lilypoo

Lily was seen by our emergency clinic on 11/14 and then again on 11/24 for allergic reactions. The first was facial swelling and the second full-blown anaphylaxis. On my claim form for her insurance, the vet marked that it was a continuation of a prior claim because the vet felt that the offending allergen (likely some sort of insect) was the same thing and that the anaphylaxis was a progression of how she is reacting to this whatever-it-is. But my health plan refuses to acknowledge it as a continuation and is regarding it as two separate health issues.

I'm wondering if I'm being unreasonable in wanting to complain that they've ruled it separate. Part of the issue may be that they have not processed the claim from the 14th because there's a line through the paperwork I faxed in and they claim they cannot read the amount (even though I called and the person I spoke to could read it and was supposed to push it through). I'm just not sure how to proceed with them and I'm a bit annoyed that they're dragging out the first claim (and another we have in queue) for something silly!

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*Chelee*

plumcrazy

Have you ever read John Grishom's book "The Rainmaker" (or seen the movie?) Insurance companies can/will/do deny claims if they can (or will try to do what they can to save money...) I don't have pet insurance, so I'm not sure how it works, but if I were in the situation you described, I would be on the phone with the insurance company. I would be talking to whoever could give me the answer I wanted - if the first person doesn't "get it", I'd ask to talk to their supervisor, and so on... if your veterinarian classifies this as a continuation, I can't see how the insurance company (who wasn't present in the room for the examinations/treatment) can argue with that.

I would definitely let the person on the other end of the line at the insurance company know that there is another claim pending and that the second one is a continuation of that one - and don't take "no" for an answer... Stick to your guns!!

Good luck!

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There is no rule requiring that you attend every argument to which you're invited...

liljaker

I agree with Plumcrazy.....stick to your guns and insist. I doubt they will want to "lose" you at this juncture.

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Jessie's Mom

i have pet insurance. recently jessie underwent almost $1,000 in tests to rule out any serious disorders that could have been causing her regurgitation. she was seen by her regular vet and a specialist. one of the claims was coded as "diarrhea" as opposed to regurgitation, most were coded as "vomiting". as a result, i was told i didn't meet my deduction for the year (my deduction is per incident). well i raised hell until i found the person who said "oops, our fault". if i were in your shoes, i wouldn't give up until i got satisfaction, just like PC said.

rikkia

It probably isn't much help to youbut when you submit a new form insist the vet lists it as 'Continuation of XYZ' symptom and lists the actual symptoms elsewhere on the form.

Poppy had recurrent chronic ear infections with one every two to three weeks. During the testing process the vet did allergy panel tests, blood work, cultures and eventually we had to resort to surgery but the vet was sure to list the main condition on the form as 'Acute Otis Externia' for each form submitted.

That may help somewhat as once they pay out on the first form anything listed with the same condition on subsequent forms has to be paid for as the insurance company admitted liability for the condition by paying for the first claim.

I also agree push for it to be classed as one condition otherwise they can use exemptions against you down the line depending on the type of insurance you have.

SusanG

I would appeal the decision. It won't hurt. Vets know how to word those things to help you out. If he put continuation, they should have accepted it. The insurance companies do everything they can to dump you back into the deductible if they can get away with it. Good thing is, there are a lot of companies out there - I wonder if they would be more reasonable if you said you were switching companies