insurance...

Hello all,

I had been wondering about pet insurance and whether or not to get it. Then I found out that they do NOT cover genetic medical conditions, so I thought, well, what good is that!? Okay, it's good for thinks like - God forbid - getting hit by a car, etc. but certainly not the conditions we are more likely to have expenses for.

Also, I read an article in Consumer Reports where they looked at the expenses of your average dog's medical problems, what was covered by several different insurance companies, and whether or not having insurance would save the owners money, and they concluded if you just SAVE your $25/mo premium, you'll have the money you need when you need it.

So I decided against it.

Am I saving $25/month? Well, I've had Molly for 2 months now, and no, I haven't saved any money, but I keep thinking, "I can easily come up with $50"... but when will that no longer be a true statement!?

I just read Molly's Mom's post that suggested getting the pet insurance as soon as you get your puppy, so now I'm thinking maybe I should invest in it...?

Molly's Mom, do you think (that should say, do you KNOW) that if you had gotten the insurance from Day 1 that your Molly would have been covered for her genetic medical expenses? If so, I'll start my coverage right now.

The reason I started reading Molly's Mom's posts to begin with - and I haven't finished reading them yet - is because I wanted to find out more about SM. I was so sad when I saw the photos of her pretty little face that reminds me of my own little girl, also a tricolor named Molly. I was looking at the photos AFTER the surgery (update on 5/24), but they brought tears to my eyes just thinking about what she had to go through. I haven't read about her experience yet, but I am glad to have read the END of the story first and know she is recovering well.

I have noticed that my Molly is scratching a lot at (mainly) her ears. I've gotten her ears checked twice now and they say she nas NO infection or mites, etc... just wax/dirt. I happened to be reading about the medical conditions that Cavaliers are prone to, and found the symptoms of SM, and started thinking, "Hmmm... could this be the reason Molly is scratching so much??" The article I read also talked about scratching when wearing a collar (which she also does, but not on walks), and yelping for no reason (which I have attributed to wanting attention). She seems to be a very happy little puppy and doesn't seem to be having any pain, so I don't know if I'm being paranoid or what. I know these things could also have another explanations, but I don't want to ignore them and find out they are something serious.

Sorry for the long post. I feel I need all the advice and help I can get, so please feel free to share your opinions. I would surely appreciate it.

-laura

lb0024 said:

Molly's Mom, do you think (that should say, do you KNOW) that if you had gotten the insurance from Day 1 that your Molly would have been covered for her genetic medical expenses? If so, I'll start my coverage right now.


-laura

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Hi Laura,

Let me start by saying that your Molly sure is a cutie, of course I am especially fond of Tri colours named Molly

I wrote a big long response to your question earlier and when I went to preview it, it disappeared and I didn't have time to rewrite it.

Petcare insurance does cover hereditary/genetic diseases if the condition is not diagnosed, noted, or symptomatic prior to coverage. This is where my problem was. My vet did not note any symptoms or diagnose SM, but the MRI Vet put in his notes that Molly had been scratching for a couple of months. I did end up being reimbursed but only after Molly's vet wrote them a professional but stern letter. I do believe that if I had gotten the policy when she was a puppy this would not have been an issue. Petcare's policy is not underwritten until you make your first claim, that's when they go over your records with a fine tooth comb. Whatever exists in your records at that point become either temporarily or permanently exluded.

If I had to do it all over again especially with a Cavalier and now knowing first hand how costly veterinary care can be, I would get a policy as soon as possible (before too much information is listed in my puppy's chart ), and get the highest coverage I could afford. There is another pet insurance company in the states that covers hereditary conditions, I can't think of the name off hand (you can always do a search). I believe it has higher coverage, but with a co pay.

I can't tell you specifically at what age Molly started scratching her neck. But it became a pattern when she was about 16-18 months old. Left sided, which increased to touch sensitivity (touch her neck and she wants to scratch) and trying to scratch while on lead at about 20months. It was at that point my gut instinct told me she had SM.

That being said, puppies are wriggly, growing, little fur babies who i'm sure have itchy skin on occassion. You can always try keeping a record of the scratching and look at the videos of affected dogs scratching and compare. But most of all try not to panic and just enjoy your baby.