How to File a Pet Insurance Claim: Step-by-Step Instructions (2024)

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• Most pet insurance plans allow you to choose your vet.
• You'll be reimbursed based on your policy, but you have to pay your vet first.
• Filing your claim correctly prevents delays in reimbursem*nt.
• Compare pet insurance coverage options and rates with Petted.

Over years of working as a veterinarian, Dr. Brian Evans has seen significant advances in the veterinary system's ability to care for pets. While that is good, it has one major downside: increased costs. Those costs are leading more and more pet parents to purchase pet insurance, something Evans sees as a no-brainer.

"One bad weekend in an emergency room can cover years of the insurance premiums, plus give you the peace of mind that you don't need to sacrifice care for your pet," Evans says.

Overview of the pet insurance claim process

Unlike human medical insurance, which pays the providers directly, even the best pet insurance plans provide reimbursem*nts. That means you'll pay for the care upfront, and then receive a portion of the cost back from your insurer after you file a claim. The exact number will vary based on your deductible, coinsurance, and policy limits.

While filing a pet insurance claim might seem like a hassle initially, it's well worth the effort. Filing your claim and getting reimbursem*nt allows you to provide the best care possible for your pet without compromising your financial health.

Preparing to file a claim

Before ​​completing a pet insurance claim form, you must pay the veterinarian for their services. You can pay via cash, check, or credit card with most vets. Many vets will also work with CareCredit or other short-term loan programs to help you fill the financial gap while your claim is processing.

Documentation needed for a claim

These are the necessary documents for pet insurance claims:

• Vet invoice: Get an invoice detailing your pet's treatments or services and the cost of individual services. The bill will be the basis of your reimbursem*nt claim.
• SOAP notes: Ask your veterinary office for a copy of the SOAP (subjective, objective, assessment, and plan). This is a written document showing why a treatment was used. You can use it to justify the treatment to your insurance company.
• Medical records: To prove a specific condition should be covered, you must send in your pet's medical record to confirm it's a new ailment, as pre-existing conditions aren't covered.

Timing considerations for filing

If you've recently purchased a pet insurance policy, a waiting period on certain conditions may also apply. In that case, your insurer won't cover the condition until the waiting period has passed. For example, with Lemonade pet insurance, you can expect a waiting period of:

• 2 days for accidents
• 14 days for illnesses
• 30 days for orthopedic conditions
• 6 months for cruciate ligament events

Additionally, pet insurance plans only cover conditions diagnosed after you purchase the plan. The best way to simplify the conversation about what pet insurance covers is to buy a plan when you bring your furry friend home for the first time.

Choose carefully, as any known condition becomes a preexisting condition if you switch insurance companies. You can change plans without triggering this issue, but not companies.

Step-by-Step guide to filing a claim

While it's easy to miss deadlines, especially when your furry family member experiences a medical crisis, be sure to file your claim as soon as possible. Most insurers will only process claims filed within 90 days of treatment. To ensure your claim is processed promptly, follow these tips for filing pet insurance claims.

Step 1: Gather and submit the necessary documentation

Follow directions closely and attach all the supporting documents, including your paid invoice, SOAP notes, and pet medical records. Submitting the required documents at one time prevents delays in coverage.

Step 2: Notify your insurance provider by completing the claim form

Now that you have your supporting documents, you must file a claim. What this looks like depends on your insurance company. Some allow you to fill out a form via a mobile app, while others require you to print out and fax or mail the claim form to a set address. Lemonade allows pet parents to record a short video to describe their pet's medical claim.

Step 3: Follow up on your claim

To ensure you don't miss out on reimbursem*nt, contact the company to confirm your claim was received. If some time has passed, follow up to ask for the status of your claim. Your insurer may require additional information to complete processing.

If your claim is approved, you'll receive a check or direct deposit. If you took a loan with CareCredit or a similar organization, you could repay all or part of your loan with the reimbursem*nt.

Understanding the reimbursem*nt process

If you're making snap decisions about which treatments to authorize for your pet, finances may be the last thing on your mind. Unfortunately, pet owners generally underestimate the cost of emergency care, which can leave them in a precarious financial position.

How reimbursem*nts are calculated

Knowing the reimbursem*nt process for pet insurance can keep you financially savvy even when emotions are high. Plans typically reimburse between 70-90% of the cost of eligible services. Pet parents should also pay attention to the maximum limits.

For example, if your policy caps out at $10,000, you could quickly exhaust your annual limits with one major emergency. On the other hand, unlimited benefits will cover you if you can afford the 10% to 30% that your coinsurance demands. When you have those numbers in mind, you can be realistic about what procedures you can and can't approve.

Typical timelines for claim processing

Many pet insurance companies brag about processing claims in one to two days. But, especially the first time, this probably won't happen. We recommend calling your pet insurance company if you're unsure at any point in the claims process. You can ask about expected timelines and if they need more information from you.

Tips for a smooth claims process

Insurance claims can be frustrating. These steps ensure your claim process goes smoothly.

Keeping detailed medical records

Your pet insurance company needs your pet's medical records to verify that the condition being claimed isn't preexisting and is covered under your policy. If you don't have updated records on hand, contact your vet to obtain them. If it's been a while since your last checkup, a pet insurance company may wait for your next vet visit.

Take a look at the following information your pet's medical records should have:

• Identification details (pet's name, breed, age, identifying details, etc.)
• Vaccination history
• Medical history
• SOAP notes
• Medication records.
• Veterinary visits
• Diagnostic test results.
• Preventive care records

Understanding your policy's coverage

Before you can file a claim, you need to know what your pet insurance does and doesn't cover. There are a lot of variations in pet insurance plans. So do your due diligence before you need coverage.

"Make sure to check the fine print," says Dr. Rebecca Greenstein, a veterinarian with Rover.

Submitting a claim for routine vaccinations, for example, is pointless if your plan only covers emergencies. Likewise, some accident and injury policies cover acupuncture, chiropractic care, and other alternative treatments.

Also, take a look at your policy exclusions. Every pet insurance company defines "preexisting conditions" differently. Some companies cover "curable" preexisting conditions with a specific waiting period.

The trickiest part for many customers is determining what is and isn't a preexisting condition the first time and evaluating the cost of pet insurance before they need it. "I highly recommend purchasing pet insurance the day you get your puppy," Evans says. "If you wait until they get sick, it will be too late and could potentially exclude them from coverage for the rest of their life."

After that, everything else should follow your policy documents. So if you have a 90% coinsurance rate, you'd be reimbursed for 90% of the bill after your deductible is satisfied. Your policy documents are like a roadmap, offering a guide to what specific services are covered, common exclusions, etc.

Make a habit of reviewing your policy once a year to keep it fresh in your mind. Knowing these details can save you a lot of frustration and unexpected expenses.

Communicating clearly and promptly with your insurer

Accurate claim filing ensures that you receive your reimbursem*nt in a timely manner. Communicate with your insurance company if you have questions about your coverage before filing a claim.

Sometimes, insurers will deny a claim. If that happens, check your insurer's appeal process. Get as much detail as possible on why the claim was rejected. Then ask your veterinarian if they can provide additional information to address the issues leading your insurer to deny the claim.

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