FYI...for those of you that have VPI...this article was in today's Chicago Tribune:
Dog's fix gives insurer pause
Pug had surgery to treat ailing hip
Jon Yates | What's Your Problem? December 19, 2007
The surgery was more than $2,000, but Klaus the pug was limping so badly that Mariel Demler decided she had no choice.
Besides, she thought, this is precisely why she bought pet health insurance -- for emergencies. In the literature provided with her $20-per-month policy, treatment for Klaus' ailment, an operation called a femoral head ostectomy that involves removing part of the hip joint, was covered.
So on Sept. 20, 11-month-old Klaus went under the knife.
To pay for the operation, Demler opened a line of credit through the veterinarian's office. Then she submitted the bill, $2,486.45 including the diagnostic work, to her carrier, Veterinary Pet Insurance.
She knew the entire amount would not be covered. Discounting for co-payments and certain exclusions, Demler calculated she was entitled to $909 for the operation, and several hundred more for the diagnostic tests.
Veterinary Pet Insurance calculated her benefits a bit differently: $0.
The insurance company, which formed in 1982 and now insures almost a half-million pets, denied her claim entirely, saying Klaus' condition might have been hereditary, excluding it under the policy.
Upset, Demler wrote the insurer on Oct. 23.
She said there was nothing to indicate Klaus' hip problem was hereditary, and nothing in the insurance company's fine print that justified such a determination.
"I understand that you are a business first and foremost, and there are times lesser claims must be denied so that larger claims can be paid. I get it," Demler wrote. "But this is a major claim. This is the entire reason that I signed up with VPI. This is why I have been paying my premiums every month."
She tried to get Veterinary insurance to change its mind, but it wouldn't. So she wrote What's Your Problem? for help.
"It seems pretty arbitrary. [The insurance company] can decide to exclude just about anything," she said. "I just think it's a total crapshoot in terms of what they're going to cover."
The Problem Solver called Veterinary insurance spokesman Brian Iannessa, who forwarded Demler's information to the company's claims department. The claims department then contacted Klaus' veterinarian, who supplied the pug's medical records.
After reviewing those records, Veterinary insurance determined Klaus' hip problem could have been trauma related, which is covered under Demler's policy.
So the insurer reversed its earlier decision and agreed to pay Demler $1,040.94, covering portions of the surgery, the diagnostic testing and anesthesia costs.
"Since there was some confusion [about the diagnosis], we decided in favor of the policy holder," Iannessa said.
Iannessa said Veterinary insures about 450,000 pets, making it the largest pet insurance company in the country. Policy holders who aren't happy with a claim can call the company, he said, and ask why it was denied.
"If they ask us to do a review of the claim, we will do it and send it to our disputes department," he said. "We can work with the vet and see if there's anything that was missed the first time we processed the claim."
Iannessa said that if Demler had requested a second review of her initial claim earlier, she would have gotten her $1,040.94 check more quickly.
As of Tuesday, the money still hadn't arrived in Demler's mailbox, but she did receive a call from a Veterinary representative Monday night, saying the check is on the way.
"It's just such a relief," she said. "I guess they're reimbursing about half. As far as insurance goes, I wasn't expecting more than that. I was expecting less."
Demler said she will use the money to pay down the credit account she established to pay for the procedure. Under terms of the account, her first three months were interest free. Starting in January, the interest rate climbs to 22.98 percent.
"At least now I can pay off this huge chunk of it," she said. "It won't be so bad."
Klaus still walks with a bit of a limp, but Demler said the pug is getting better every day.
"He's a happy guy," she said. "We went to a holiday party where there were a lot of pugs and he was running around. He's doing really well."