Anyone else notice this discrepancy?

8
Out of 10

I just signed up for 2 policies with Petplan, so I haven't had the need to submit a claim yet. However, I was reading the "Terms and Conditions" pdf in the Important Documents link (accessed after logging in to your account), and was very surprised to see this language in the "Definitions" section: "Reasonable Costs-The usual and customary fee charged for a given treatment or procedure within the geographic area in which the fees are incurred, as defined by the most recent American Animal Hospital Association Veterinary Fee Reference Guide". However, on Petplan's website, in the section regarding "what Petplan covers", if you click on the "Petplan policies" link near the top, it takes you to a page which says "Reimbursement is based on what your veterinarian actually charges. It is not based on what a benefit schedule dictates or a "usual or customary" fee determined by the insurance company."Since I am within my 30 day cancellation period, I have to ask "which is it?". Has anyone else noticed this and has it been an issue with anyone regarding the amount Petplan has paid on a claim?

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Posted: 08/18/2009
By: Leah

I would be very interested on what the owners of the policy say is the correct limitation. I myself am considering this policy and would like this to be calrified. It is important for all policy holders or future holders to have 100 percent clarity.
Please let me know what you hear.

Posted: 08/19/2009
By: Michele

WOW - that's a MAJOR discrepancy!!!!!!!!! I almost signed up with Pet Plan SPECIFICALLY because they claim to pay by vet fees not schedule. This is a perfect example of bait and switch. I'd file a complaint with the state insurance commission.
Sorry this happened to you, but thanks for posting so others won't get baited the same way. I don't want to have to bother to cancel after 30 days.

Posted: 08/19/2009
By: Susan Hollar

In response to my comment, I received an email from someone from PetPlan, who identified himself as a "pet insurance advisor lead". This is, in part, what he said:
"You are absolutely right to question why the policy wording mentions the phrase “Usual and Customary” when we do not calculate reimbursement that way. The simple fact is that the phrase was originally used in the policy to maintain a fall back should a veterinary facility start charging unreasonably high fees for a client simply because they have pet insurance. In reality however we quickly realized that the Usual and Customary phrase was unnecessary and we have never used it to reduce a payment to an insured. However since all of our policy documents are filed and approved by each state’s insurance regulators, we cannot simply go ahead and make a change to the policy wording without re-filing a new document in every state."

He went on to say that PetPlan is in the process of re-filing new documents in which "usual and customary fees" does not appear.

Because of this information and because PetPlan has received such great reviews, I am going to stay with them. I chose the Gold plan, which has an annual maximum of $20,000 and no maximum per illness or injury, apart from the annual maximum ("Petplan covers injuries and illnesses for life with no dollar limits per condition.") None of the others that I've researched offer this. Many consider a condition "pre-existing" (and, so, no longer cover it) if it goes on beyond the first year, as if, when your current policy expires, you're signing on with them as if it were the first time! Even if they continue coverage, there's a limit per illness injury, typically somewhere between $2500-$7000. PetPlan definitely offers the most coverage when it comes to situations like this (and situations like this are when you really need pet insurance!).

I'm sticking with PetPlan and appreciate the personal attention my concern received! Thank you!

Posted: 08/24/2009
By: Nef

I am doing major research and reading into each insurance company to find the best coverage for my pet. I'm debating between PetPlan and Embrace at the moment. After reading some reviews for Pet Plan, I gave them a call to discuss discrepancies or major complaints. For this particular review/discrepancy, I was told the same thing as the email to Susan (without having read her comment beforehand). Thank you for updating Susan! I believe I will go with PetPlan as well...

Posted: 08/30/2009
By: Donald

Very insurance company like????

Posted: 08/31/2009
By: Shanna

I've had policies for my 5 dogs with petplan for over 2 years and they have NEVER not paid my entire claim or even argued the amount even when I've gone to emergency vets and such.

Posted: 09/12/2009
By: Vincent

I just purchased 3 PetPlan polices for my cats, one gold for the 2-year-old male, and two bronze plans for the 1-year-old male and female I just adopted. All have the same high, $200 deductible, so they're for something unexpected basically. I had 24 PetWatch/PetCare for two years on my 2-year old, and they were OK, paid as they said on the one claim I submitted for a visit to the emergency/after hours vet for what turned out to be an infected wound from a catfight. However, PetPlan has such a good reputation, and even my vet has brochures for it.
I need to learn more about PetPlan. Like your noticing the "reasonable charges" exclusion, I've noticed they say they'll only pay 70 percent of emergency/after hours vet visits, as well as 70& of visits to specialists. PetCare covered it at the same co-insurance rate it paid for visits to the regular vet. Is it true that PetPlan only pays 70 percent of the bill when you take your cat in for an emergency or specialist versus the coverage you get if you take your pet to the regular vet, 80 to 100 percent of the bill over the deductible?

Posted: 06/08/2013
By: Deb

Be aware that PetPlan's $200 deductible is per INCIDENT not per year. So basically every time you submit a claim, 200 bucks is getting knocked off of it right from the get go.
I've had 2 claims in the last couple of years and have gotten very little back on one and nothing on the other. Add in my annual premium to them and I've pretty much lost money on the deal.

I'm in the process of looking into other options now.

Posted: 07/12/2013
By: Rich

I've had Petplan for the last four years for two dogs. I carry the $200 deductible, with no copay (100% coverage after deductible). My dogs (Pointers) were 7 and 8 at last policy renewal and their premiums were $698 and $741. That seems outrageous for some, and it is expensive, but when you need it, it is the difference between saving your pet's life for most who could not afford major surgery fees. My 8-year-old has had two cruciate surgeries (Petplan is one of the few companies that will cover the opposite limb for cruciate surgery, so long as there is a one year lapse between the two), and a slipped disc. The slipped disc required a neurologist for surgery, and cost $7000. Petplan paid 100% for this specialist instead of 80% like normal, because the surgery was considered life saving (my dog would've been quadriplegic without surgery). The surgery was completely successful, and my dog is here today because I invested in insurance. On the other hand, the 7 year old has never had a claim, and I was beginning to think that such a high amount of insurance on him was too expensive. Then a month ago, he suddenly tore his Achilles tendon, requiring surgery by an orthopedic surgeon, and his bills totalled $5806. I received a check yesterday for $4542. The initial visit by his regular vet was covered at 100% minus the deductible, and the surgery by the specialist was paid at 80% because it was not a life saving surgery. I know that I will paying in excess of $1000 a year for insurance as they get older, but I will not go without Petplan insurance on them. Something to consider, however, is lowering your premium by carrying a policy that only pays 80% instead of 90-100%, as your most expensive bills are generally going to be from conditions requiring specialist treatment, and those bills will only be paid at 80% anyway. On the other hand, the difference between 80% and 90-100% is only a hundred to two hundred more a year, but will save you a thousand or more in reimbursement in the event of a serious, life threatening accident/illness, requiring specialist treatment.

Posted: 12/08/2009
By: Dr. Doug Kenney

I have written a book about pet insurance and have spent the past 2 years researching it. This is what I found out.If you look closely, virtually every pet insurance company's policy (except VPI which pays according to a benefit schedule) contains the language "usual and customary." Only two companies that I know of actually use this when figuring reimbursements (AKC and ASPCA/Petshealth). The language is in these policies as a fallback provision in case a fee seems ridiculous. Most of the newer companies will tell you that they have never had to actually use this provision. One concern may be that if companies continue to pay "according to whatever the veterinarian charges," the time may come when they have to start instituting this provision just to stay competitive because they may find that there is a ceiling to premium increases that pet owners will tolerate. In other words, there are only two ways that the insurance companies can continue to do this long-term, either increase premiums per veterinary fee inflation or come up with ways to limit reimbursements. My philosophy is enjoy the "paying according to whatever the veterinarian charges" while you can. The main reason that the newer companies started doing this is to simplify the understanding of how pet insurance works and I think they also learned from the complaints that veterinarians and especially pet owners had with the existing (older) companies. Pet owners ideally need to be able to plan on what their expected out of pocket costs will be with an insurance policy.

As to the increase in copay when referred to a specialist. It was explained to me that because specialist have advanced training, used advance technology (e.g. CT scans, MRIs, etc.), do more difficult and advanced surgical procedures or treat more difficult to manage medical cases that require intensive care that their fees are higher. The increased copay takes this into account and keeps premiums lower for those majority of cases that don't require referral to a specialist. PetPlan is in the process of getting this lowered to 20%, but it takes state by state approval and may take awhile.

As stated the copay also increases when taken to an emergency center (after-hours facility) for a NON - EMERGENCY. As many of you know, trips to the emergency center costs more than your vet usually charges. PetPlan said that sometimes pet owners will visit an after-hours facility for "convenience" rather than for a true emergency. If your pet is treated for a true emergency, your regular copay applies.

Posted: 09/30/2013
By: Ida

I saw that too...including wanting all documents from your vet's file.....the wording play is the key....so I asked for my policy to be cancelled within minutes....when I read that....I never had insurance, and I'll be darn I am gonna fight to get reimbursed!

Posted: 10/03/2013
By: Ida

I noticed that too...and cancelled immediately upon signing......they charged my credit card and have not refunded me yet...4 days later. I am notifying the NC Attorney General of their practice. Also have proof to my bank of their later stating they have cancelled it...yet no credit to my card...crooks and liars. glad I found out now!

Posted: 02/28/2012
By: Bob

Michele...you are silly.
"Usual and Customary" appears in virtually 100% of insurance policies. It's just lingo that says "reasonable costs - not $100,000 for a hangnail".

And it works to your benefit as well - if everyone charges about $1,000 for a procedure, that's "usual and customary" and an insurer can't say "well, we only think $500 is U&C".

Don't listen to Michele.

Posted: 09/05/2012
By: Taylor

Petplan sucks you in with their really low premiums for the coverage they offer on the first year you sign up. Their reps tell you that you can expect an annual increase of a dollar or two per month. But thats a load of crap! My mother signed up our "co-owned" dog last year. She's a 3 year old chi mix. She's only 4 years old this year. And she has had no claims. Her premium has increased a hundred dollars per year and the rep now has indicated that she can expect the same increase each year so by the time the dog reaches 10 she would likely be paying a $1000 per year in insurance and have spent $5200 in insurance up to age 10!

Posted: 01/15/2015
By: Angela

Just opened my credit card statement and saw an outrageous amount for my quarterly premium. After (very difficult) investigation. (Pet plan makes your account information really difficult to pull old information from) I discovered since I started the plan in sept of 2011 for $420/yr, it has increased over $300 to $760 a year! They don't warn you or tell you it's going up let alone by how much. And this is never having submitted a claim!

Posted: 03/01/2015
By: Kira

Just have to say we have had Pet Plan coverage for our 2 dogs (labs) and 1 cat, for 2 years now. We have NEVER had a problem with the covering any claim. In fact they have paid every claim in full without an issue.

Posted: 07/28/2017
By: Aaron Guimond

My Bulldog's premium is $1026/yr. So far this year with bladder and prostate infections plus eye surgery he has cost me over $3000 in vet bills.
Petplan has reimbursed me $27. That is not a typo.

Waste of money.