Reimbursements Based on Impossibly Low Rates

3
Out of 10

ASPCA Pet Health Insurance is the third pet insurance plan we've tried over the past 20 years. Their coverage is average, their "fine print" is average, and the speed of their claims handling is average. The biggest and most heinous issue with this company is their adherence to reimbursements based on a totally out-of-touch, unreasonable and almost fraudulent set of "average local charges" as published by some pro-insurance-company (and perhaps owned by them) rates researcher.
Generally, ASPCA has reimbursed our claims at an average of 40 to 45% of what we've had to pay the veterinarians, regardless of the illness, medical procedures, or other costs. For a $350 procedure, they "allowed" $151. For a $260 procedure, they "allowed" $127. This is not including deductables. When we asked them to provide the name of a single veterinatian within 25 miles who charged what they were "allowing," they claimed to only go by this published book and could not provide names. When I asked for the name of the publisher of the book, they refused to provide it. Needless to say, the book, whatever it is and whoever publishes it, has no relationship to the real world and merely serves to accommodate their unreasonable payouts.

Think twice about any pet insurance company. In hindsight, we've realized that it would have been more cost-effective to self-insure by setting up a savings account and paying the "premiums" to that account.

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Posted: 09/30/2008
By:  

I asked about these ficticious "books" as well and got no response. Subsequent letters requesting information on the literature on which they base their decisions on also went unfullfilled or were met with a generic "Oh, you can go to your local library and pick up a book about your breed and find it in there." Did you know that their "reasonable costs for your area" also factors in discount medical care that is offered by shelters, for sheltered dogs? If you or your dog are not eligible for one of these discount shelter clinics (eg, you didn't adopt your pet from the local shelter) you are out of luck because your adjusted reimbursement will reflect these averaged in discount prices!! Their replies to the BBB were, that even though at this time they had no comprehensive lists pertaining to exclusions, they were indeed working on one (As of 1 year ago and I guess they're still working on that list that they refer to when denying claims). I propose that there are many different professional views on what is considered a congenital/hereditary defect in a particular breed, but the Hartville group, (VPI, Petshealth, ASPCA, Yes they are ALL the same company, you thought you had shopped around didn't you?) only leans towards whatever views and opinions are in their best interest and at many times during my dogs 8 years of coverage have often been conflicting from 1 policy period to the next. Just two more words on this matter, SUE THEM!!!

Posted: 09/30/2008
By:  

One more thing!! The price of "Heartguard" went up $20.00 one year (We all remember when this happened about 2 years ago, I almost died when I found out) That year my vet cut me a break and gave it to me at his cost just the one time to help ease the pain a bit. Do you know that Petshealth Insurance actually adjusted that price on my claim by $5 even though I had purchased it at cost!!!!! I called up and asked them where I could purchase Heartguard at $5 below cost because I sure as heck would love to go there to stock up!!!! What a bunch of crooks!!!!