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Pet insurance claims - client information

Making a claim on your pet insurance should not be a hassle. We have a dedicated insurance claims team who are on hand to guide, help and manage insurance claims.

Should you wish to make a claim through your pet’s insurance please notify the surgery in advance of the treatment when possible.

Please read the following guide to making a claim with the practice.

 

  • An indirect claim is submitted to an insurance company once treatment charges have been paid.
  • Payment is made to the policyholder or nominated party.
  • Payments made to the policyholder may be equal to or less than the total claim amount. This varies depending on theterms of the policy.
  • Typical reasons for deductions are:
    • Fixed excess payments
    • Co-excess / voluntary excess / % excess
    • Non insured items such as food, anti-lick devices, and supplements (what is and isn’t covered varies in line with the terms of your cover)
    • Exclusions
  • An insurance processing fee of £12 is payable at the time of handing in a claim form irrespective of claim value.
    We will not process claims where the processing fee remains outstanding.

A direct claim is paid directly to the practice. The policyholder is required to pay any excesses or deductions in advance. Direct claims MUST be authorised by the insurance team prior to treatment commencing.

In order to proceed with a direct claim, the following stages must be completed;

  1. We charge a £48 processing fee for the FIRST CONDITION direct claim, payable per condition, per policy year. Subsequent conditions for the same patient will be charged at £12 per condition per policy year.
  2. Where possible we may submit a pre-authorisation request to your insurer.
  3. We will need to speak with your insurance company to verify your policy details. The policyholder will need to speak with the insurer and give permission for AllPets Veterinary Surgery to discuss the policy details. You may be asked to set a password, please notify us of the security password once it has been set.
  4. We require an electronic direct debit mandate to be completed, an email address is required for this. The direct debit mandate will be used to sweep up any outstanding excess or other deductions made by the insurer. Full details of the direct debit system will be provided, we will always notify you before payment requests are made.
  5. Once the above steps have been completed, a direct claim authorisation will be placed on your account for that patient/condition and you will be notified that you are now eligible for direct claims. The direct claim authorisation will remain in place until the end of the policy year subject to our verification checks. Unless, the maximum benefit of your policy is exceeded prior to this date.

Set up a direct debit

Where possible we will always pre-authorise a claim to ensure liability is accepted by your insurance company.

The pre-authorisation process must be completed PRIOR to any treatment commencing. Should the claim be declined the insurance company will not cover any charges.

Pre-auth typically takes 5 working days from the date of submission.

There is a £48 processing fee for pre-authorisation submissions payable per condition. Irrespective of the outcome, charges for pre-auth are non-refundable, you will not be charged an additional insurance processing fee on top of a pre-authorisation for the same condition.

You will be notified by email regarding the outcome of the pre-authorisation.

Sometimes the policyholder needs to trigger a pre-authorisation claim, when this is the case please call your insurance provider and ask for the relevant form to be sent to our insurance team. We are able to submit pre-authorisations directly to some companies, we will advise you on what action you need to take.

We process up to 1000 insurance claims per year, this number is increasing as more people are choosing to obtain pet insurance. The insurance processing fee is payable to cover our time and resources. We now have a dedicated insurance claims team consisting of a registered veterinary nurse and office manager. Unfortunately, insurance processing fees are not covered by most insurers.

An excess is the amount of money the policyholder must pay towards treatment costs. There are different types of excess:

  • Fixed Excess: this is the set amount that must be paid by the policyholder, in our experience, ranging from £50 to £200. The actual value differs between policies. Insurance companies will not settle claims that are less than the value of the fixed excess. Individual invoices might well be less than an excess amount, however, these can still be settled as it is the total combined charges that are considered for claims. Please note that the fixed excess is usually only charged once per condition per policy period.
  • Co-Excess / Percentage Excess / Variable Excess: This is an increasingly common excess that pet insurance providers are building into their policies. Once the fixed excess is paid, this excess applies to the remaining balance. The policyholder will often set the level of this excess at the time the policy is taken out. A higher variable excess will reduce the monthly premiums and vice versa. Some policies do not have variable excess’ at all.
    • For example, a policy has a fixed excess of £50 and a variable excess of 20%. The total claim is £250 and this will be the first claim made on the policy. The breakdown of the payout will be as follows:
      • £50 deducted for fixed excess (paid by the policyholder) leaving £200
      • 20% of £200 is £40 (paid by the policyholder), this is deducted from the above £200 leaving £160
      • Settlement £160, Policyholder pays £90
      • If a similar claim is then made within the same policy period, the fixed excess will not be deducted and the payout would be £250 less 20% giving a settlement of £200 with the policyholder paying £50.
  • Policy Period Excess: This typically applies to ‘lifetime’ policies. For ongoing conditions such as diabetes or heart disease, a new fixed excess is charged each policy period. A policy period is defined by your insurance provider, most are 365 days but there are a handful of insurance providers that have shorter periods – PLEASE CHECK YOUR TERMS.

Insurance companies sometimes make deductions from the original claim submitted. For example, some companies might cover the cost of an anti-lick collar whereas others might not. In these instances, the direct debit will be used for collecting payments for deductions made. You will always be notified in advance (by email) of any direct debit payment due.

Your insurance company will often send you a breakdown of any settlement paid and details of any deductions made. We will also notify you when payment is made to us and provide details of any payments due or any overpayments.

Set up a direct debit

The policy period is the period of time that your pet insurance covers, the start date is the date you took out the policy. Typically policy periods are twelve months. Some providers have policy periods as short as 28 days. Please check the terms of your insurance policy to find your policy period.

Policy periods are very important as they determine exclusions and excess payments. Very often (typically with a lifetime policy) you will have to pay a new fixed excess each policy period and this may or may not be per condition claimed.

If a claim is started within the last week of your policy period and the claim continues into the new policy period you will likely end up paying two fixed excess’ (see terms of your policy).

Your insurance provider may apply new exclusions in a new policy year, this is typical of a time-limited policy. Our insurance team will check for such exclusions when processing direct claims.

When you enter a new policy period your treatment cover levels are replenished, this is typical of a lifetime policy. For time-limited or maximum benefit type policies this might not be the case.

Your insurance provider might well adjust your premium as you approach renewal and enter a new policy period.

The inception date is the date your pet insurance cover came into effect.

This date is very important as any health conditions noted prior to the inception date will generally be excluded from cover on your insurance policy.

Typically there is a fourteen-day cooling-off period after the inception date, any illness that develops within this window is generally not covered. Better insurance policies will cover accidents from the date of inception – check your terms.

The inception date is the date your pet insurance cover came into effect.

This date is very important as any health conditions noted prior to the inception date will generally be excluded from cover on your insurance policy.

Typically there is a fourteen-day cooling-off period after the inception date, any illness that develops within this window is generally not covered. Better insurance policies will cover accidents from the date of inception – check your terms.

In general terms, a pre-existing condition is any health ailment or symptom that occurred before your inception date.

Some insurance companies will cover conditions that ended more than two years before to the date of inception. However, please check the small print as these conditions may be subject to a higher excess or attract less cover.

 

Disclaimer: Please note that insurance policies are specific to individual pets and vary. Any information given is based on our experience and is intended as a helpful guide only.

 

Have more questions?

Please get in touch by completing the form below.

 

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