1
out of 5
POSTED: | BY: Ragui
Stereotypical outcome - claim denied
I filed a claim for surgery performed on our dog Mambo on 11/2/2018. The surgery was to remove stones in his bladder. The claim was denied as pre-existing. My policy states: "A condition will no longer be considered pre-existing if your pet's condition has been cured and free from treatment and symptoms for a period of 180days". Our dog has no other medical history for the last 12 months, which his medical records show. Our vet has provided the following letter to the insurance company: "To Whom it May Concern - XXXXXX, 12y MN havanese, has been under our care here at XXXXX Veterinary Clinic since September 2017. He presented for inappropriate urination signs, and during workup it was found that he had urocystoliths. We performed a cystotomy 9/23/17, with a stone analysis which was consistent with Calcium Oxalate uroliths. The Hills C/D diet was prescribed for the first time post-operatively (again, 9/23/17). Ms. Selwanes refilled this food several times from 9/2017 thru 10/2018. During this time, Mambo had no clinical signs of urinary disease at home. He was seen for a routine vaccination visit on 6/8/2018 and no clinical signs of urinary disease were noted. He came in for his annual exam and labwork on 10/30/18 and still reported no clinical signs of urinary disease. However, on his urinalysis we noted hematuria and crystalluria and recommended abdominal x-rays. A second cystotomy followed on 11/2/18. I hope these details help clarify the timeline so that Ms. Selwanes claim can be processed fairly. Please call me with any additional questions or if medical records are required. Take care, xxxxxx, DVM MIVC xxxxxxx" Our vet furthered with: "To Whom It May Concern, Regarding our patient xxxxxxx, his Hill's Prescription Diet earlier this year was not prescribed for urocystolith dissolution. Please feel free to contact us for more information if required. Sincerely, xxxxxxx, DVM xxxxxxx Veterinary Clinic xxxxxxxxxx", Seems irreconcilable to me that the Vet says we meet the condition, and the insurance company knows better????