Beware the exclusions and rejections

Out of 10

We had PetPlan insurance for about a year for our rescue pooch. We purchased the insurance about four months after adoption, and after she had to go to the vet for pyoderma (a bacterial infection of the skin, usually treatable with antibiotics). A few months after we purchased the insurance the poor pooch had another episode of pyoderma. Our claim was rejected because somewhere buried in the policy we never received -- and more importantly cannot be found on their website -- there is a 24 month exclusion for pyoderma. Thus, because she had been diagnosed with the condition less than 24 months before, the claim was rejected.
Flash forward to Christmas Day. While visiting relatives we saw blood in the pup's urine. We took her to an emergency hospital that diagnosed her with a very treatable urinary tract infection. The claim was rejected because it did not meet our $200 per condition deductible. The followup visits were also rejected because they were in a different policy period.

Bee sting -- rejected because of $200 per condition deductible, after rejecting the DVM's entry of "routine examination". In other words, we brought the pup in because of a bee sting, and the doc charged for a routine exam and benadryl and the like. PetPlan first rejected the "routine exam" charge, and then determined that the remaining charge was less than $200.

Hip lesion -- same.

Rejections come without explanation; you have to contact PetPlan to try to have any idea of the rationale for the rejection.

While PetPlan is friendly enough, and most likely would work well in case of a major emergency, the idea of paying thousands of dollars in premiums over the life of the pup on the off chance she has a major illness seemed silly. So, while PetPlan may be perfectly within their contractual rights to reject claims, caveat emptor certainly applies. Ask to read the policy before buying.

Did you find this review helpful?
Claim Amount
Age of Pet

Leave a comment

Enter the characters shown in the image.
Posted: 04/22/2010

There seem to be two complaints here and I don't think either of them is completely reasonable. First the so-called "exclusion" for pyoderma. It was not the condition per se that was excluded; pyoderma was judged to be a pre-existing condition, something that all insurance policies include. In fact Petplan seems to be somewhat unique in that certain pre-existing conditions become reimbursable after some time has gone by after the original incident, in this case 24 months. Some insurers would preclude the condition for the life of the animal.
A way to avoid "surprises" is to have the policy underwritten as soon as it is taken. This requires sending Petplan all of your medical records in advance of any claim. They will then very clearly reply with a list of conditions they will not reimburse or will require a waiting period to reimburse.

As for the complaint that various incidents were not reimbursable because they did not meet the $200 deductible, that is under the control of the insured and can be changed from policy year to policy year. As it happens, Petplan is somewhat unique in allowing the insured to choose both a deductible (per incident) and a percentage of reimbursement. Actually choosing 100% reimbursement vs. 80% does not increase the premium nearly as much as choosing a lower deductible. If your pet is unfortunate enough to require medical attention more than twice in a policy year, it probably pays to have the lower deductible and higher premium. As it is, Petplan is one of the very few companies offering 100% reimbursement and while the per incident deductible does somewhat increase out of pocket costs, I have had insurance that had a yearly deductible that cost more and paid out less.

Posted: 04/23/2010

Your dog had a pre-existing condition! The policy is very clear about this. My Lab has tons of pre-existing conditions and I know what is and what isn't covered. You can lower your deductible if you want- you just have to pay more monthly. Again, it is very clearly spelled out plus when I had questions, I called the customer service number and had them answered.

Posted: 05/06/2010

So it's $200 deductable PER CONDITION? Did not realize that.