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Hi all….I need advice on a pet insurance claim matter….apologies for the long post.
My sister took her cat to the vets (July 2016) when he started dropping his food…this was a few weeks after she had insured him initially….but a couple of days after she noticed the problem.
The vets said he had lumps on the inside of his cheeks but his teeth and guns were fine. They gave him a course of antibiotics. These had little effect so she took him back a week later. The vets then said that he most probably had an immune system condition whereby they ‘reject’ their own teeth and that they wanted to do biopsies on the cheek lumps.
A week later she took him into the vets for the recommended biopsies and they also mentioned that he may need to have several teeth extracted as a long term solution. She was aware and advised the vets that the insurance did not cover teeth and gums so she would have to pay for the extractions etc.
She paid the bill and submitted the claim form via the vets.
She received a letter from the insurance company refusing the claim and after enquiring she discovered the vets had submitted all the bill – including extractions!
The insurance company said to submit another claim form – so she did – minus anything to do with teeth etc.
It was then refused again as the vets had stated the condition as Gingivastomatitis – ie gums? The insurance company then said to submit another claim omitting anything mentioning Gingiva – so ‘stomatitis’ – an immune system problem…which her vets did.
They refused it again – even though the vet had submitted a letter in support of her claim.
She took it through their complaints procedure ...which took several weeks...and they refused it again – for the previous reasons – stating that it was teeth and gums – but also the vets have stated on a question which asks when the owner first noticed symptoms – 7 days – which takes it into the exclusion period.
She has spoken to the vets and clearly they have misunderstood/made an error in stating this….the person who deals with the insurance claims confirmed that nowhere in the notes does it state 7 days…possibly the vet has stated the timeframe between initial consultation and operation??
Where does this leave her now as if she escalates it to the ombudsman – the vets have automatically invalidated the claim by stating this.
Any thoughts would be most welcome.
Thanks
Foxy
My sister took her cat to the vets (July 2016) when he started dropping his food…this was a few weeks after she had insured him initially….but a couple of days after she noticed the problem.
The vets said he had lumps on the inside of his cheeks but his teeth and guns were fine. They gave him a course of antibiotics. These had little effect so she took him back a week later. The vets then said that he most probably had an immune system condition whereby they ‘reject’ their own teeth and that they wanted to do biopsies on the cheek lumps.
A week later she took him into the vets for the recommended biopsies and they also mentioned that he may need to have several teeth extracted as a long term solution. She was aware and advised the vets that the insurance did not cover teeth and gums so she would have to pay for the extractions etc.
She paid the bill and submitted the claim form via the vets.
She received a letter from the insurance company refusing the claim and after enquiring she discovered the vets had submitted all the bill – including extractions!
The insurance company said to submit another claim form – so she did – minus anything to do with teeth etc.
It was then refused again as the vets had stated the condition as Gingivastomatitis – ie gums? The insurance company then said to submit another claim omitting anything mentioning Gingiva – so ‘stomatitis’ – an immune system problem…which her vets did.
They refused it again – even though the vet had submitted a letter in support of her claim.
She took it through their complaints procedure ...which took several weeks...and they refused it again – for the previous reasons – stating that it was teeth and gums – but also the vets have stated on a question which asks when the owner first noticed symptoms – 7 days – which takes it into the exclusion period.
She has spoken to the vets and clearly they have misunderstood/made an error in stating this….the person who deals with the insurance claims confirmed that nowhere in the notes does it state 7 days…possibly the vet has stated the timeframe between initial consultation and operation??
Where does this leave her now as if she escalates it to the ombudsman – the vets have automatically invalidated the claim by stating this.
Any thoughts would be most welcome.
Thanks
Foxy
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