Would you be Upset with your vet or insurance
 

Sort of wondering if I am correct in being upset with my vet and with my pet insurance.

Lola has been very healthy but of course you never know what could come down the pike so I got Pet Plan Health Insurance. At my last visit before taking the insurance my vet gave me every indication that Lola was fine so never in a million years would I have thought that the insurance company would see her as having a "pre existing condition"

I have had full blood work done each year I have owned her and everything has been normal according to her vet. In 2012 her CPK level was 231 and the range is 10-200. The vet said it could be anything like over muscle use, wiggling during a blood draw and since everything else was normal there was no concern. In 2013 everything was normal including the CPK so of course there was no concern about anything. However in 2014 months after the insurance is in place, her blood work indicates a CPK level of 1509 and the range for her age is 59-895. The vet once again talked about a possibility of a muscle strain and not to worry, however I say, "oh but it was high last time". I was going from memory not the dates because last time it was not high, the vet who was not looking at the blood work history goes along with me and says, hmmmm well then it could be something like strain on the heart muscle, I say well she does pant heavy during play time so perhaps it could be her heart. Then she says you could have a heart ultra sound to rule out heart issues. I go to the specialist the next day and they do a heart ultra sound, which thankfully comes back normal and they say her heart is excellent. The specialist also said that 2014 CPK number is not even a concern to her and that it really only indicates heart problems in cats not dogs and with those situations the number would be about 10 times higher than what Lola's was and in fact did not even think I had to have the ultra sound, but I thought I would like to know 100% that she was OK.

So I file the claim for the heart test, it's denied because of they claim in 2012 the CPK value was high and they consider this a pre existing condition and that I needed to have two normal blood tests between the bad one and the good one. However since it was hardly elevated the first time and not at all in 2013 my vet would never have recommended another blood test within less than a year's time. They said I can appeal. When I start to look over the records to do the appeal, I see the first thing my vet had wrote on the chart was it was high last time, which is was not, but she picked it up from my initial comment. The appeal process states if there is a mistake in the records please send in a new record that shows an update with the correction.

I call my vet's office two weeks ago, explained all that in detail, tell her all I need is an update on the medical record stating the results were normal last time and no other tests were required. I then send a follow up email explaining why the claim was denied and suggestions on how to truthfully make a statement in the record so I could get my claim covered. My vet agreed and said in her opinion there was never a pre existing condition because of the 2012 CPK number. I made several follow up calls to the office and even asked them to email me what they were going to put in the records to make sure we were all on the same page. I have been on vacation so I checked in with them yesterday and today I get an email with a letter from the vet that she was sending directly to the insurance company. It is poorly written, sort of confusing and seemed to stress more on the findings on the heart ultra sound, and how I am a good pet owner with pet insurance, and only a brief mention of the slightly elevated CPK level, but throws in could be due to struggling during a draw or secondary to luxating patellas, which Lola does not even have!!!! I am not happy with this letter since this is clearly not what I asked for, I ONLY asked for the mistake to be noted and corrected on the medical record (which could have been simple and to the point), plus the way it was written it sounded like Lola's has a problem with her patellas, which could cause a problem down the road for reimbursements if that bridge had to be crossed. I called the vet to say this is not what I wanted, she gets on the phone and that's when I found out she took it upon herself to call the insurance company to find out why the claim was denied and that the letter was already sent in. I never asked her to do this and I do not think it helped my case a bit. I know she feels strongly that Lola did not have any pre existing conditions and wanted to help, but frankly I am so pissed because I feel she overstepped her bounds, she has cost me hours of needless calls and email writing and after all this I will most likely not get my claim paid because once again on the phone Pet Plan said I still need to start the appeal process and have updated medical records.

Even though Pet Plan denied my claim I am more upset with my vet, because I think the way she wrote the medical records will keep me from getting my claim paid.

for those of you that have pet insurance I believe that most of the companies try hard not to pay the claim, so please protect yourself and triple check any vet records you submit because often vets write very short notes and they are not always correct or helpful in getting claims paid.

Why don't you get the heart specialist to write a clarifying letter about the numbers? Why are you even dealing with the general vet for a claim as to a specialty visit?? I would think that the specialist might have more weight for your appeal.

I was thinking about doing that, it's just that the denial stems from the blood work done by my primary vet and the fact that she had an incorrect statement on Lola's medical records which I do want corrected. But thank you for the suggestion I am going to take it and I will contact the heart specialist in the morning.

I would also have the vet correct the record.

I don't think PP is at fault. They are only following protocol. The vet is at fault for not writing records correctly. But I would not hold out hope for PP to pay either way. She needed two normal draws and only had one. Right or wrong they can get out of it. But I also have PP and that verbage is not in my policy.

I would make sure it is noted in her records that her patellas are fine at her next visit. That should help if a problem ever does arise with them.

You might reconsider the whole insurance idea if you think you could handle an emergency. Many people actually start a savings account and contribute the cost of the insurance monthly. Or open a credit card now if your credit can handle it, but don't use it and save it for a pet emergency.

Maggie is 4 years old. That is 48 months of $30 that we have not paid for insurance. Knock wood, she has had only well visits and shots except for one visit when she hurt her back and that wasn't much $ ( and now I let the shelter do the shots as long as her vet check was good). That's almost $1500 we would have spent on pet insurance. Hopefully she remains healthy. When she plays crazy I remind my husband that if she hurts her knees we WILL be paying for it!

The $30 per month is just what I vaguely remember getting an estimate for on the insurance. Yes, I know peace of mind is valuable and some people get insurance for that reason. I just wanted to toss out the idea that if you can set side $, you might not need it.

Honestly I read a lot of stories like this and it's what makes me unsure about pet insurance. I just have never been satisfied with any of the plans I read and it would be my luck that something like this would happen to me too... I'm sorry no advice. :(

it's not in any written policy of theirs, which is a problem, they claim it's procedure with this type of situation that they consider a pre existing problem or condition, the trouble is an elevated CPK number is not a condition since that number has wide swings. It's just like us if our cholesterol is only a few points high it does not mean we have hardening of the arteries and our next blood draw might be totally different. This is why my vet would never have suggested she get a second blood draw after the 2013 because everything was well within normal.

I have been thinking about that as well, I am lucky we could probably handle any expense that came our way, plus we have credit out the wazoo, Lola is our only pet and my husband is crazy about her so I know he would spare no expense. Plus now that I know her heart is healthy I am not as worried. But of course many other things could go wrong. I took the top of the line plan which costs $40.00 a month so $480.00 a year is still less than any major surgery would be, but if it is a hassle to get paid it might not be worth it.

If I cancel now I can't help but wonder if it will hurt the appeal, which dang it, can take up to 8 weeks! I did however reduce my plan to the cheapest which is $21.00 a month for 80% coverage instead of the 100% I have now.

after goggling a bunch of info on them, I see there are all most as many complaints about them not paying claims as there are with people that are satisfied with how their claims were paid. I am a commissioned sales person and my husband said if I made prospecting sales calls during all the time I spent venting about this or calling the vet and the insurance company I probably could have made more money than the claim was worth. He is probably right, but LOL that's not the point is it :D:D:D

Oddly enough since yesterday Lola has been sneezing a lot, no coughing just sneezing, no running eyes, no trouble breathing, no scratching, and eating and playing fine. We have the air on and she hardly was outside all day yesterday so not sure what it could be, but on Monday she was out on the deck with me when I was blowing the Oak pollen seeds off so perhaps that got her going, but now I plan to call the vet when they open, so maybe I will get a claim out of the insurance company!

It sounds like w/ all the phone calls/emails/messages passed on etc, that things got lost in translation, unfortunately. Yeah, I'd too be upset bc of the way it all played out and the mere hassle, ugh. But, it's understandable how miscommunication could easily happen w/ your vet. What I don't understand is why on earth she mentioned LP AT ALL - she has got to take that off your records if it's on there, and you now need an amended letter stating she does not have LP.

I can't really fault PP bc they are doing what they should be doing. I used to have PP for Pfeiffer and they paid thousands in vet bills for her when she was a puppy...had no probs w/ claims at all. I now have all 3 of mine on Healthy Paws.

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would be my luck too.

I bought insurance when we first got our puppies. Had them checked out by my vet and they were perfect. One had a slightly elevated BUN. Vet said no problem, he probably didn't drink too much water (happens to me all the time). A few months later we had to do some dental work (as usual) on that puppy. Put in the claim and it was denied because he had a "pre-existing" condition. Vet responded, but they would not reconsider until I did additional blood work and they (the insurance company) determined he was OK. I canceled the insurance that day. At $37 a month, I don't need to fight with insurance companies. Both puppies are healthy and happy and thank goodness we can afford the vet bills if need be. I also saved over $1000 in the past 18 months by not having insurance. We all have to do what we think is best. For me, this was the right decision.

It seems like the vet over analyzed the situation after needing some clarification. The insurance company is only going by their policies so not necessarily the ones to place blame on. I hope you do get some type of reimbursement as well as satisfaction from the vet with updating the records to reflect what you want with accurate information.

This is the exact reason why I did not get insurance...Keylo has CT so pre-existing and Lola was 5 years old when I looked into getting it for everyone and well it was just to expensive compared to the benefits. I hope you get the situation cleared up but I would be a bit upset at how the vet worded the letter also...doesn't seem it needed to go in that direction as you stated just a simple her levels were normal until this last testing. good luck.

BUN is another value that can change and be high one time at not the next, just like with creatine, and this happens with my personal blood work all the time and my doctors have no issue with it, nor do I have a pre existing condition. I guess pet plans work to a higher standard:rolleyes: or perhaps their own standand that is hard to figure out or tied to their bottom line$$:mad: If pet plans are going to use that as pre existing conditions when vets do not see it as so I am definitely going to cancel soon.

Also the last bloodwork prior to me getting insurance was fine, so they are going back further, if there was indeed a CPK problem it would have shown up on that test as well. Also pet plan does not spell out in their policies on what or how they determine pre existing conditions , both vets at the office said Lola had no pre existing conditions but I guess the insurance companies know more than my vet does.

I asked my vet his opinion of getting pet insurance and he stated instead of paying the $37 a month to save money in the bank each month for possible illnesses. But if the dog had a serious illness you may be able to take out a care charge card to pay it off.