Advice re insurance claim please

[JamieFrasersSassenach]

Hi,

Hoping someone who works in a vets, pet insurance or who has even experienced something similar can give me some advice please?

Ddog is booked in to our vets on Monday for cruciate surgery. Our insurance has an inner limit of £500 for cruciate and an additional £1500 cover. The surgery cost is £2600 including all aftercare/follow up consultation and x-rays.

Having spoken to the insurance company they have said that the inner limit covers the actual operation and all other costs can be covered under the £1500.

My vet is saying they will only claim £500 and we have to pay the other £2100 because they are unable to break their costs down for the insurance company.

I am more than a little peeved about this.

Can anyone offer any advice on how to deal with this please?

Thank you

[BiteyShark]

Sorry not a vet or insurance specialist but at my local vets absolutely everything is broken down completely (one invoice involved about 3 A4 sheets of everything listed).

However, when we went to a specialist animal hospital they listed each operation as one set price so maybe it's because of something like that.

[JamieFrasersSassenach]

Thanks @BiteyShark - I'm aghast that they won't break the costs down - they get paid either way, but I would far rather have the extra £1500 in my bank account than the insurance company's.
I'm wondering if I can find another vet who will do the surgery costed out separately.

[DarlingWithoutYou]

Shop around vets and explain your predicament.

[JamieFrasersSassenach]

@DarlingWithoutYou even though surgery is booked for Monday morning and my insurers have pre authorised it with the current vet?

[BiteyShark]

Phone your insurance company back up. Explain the problem, ask if you are ok to phone around next week to see if you can find another vet and the reasons why.

If the insurance firm says they are ok with you pausing this one to try and find another then I would in your situation if my dog wasn't in pain e.g could wait a few days/week for the surgery.

[JamieFrasersSassenach]

@BiteyShark

Phone your insurance company back up. Explain the problem, ask if you are ok to phone around next week to see if you can find another vet and the reasons why.

If the insurance firm says they are ok with you pausing this one to try and find another then I would in your situation if my dog wasn't in pain e.g could wait a few days/week for the surgery.

Thanks @BiteyShark that's exactly what I am going to do - as soon as my insurance company opens this morning

[Medievalist]

Not sure I follow. So insurance will only pay £500 towards an operation that runs into thousands? But any associated costs can be claimed out of the extra cover? Does that just mean aftercare? Presumably that will just be an X-ray and follow up consultation though, which will be maybe about £300?

At the moment you might have to wait more than a few days/week for someone else to do the op.

[currahee]

I process pet insurance claims for a veterinary group and I'm not sure I follow either - have you got the actual policy wording? I understand having a lower cap on specific procedures but not one that would allow you to spend a separate pot of £1500 on the same procedure, surely all associated costs relate back to the cruciate.

[Lonecatwithkitten]

So the insurance will pay just £500 for the cruciate surgery and £1500 for the aftercare.
Very bizarre policy.
£500 is nowhere near enough to cover the actual surgery it will be costing roughly £1-2K.
The practice are offering to create a global bill to try get round this bizarre policy. But if they provide a detailed invoice it will be really clear that the actual surgery cost far more than £500. No practice should lie as to how the costs are broken down it would be insurance fraud and false certification.

[JamieFrasersSassenach]

It is really weird - they are saying that the whole package - surgery, aftercare, follow up 6 week consultation and x-ray are all included for one price - £2700.

The inner limit for cruciate surgery is £500 so the insurance company have said to me that if for example the surgery cost is £1500 they will pay £500 and I will pay £1000, they will then pay up to £1500 for the aftercare - so if that is £1200 they will pay for that (I have plucked those figures out of thin air - no idea if they are accurate)

Vets are telling me that because it's a package they can't itemise the costings so it will all fall under surgery and so I must pay £2200.

Ins company letter to vets says they authorise the treatment within the two limits and will require a full breakdown of costs once treatment is completed.

I just cannot understand why the vets can't say - this is the cost of the follow up consultation, this is the cost of the painkillers, this is the cost of the x-ray at 6 weeks post surgery - because I can claim for those - but only if I can provide an invoice with those costings.

I have looked on the RCVS website and it clearly says that customers must be provided with a fully itemised invoice for any procedure/services provided.

I'm now hoping that the person dealing with the insurance at the vets is just inexperienced and in a middle (she did initially tell me I would only have to pay £600 until I double checked re inner limit - she then said oh no I've read it wrong you have to pay £2200 before we do the operation).

I am losing the will to live with it all if I'm honest!!

[JamieFrasersSassenach]

So this is what the ins co have sent the vet. When I phoned the ins co they told me the inner limit splurges to the actual operation - all other costs associated can be claimed out of the remainder of the cover which is £2000 for each condition per year. The insurance guy told me that means the initial consultations and follow up aftercare all fall into those associated costs.

[Lonecatwithkitten]

Can I ask who you are insured with as I am curious as to who puts such a crazy low limit on a TPLO surgery and why - as TPLO is pretty much the gold standard.
I would be also curious as to whether they have other weird crazy exclusions.
Breaking down the actual surgery will be around 75% of the £2700 the appointments and x-rats etc around 25%.

[BiteyShark]

I know this doesn't help you OP but for anyone looking at this thread and thinking about insurance this is why I recommend not having a limit per condition. It's better to have an overall amount each year you can claim simply on 'vet fees'.

[Floralnomad]

If they are going to only pay £500 for the actual surgery it won’t really make a lot of difference which vets you use as the aftercare is going to be a minimal amount of the total cost , it’s the surgery that is the main cost . I’d be changing insurance companies

[currahee]

The closest I've seen to that wording is Scratch and Patch.

Again no help to the OP I'm sorry but for the sake of anyone reading for insurance advice, bear in mind that many practices will refuse to do direct claims or charge you for doing so, possibly with the exception of a few approved reputable insurers, for exactly the reason that some have crazy limits and unreasonable exclusions.

[Medievalist]

I’d be changing insurance companies

Except further leg ops and any other pre-existing conditions are likely to be excluded by any new insurer.

[JamieFrasersSassenach]

It's Legal and General, not a top paying policy - so I have no issue with the £500 limit. What I have an issue with is not being able to claim any of the other costs, or even know how much of the package is actually the cost of surgery, because the vet will not break the fee down.
Even if i can only claim an extra £500 then I should be able to do that - but the vet practice seems to be standing in the way of that.

[PurpleM]

I did a pre-auth for referral vets and they sent off a full invoice quote which could (& did) vary based on findings on the day as more xrays taken etc. I assume vets system is set up to charge specific things per treatment/op as was very detailed down to syringes, glove/gown costs.

Its a very low limit for surgery do you also have an excess to pay? Ultimately you are responsible for paying the vets bill and the vets don't have to accept a direct claim, I suspect they feel its a risk insurers won't pay out quickly or try to quibble on this odd associated cost pot & end up carrying the debt. However they should tell you if its that's the case, I'd ask if can speak with vets practice manager or person that processes the insurance claims for clarification.

[JamieFrasersSassenach]

Thanks @PurpleM - that makes a lot of sense actually.

I am wondering if once the treatment is complete I will be able to claim the non surgery costs back.

I have been in contact with the person who processes the insurance at the vet practice - all she keeps doing is repeating that because it is a package they don't break the bill down and so I have to pay all but the inner limit. To be honest if I can claim the follow up costs back in retrospect I will be happy to do that, I will check on Monday if that is the case.

[BiteyShark]

As for changing insurance as PP mentioned although you will have preexisting conditions excluded it might be worth seeing exactly what list that would be and weigh up the pros and cons of having a better policy for everything else. BBM actually have a policy that will cover them but you would need to look at the T&Cs carefully.

£500 is so small it's kind of worthless having it for me. I have £4000 per year for any vet fees but even that I now consider to be low although my list of preexisting covers about the whole of his body so yes it's worth me keeping mine.

[JamieFrasersSassenach]

Is that £4000 inner limit @BiteyShark ?

I have £2000 cover but £500 inner limit for cruciate surgery.

It is a low policy - I knew that when I took it out 7 years ago and I don't have any issue with that. I just want the vet to use a clear itemised charging structure to enable me to claim for more than just the actual operation.

[BiteyShark]

I am with petplan and for vet fees I have a limit of £4K per year. It doesn't matter whether that is spent on an operation, investigations, admissions, drugs etc.

As long as it's not a preexisting condition (we don't have any) or excluded then I just claim. If I hit that limit then I have to wait for the renewal (I have a life policy) and it gets reset again.

The £4K per year limit is not split up or ring fenced at all so it could be made up of many claims or one operation iykwim.

[BiteyShark]

Sorry should say I have been with petplan from the start so I don't have any preexisting conditions with them but would have a list as long as my arm if I moved companies because I have had many many claims for various things over the years.

[JamieFrasersSassenach]

Ah ok, I see - I didn't go with petplan at the outset because the premiums were much much higher than a lot of other ins companies. I have been lucky and never needed to make a claim in that 7 years until now so I'm happy with the level of cover given how much I have saved in monthly payments. I would just like the vets to be a bit more transparent about how they will split the bill so that I can claim the maximum I can.

It may be that from the next renewal I increase cover or consider changing ins companies - ddog is 7 so I know who ever I insure her with it will be considerably more expensive from the next renewal.

As I say though that isn't what I am concerned about. It simply is the vet practice saying that they will not itemise the bill for me. To be honest I wouldn't take my car for a service and not expect an itemised invoice. I pay an annual package to the vet for ddog's injections, workers, flea treatments, bi-annual check ups - I can see very clearly what each of those items cost if I pay separately so I just do not understand why the treatment package for cruciate surgery cannot be set out in that way. As I said in a pp - even if I pay for it all up front and then receive an itemised bill once treatment is complete, I can then go back to my insurance company, but the vet practice are saying that they will not itemise the bill.

[JamieFrasersSassenach]

Wormers not workers!