Good -- but WATCHOUT does it meet your need?

7
Out of 10

Pay attention to the clause that says "if your vet refers you to a specialist you will be reimbursed at 70%".
In human terms this translates to getting an insurance where you are only reimbursed full when you go to your PCP but if the PCP refers you to a neurosurgeon then you get paid only 70%.

I will give you a true story which is my own specific case. We are laymen. Our dog vomits on friday night, we wait. All night his stomach rumbles REAL BAD but we wait. Saturday morning we take him to our vet (Banfield) who says the dog's stomach is severely distended and refers us to VSH (a specialty after hours clinic). They put a tube and remove the gas but keep him in observation. Next morning (Sunday) our dog continues to vomit, so they ultrasound him and figure out that there is a corn cob. They immediately perform surgery and save him. Banfield bills us 350 dollars. The specialty clinic bills us 3000.

If I have insurance from Pet plan that supposedly has 0% co-insurance it would have reimbursed me 3000*0.7 = 2100 + (350-200(deductible)) 150 so that the total is 2250.

However, I had insurance from AKC which at 20% coinsurance and 125 deductible reimbursed me (350-125)*0.8 + 3000*0.8 = 180+2400 = 2580. I won with AKC!!

Matter of fact .. I have been paying 400 dollars as premium with AKC for last 3year (so total 1200) with pet plan this would have been 250/ yr (total 750)so I would have saved 450 dollars in premium that compensates for the lesser reimbursement Pet Plan would give. But what if the surgery had cost 5000 dollars?

While I surely agree that AKC is no where when compared to Pet Plan .. I am not sure if Pet Plan is right for every one!! Perhaps TRUPANION or some other might be better.

I am still doing research.

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Posted: 10/06/2009
By: Ron Ross

Firstly, Trupanion so far as I know only insures puppies to begin with so their acturial model is unique.
PetPlan will have some of the highest out of pocket costs for "emergencies." Pls correct me if I am wrong but the OP describes a life or death situation and last time I studied my PetPlan policy the co payment applied with the exception of the illness being life or death. So I would have expected them to bend in this instance.

FWIW I have 100% coverage after a $200 deductible on the maximum policy with PetPlan in New York and they confirmed the co-payment would be 20% rather than 30%.

It really pays to read PetPlan's policy carefully but there aren't any gotcha's I can find. Knowing about the specialist/emergency co-pay and having lost a dog who require several thousand dollars in well worthwhile specialist care towards the end, I enthusiastically chose PetPlan.

In the event I have a pet that $20,000 in specialist care will help, I'll come up with $4000 of that. In reality, before that $20K came into play I would have spent x-thousands on a "normal" basis, or 100% reimbursement after deductible. So say, $15K went to the specialist for heroic measures, my copay would have been $3K.

Try taking five figures in specialist charges to any other insurer and tell me how happy they are to pay all of it. VPI, anyone?

Posted: 01/15/2010
By: Susan

I just looked to see if the coinsurance for specialists went up from 70% to 80%, like I was told would happen at the end of the year, and this is what I found under coinsurance:"30% coinsurance applies to specialist veterinary treatment i.e. veterinary treatment administered by a referral veterinarian; or at a referral veterinary facility, after hours veterinary facility, or accredited school/college of veterinary medicine. This coinsurance will only apply in exceptional cases where your current veterinarian is unable to perform the treatment necessary to treat your pet and needs to refer you to an external facility."
I am shocked and sick to my stomach! I am calling Pet Plan first thing tomorrow!