How To File a Pet Insurance Claim

Obtaining pet insurance for your dog, cat, or potbellied pig is only part of the story. At some point, you will likely have to file a claim. As pet insurance usually follows a reimbursement model, it’s good to know how that process works and when to expect your money. This article takes you step by step through the claims process.

Step 1: Conduct a ‘Direct Pay’ Pre-Check

If your insurance is one of the few that offer to pay your vet directly, and you want to use it, you need to check with the vet’s office to make sure it accepts direct pay from your insurer before seeking treatment for your pet. As direct pay is an option, if your vet doesn’t accept it, you will be shifted to the insurer’s reimbursement plan if you go ahead with the visit.

Step 2: Know Your Waiting Period

Almost all pet insurance policies have a waiting period of from 10 to 30 days from the date the policy starts until coverage begins. Make sure you are past the waiting period before seeking regular care. If you are dealing with an accident or serious illness, the waiting period may not matter, and your pet will likely not be covered for this event.

Step 3: Review Policy Coverage, Terms, and Conditions

To avoid financial surprises, make sure you know whether the treatment your pet needs is covered by your policy, as well as all pertinent terms and conditions.

• Preexisting Conditions Exclusion – Most policies won’t pay for congenital defects, hereditary conditions, or anything diagnosed and treated prior to the policy start date.
• Other Exclusions – Often excluded are preventive treatment or wellness care, dental care, vaccinations, flea prevention, spaying or neutering, and behavioral training. Note: Some policies come with a wellness rider that does cover these exclusions.
• Deductible – This is the amount you pay before coverage kicks in (after the waiting period). Some policies have a per-incident deductible; others are annual.
• Co-Pay – Once you meet the deductible, you may have to pay co-insurance or a co-pay. If your reimbursement rate is 80%, your co-pay is 20%, for example.
• Limit – This is the maximum amount (per incident and/or policy term) you will be reimbursed.

Step 4: Obtain a Claim Form and Fill It Out

Insurers offer claims processing in several different ways. Many use online claim forms or a mobile app. Others let you download and print out the claim form. Familiarize yourself with the process used by your insurer by going to the insurance company’s website and looking for the claim filing section—preferably before you need to file one.

Once you have access to the claim form, collect whatever additional documents you need, including paid invoices from the vet and any required medical records, such as the SOAP (subjective, objective, assessment, and plan) notes for the specific treatment your pet received.

Carefully complete the claim form, making sure you describe treatment, not symptoms, and follow all instructions completely. Your vet’s office can provide help if you need it.

Step 5: Submit the Claim

Once you have completed the claim form and gathered all documentation, submit your claim online, via mobile app, email, fax, or by regular mail following instructions for including invoices and medical records depending on the process you use.

Step 6: Verify That Your Claim Was Received

Depending on your insurer, you may receive notification that your claim was received, or you may have to check with the insurer to get that information. How long that will take will likely depend on the process you use. If you submit online or via a mobile app, notification may be almost instant or within 48 to 72 hours.

Step 7: Wait for Claim Review and Processing

Some insurers say they process most claims in 24 hours, but 15 to 30 days is more common. Many insurers will want to review your pet’s medical history when you file your first claim. This will extend the time it takes to process this claim, with all subsequent claims processed on the insurer’s regular time frame.

Your insurer may contact you during the review process to request additional information. Make sure you respond quickly, as the request likely resets the time clock on review and processing.

Step 8: Receive Notification of Approval or Denial

At the end of claim review and processing, you will receive notification that your claim was approved or denied in full or in part. You will also find out the amount of your reimbursement. Approval may come with a check for the amount of the reimbursement or via direct deposit if you signed up for that ahead of time.

Step 9: Cash the Check or File an Appeal

If your claim is approved and you agree with the amount of reimbursement, you’re finished. If your policy includes direct pay to the vet, you will be notified that the veterinarian has been paid and whether you have a balance due. If you disagree with the finding, your next step is to file an appeal.

Step 10: Know How and Where To Complain

The appeal process begins with your insurer. Check the insurer’s website for a section titled “Appeal” or “Claim Review.” Follow the appeal process instructions and be prepared for that process to take up to 30 days, just like your original claim.

If the appeal process proves unsatisfactory, contact your state insurance commissioner’s office. You can obtain contact information through the National Association of Insurance Commissioners (NAIC) or on your state government website.

The Bottom Line

Knowing how the claims process works will help ensure that you get the coverage you bought. Be sure to gather the records you need, so you have backup for your claims. If you don’t receive your check, make the extra effort to appeal your case.