KingstonsMom said:
Judy...would you mind elaborating on the language that PetCare looks for from the vet? What have you been told?
If there's an illness, they are supposed to just put the diagnosis, just one or a few words will do. Later, i will go look at the insurance forms for Zack and see what was written by two of the three vets which got covered.
The third one got covered too, but i had to have her resubmit a new form, and i had to pay an extra deductible because of the language. It wasn't just the vet's fault, it was a confusing situation.
I took him first to one vet and the symptoms weren't showing yet although he'd been acting sick. I left the claim form with her. There was no diagnosis, but he had lab/blood work $180, and SC fluids, and he also had anal glands expressed and toenails clipped, which are not covered. She didn't fill out the form right away, she held on to it.
Then, that night, zack broke out in skin lesions. She was booked (it was a holiday weekend) and i couldn't get him in to see her for the next 5 days, so i took him to a different vet who i'd used before.
The second vet wrote down on the form something like "Skin infection," and maybe one other word, "pyoderma," not sure. The blood work came back that day and was faxed to the second vet, it was two days after it was taken.
That second vet faxed the form to the insurance immediately and they covered it immediately.
I called the first vet (who's my favorite, treatment-wise) and discussed the bloodwork and she made a diagnosis over the phone, pyoderma. But before this, she had already faxed the claim form to Petcare and faxed me a copy. On the form, she didn't write a diagnosis of an illness. She wrote down something like "routine wellness exam." I was like, :yikes
I called and asked her why she wrote that when he was really sick and i brought him in because he was sick, and she said that with the insurance, it's better to start off really general and then let them ask for what they want and then put something more specific. She said that if you put something specific in the beginning, that restricts what they will cover later, if something more broad is needed. I think she was wrong about this, maybe she experienced that with another insurance company, i dont' know. But the insurance, of course, denied the claim for the $350 or whatever it was.
So, then i wrote a letter to the vet explaining what happened and what was needed and sending her another form. A different vet in their office got the fax because she wasn't there, and he wrote a letter to the insurance company (which was unnecessary, Petcare told me they just needed a new claim form with the diagnosis, as i said in my letter to the vet, but he did a new claim form and wrote a letter of explanation (these two vets in this office seem to overcomplicate things).
Then, the insurance company paid the whole claim, but they charged me another deductable because they treated it as another incident. When i called, they said all they needed was for the vet to write "follow up" on the claim form, and then the deductible would not apply.
I never got around to asking the first vet to do that because it was all too complicated and i decided to just eat the $50 rather than make more phone calls and follow up phone calls, i was too busy.
I had also seen a third vet in a third practice who was a skin specialist, and the insurance covered that whole claim (they even accidentally covered the flea medication i got for my cat on that day), that vet wrote "pyoderma from flea infestation" or something like that, and she did not write "follow up" but i was not charged a deductable because it was just four days after the claim from the second vet with a very similar diagnosis, so they could see it was the same incident. The deductible is per incident. All three were for the same incident, but the first one was the one they charged the second deductible for (see, i told you it was complicated). That's why i didn't bother to have the first vet submit a new form saying "follow up," because actually, she was the first vet i saw so it really wasn't a follow up. She would've written it, she said "just tell me what they want and i'll write it," and Petcare didnt' seem to care either, they said even though she was the first vet, if she would just write 'follow up," they were refund that deductible, or the other one. But i just got burnt out on it and paid the $50.
I was just so happy to be getting the claim paid, the total was around $600 or $700 i think. Those things really add up. So i paid $100 in deductibles and they paid the rest. If it had been written up right, i would've just paid a $50 deductible.
all in all, i was pleased with how smoothly the claims were paid. No questions were asked about anything. They just paid.
Another thing: These three vet offices each handled the claim form differently. The first vet office, the one i think overcomplicated things, held on to the form and didn't fax it for a couple of days. The second vet faxed it immediately the same day. The third vet filled it out immediatley while i was there and gave it to me, and i faxed it to Petcare the same day.
I have a preference for the third way of doing it because if the vet office faxes it themselves i still have to call them and get them to fax me a copy. So the simplest was the third way. The hardest was the first one (hardest in terms of follow up phone calls).
The next time i went to the first vet, i asked that the form be filled out while i was still there and given to me so i could fax it to Petcare, and they did that (for his eye injury). so, in the future, i will always ask for that, it saves me time and stress.
The main thing about the language with Petcare is, keep it simple and short and either name the illness or write follow up.
I was confused about what they do if there is no diagnosis. Zack didn't have a diagnosis on the first visit (the one where she later put "routine wellness exam".) But i guess a vet can come up with a provisional diagnosis. Petcare needs to know what category to count it as, i think.