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Taking your pet to the vet is often a stressful event—especially if the pet is severely hurt or sick. At that moment you’re focused on nursing your pet back to health. And the looming, unknown veterinarian bill may be on your mind, too.
Pet insurance is a financial safety net for situations like this. With its reimbursements for vet charges for accidents and injuries, you can visit the vet with much less fear about how you’ll manage to pay a giant bill.
Understanding how to file a pet insurance claim before something happens can make the whole event less anxiety-ridden.
Related: Best pet insurance plans
How Do You File A Pet Insurance Claim?
You’re likely familiar with the process of submitting a (human) health insurance claim. You or your doctor sends a claim to your insurance company, which then pays expenses that fall under your coverage. You pay the remaining balance not covered by insurance.
There are usually two ways to submit a pet insurance claim—by either requesting reimbursement or paying the vet directly.
Request reimbursement. With the reimbursement method—the most common method among pet insurance companies—you first pay out-of-pocket for the vet bill and then the insurance company reimburses you for covered expenses. You will:
- Pay the veterinarian bill right after the visit.
- Complete a pet insurance claim form.
- Submit the claim and supporting documentation to the insurer via an app, online portal, email, fax, or mail.
Once you submit a claim and it’s approved, you’ll get reimbursement via direct deposit or check.
Pay the vet directly. Some pet insurance companies like Pets Best and Trupanion have the ability to pay the vet directly. With Vet Direct Pay by Pets Best, the insurer pays a vet directly after a claim is approved—as long as your vet agrees to this form of payment. This means that you won’t have to pay and wait for reimbursement.
Trupanion has its own claims processing system—Trupanion Express—that gives the vet the capability to submit claims via a web-based system.
Verify the specific process with your own pet insurer.
Avoiding Claim Payment Surprises
It’s also good to be familiar with what your plan will cover, so you’re not surprised by the amount of a claims check.
For example, you may have forgotten the level of coverage you bought when you originally purchased the pet insurance plan. Pet insurance typically doesn’t cover 100% of vet bills. Check your policy for:
- Your deductible: You’ll have chosen a deductible such as $250. This will automatically be deducted from your first claim of the policy period.
- Your reimbursement level: This is like co-insurance for a pet plan. Plans generally pay 70%, 80% or 90% of eligible vet bills—after the deductible.
- Coverage maximum: Check for the annual coverage cap, such as $5,000. Vet bills over the cap won’t be paid. Some plans offer unlimited annual coverage.
Related: What does pet insurance cover?
What You’ll Need to File a Claim
When submitting a pet insurance claim, here’s what you generally need to include:
- Itemized invoice of the visit. The veterinarian bill should show all charges, discounts, taxes and all other fees. Make sure to grab your invoice at the time you pay, and verify it shows a zero dollar balance.
- Claims form. Some insurance providers will require a claim form. However, if you’re using an online platform like MyEmbrace from Embrace Pet Insurance, all information is entered right from your log-in, so you don’t need a separate form.
- Veterinary medical records. To file your first claim, you must submit your pet’s medical records. Since pet insurance coverage usually excludes all pre-existing conditions, the medical records help identify any conditions the pet had before coverage began.
- Bank routing and account number. Some pet insurance companies offer electronic reimbursements. If you want to receive an electronic payment, make sure you provide your bank account information.
Wait Time for a Claim Payment
Since the claim process varies by insurer, so will the time it takes to get your reimbursement. As long as you send in all of the correct paperwork, insurers usually turn claims around in five to 14 days.
But the pandemic stretched out claims payments times. “In the last year, the pandemic has made the biggest impact on turnaround times for claims,” says Alex Stone, founder of PetInsurer.com, a pet insurance comparison provider.
“Because some insurers weren’t set up for a remote work environment, it took them a little while to have staff fully set up at home. This slowed the claims process down, and then, as millions more pets were adopted during Covid, it only made the process more clunky. Happily, claims processing times have now pretty much returned to pre-pandemic levels,” says Stone.
How to Avoid Pet Insurance Claim Problems
“Fundamentally, the reason to buy pet insurance is to use it. So knowing that you’re going to have a claims process that’s efficient, simple, and is going to work, gives consumers peace of mind and confidence in their purchase,” says Walter Haugland, a spokesperson for Pets Best.
There are things you can do to ensure the claim-filing process goes without a hitch.
Be confident that your claim is valid. “Before you submit a claim, make sure it’s for a new condition that occurred after any waiting period expired,” says Stone. “If your pet was showing signs or symptoms, had been to the vet, or was taking medication for this condition, then understand it’s likely not covered by the insurance company.”
Follow the claim instructions. Every insurance company has a different process for claims. It’s important to follow the claims process and avoid cutting corners on tasks like sending the necessary documents.
Submit your claim right away. Because some insurance companies limit the time they pay out claims after treatment, it’s in your best interest to get the process underway as soon as possible. For example, you might have 180 days from the treatment date to submit your claim and the paid invoice. Check your policy to verify the plan’s deadline.
Being prompt can ensure you address any claims hiccups promptly. Plus, unless the insurer can pay the vet directly, you’re waiting for your money.
Provide all medical records. This may require making multiple calls. “Often, there are multiple vets involved in pet care, and insurers may require all medical records from all vets. Therefore, whether it’s your first or fourth claim, you may need to ensure all medical records are sent to the insurer,” says Haugland.
“If you don’t provide all medical records upfront, the insurance company will likely reach out to you and the vet directly, which usually slows down the claim-filing process.”
Be communicative. If your pet insurance company requests further documentation, try to send it promptly. Ask your insurance company what kind of waiting time to expect for payment and how you can expedite the claim.
Appeal if you’re not satisfied after a claim denial. If you find out a claim was denied because the treatment simply wasn’t covered by the policy, you may decide not to pursue the issue. But if you disagree with a denial, ask the insurer what their appeals process is. For example, with Pets Best, if you disagree after the first appeal (for example, due to medical facts), they will bring in a third-party vet to conduct another review. After that, the vet’s decision will be final.
If the claim issue is still not resolved to your liking, you can make a complaint to your state’s insurance department. Insurance departments are responsible for regulating insurance companies and monitoring patterns of complaints, so they are the best place to take a grievance.
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How To Make A Pet Insurance Claim - Forbes
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