Pet insurance and dentals

Re: Pet insurance and dentals

Rob Davis — Tue, 18 Jun 2013 14:42:45 GMT

Evelyn, please never become a claims consultant or we'll never get any claims paid!

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Tue, 18 Jun 2013 14:35:09 GMT

[quote user="Bob Russell"]I 'define' pre-existing as a condition that the owner knew was present before insurance was taken out or should have reasonably known was present.[/quote]

No, that would be an undeclared pre-existing condition and obviously would be excluded.

Re: Pet insurance and dentals

Bob Russell — Tue, 18 Jun 2013 13:05:24 GMT

I 'define' pre-existing as a condition that the owner knew was present before insurance was taken out or should have reasonably known was present. This is not a legal definition but seems perfectly fair for both owner and insurance company.

Can of worms left unopened!

Re: Pet insurance and dentals

Rob Davis — Tue, 18 Jun 2013 12:25:58 GMT

[quote user="Evelyn Barbour-Hill"]Yeah but that doesn't mean it's not a pre-existing condition. It would depend on how the policy dealt with developmental things.[/quote]

That's a bit of a can of worms..... What about hip/elbow dysplasia, entropion/ectropion, cryporchid castrations (or neoplasia) etc?

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Mon, 17 Jun 2013 17:28:35 GMT

[quote user="Rob Davis"]There would have been no way of knowing prior to this that the tooth would not erupt normally unless you know something I don't[/quote]

Yeah but that doesn't mean it's not a pre-existing condition. It would depend on how the policy dealt with developmental things.

Re: Pet insurance and dentals

Rob Davis — Mon, 17 Jun 2013 17:00:44 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Suzanne Kelly"] By "impacted tooth" I mean a permanent tooth that failed to erupt and is fully formed but visible only on x-ray. I don't know what else to call it? The type of tooth that can cause a dentigerous cyst.[/quote]

Yep. I fear that would be a pre-existing condition, unless maybe the dog started its insurance at a very very early age.

[/quote]

Surely as long as the dog was insured before the adult teeth erupted this could not be classified as a pre-existing condition. There would have been no way of knowing prior to this that the tooth would not erupt normally unless you know something I don't (actually I am quite certain that there is much that you know and I don't, but you know what I mean!).

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Mon, 17 Jun 2013 16:24:31 GMT

Yep. I fear that would be a pre-existing condition, unless maybe the dog started its insurance at a very very early age.

I think the wording in the policy that you originally complained of, although desperately clumsy, means that you should spot early signs of periodontal disease at the "annual routine" examination, and treat accordingly, the owners paying, otherwise the insurance will not cover anything more serious in the periodontal line that may occur. Which seems pretty fair to me.

[quote user="Suzanne Kelly"] It's hard to get an owner to agree to a procedure and pay for it when the practice up the road will do a full "dental" including extractions for €70.[/quote]

I sympathise. Oh how I sympathise. There are I suspect still many practices that regard "dentals" (whatever that means) as a moneyspinner. They can do 'em cheap because they do an absolutely lousy job anyway. I can't suggest an easy answer. Just bash on doing a good job, and charge as little as you possibly can until your reputation starts to build. Don't look on dental work as a "profit centre", and you'll find it gradually starts to bring a reasonable profit.

Forget insurance.

Re: Pet insurance and dentals

Stephen Courtney — Mon, 17 Jun 2013 15:29:45 GMT

So challenge their position - make the argument. I would suggest resubmitting part of the claim at least - for an unerupted tooth /possible dentigerous cyst - and not try to claim for 'routine' or 'preventative' dentistry in any way. So cost of pre op work up, anaesthesia, rads and surgery for the unerupted/ possible dentigerous cyst plus further treatment as indicated, gets claimed for. Costs for descale and polish and extractions of loose teeth - doesn't.

In my experience most insurance companies won't cover dentistry unless there is another proven pathology - eg a broken tooth - or something like total mouth extractions causes by calici virus-associated stomatitis/gingivitis in cats. I would have thought a pathology like an unerupted tooth should be covered - hence my advice to argue!

At the very least it will give you a little more understanding of what the insurance company will accept.

Re: Pet insurance and dentals

Suzanne Kelly — Mon, 17 Jun 2013 12:41:57 GMT

The dog is insured since a pup and has been in at least once a year for check ups. By "impacted tooth" I mean a permanent tooth that failed to erupt and is fully formed but visible only on x-ray. I don't know what else to call it? The type of tooth that can cause a dentigerous cyst.

The owner does her best to brush the dog's teeth. Whilst I appreciate that whether a dog is insured or not and what the policy does or doesn't cover is the owner's business, it does affect my business! Pet dentistry in Ireland is really only in it's infancy. There are no dental specialists here and as far a I know we're the only practice in the country to even have a dental x-ray unit. I'm doing my best and trying to learn.People here are hugely cost sensitive and there is low awareness of the importance of dental health. It's hard to get an owner to agree to a procedure and pay for it when the practice up the road will do a full "dental" including extractions for €70. I worked for many years in the UK and most insurance companies there did pay for dental work. This particular company did too until recently. What's making me mad is that they won't pay for treatment that's recommended at the annual health check for dental work. However they will pay for lump removals, blood tests, x-rays etc for other conditions that are picked up at the annual booster/check up.

I know a lot of the periodontal disease we see can be blamed on owners not brushing and feeding crap food, but the insurance company will pay out for loads of other things that are the owner's fault e.g. RTAs, gastroenteritis etc. Also some little dogs just seem to have a predisposition to periodontal disease. May be it's just me but I see plenty Yorkies and maltese where the owners have fed a good diet and regularly brushed their teeth and they still suffer with periodontal disease. On the other hand I see plenty Collies and Labs with great teeth that have been fed crap and never seen a toothbrush in their lives.

I fully appreciate that insurance companies can do what they like and exclude what they like. I'm mad because from a personal point of view I can't do a lot of what I want to do with dentistry because the clients in a lot of cases can't/won't pay for it and now the insurance company won't either. I'm also mad because I think excluding the mouth whilst insuring the rest of a pet is not very fair. In this particular case the owner has been very diligent in her care, I've been diligent in mine, yet they've added this exclusion. If every preventable veterinary condition was excluded we'd all be in trouble.

Re: Pet insurance and dentals

Stephen Courtney — Sat, 15 Jun 2013 17:28:06 GMT

True - I'm not entirely sure what the OP means either.....

Suzanne can you enlighten us?

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Sat, 15 Jun 2013 15:14:10 GMT

[quote user="Stephen Courtney"]Depends when the policy was taken out surely? Can't impact till it's impacted, and if the dog was insured all along, then there should be no problem. If it's a new policy then i agree.[/quote]

Before we get heavily into that we should establish exactly what the OP means by the tooth being impacted.

[quote user="Stephen Courtney"]I take pains these days to avoid asking a client if they have insurance until AFTER I have made recommendations and given an estimate - simply to avoid giving the impression that my estimate is based on their ability to pay / insurance status etc. this includes clients that i believe to be insured as often-times they have changed or cancelled policies particularly as animals become older and the policies become more costly.[/quote]

I never ask if they have insurance, except on the odd occasion when they are worried about the cost and I wonder if they have forgotten that their insurance covers it. It does happen.

Re: Pet insurance and dentals

Stephen Courtney — Sat, 15 Jun 2013 12:59:26 GMT

Depends when the policy was taken out surely? Can't impact till it's impacted, and if the dog was insured all along, then there should be no problem. If it's a new policy then i agree.

Perhaps the OP's outrage is based on an assumption of what would be covered, and perhaps being to quick too accept a direct claim? It's very easy to give a client the impression that their insurance cover will take care of everything when that may not be the case.

I take pains these days to avoid asking a client if they have insurance until AFTER I have made recommendations and given an estimate - simply to avoid giving the impression that my estimate is based on their ability to pay / insurance status etc. this includes clients that i believe to be insured as often-times they have changed or cancelled policies particularly as animals become older and the policies become more costly.

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Fri, 14 Jun 2013 19:18:03 GMT

And the impacted tooth? That would be a pre-existing condition anyway, wouldn't it?

Re: Pet insurance and dentals

Evelyn Barbour-Hill — Fri, 14 Jun 2013 19:15:38 GMT

To be frank, I can't really see that you have anything to complain about. (Well, I mean your client has nothing to complain about. What insurance pays for is not really your concern).

I don't know of any insurance that would pay for extractions arising from periodontal disease, or any other periodontics for that matter, unless arising clearly and exclusively from another cause such as external trauma. I don't see anything sneaky in the policy wording.

Re: Pet insurance and dentals

Stephen Courtney — Fri, 14 Jun 2013 19:09:20 GMT

Argue with them. you cannot claim for the 'routine' dental, but the impacted tooth that was subsequently discovered and needed specialist attention is a different story. If you explain your position and make it clear you are backing the client they will often reconsider. especially if the specialist also wades in to back this position too.

In the UK if the insurance company is obdurate the clietn can take them to the ombudsman, and this often makes insurance companies rethink their ground.

I assume that you are talking about Petplan? If a story is true i don't see why we should pussy foot around . my experience of Petplan and dental claims is positive. Perhaps the claim was assessed by an ill informed assessor?

Did you claim just for the specialist treatment, or did the claim include the scale, polish and extractions you described ? I would suggest you call the insurance company and discuss the case. Usually you will be told if you put it in writing they will reconsider. Make a note of which people you talk to as well. I think you might be surprised. Too many people just give up when insurance companies say no, bear in mind it isn't the company that has said no, right now, just some oik who probably has no real knowledge of the dental issues and cannot see past the concept of 'teeth'

Re: Pet insurance and dentals

Michael Woodhouse — Fri, 14 Jun 2013 19:02:21 GMT

I've always work on the theory that insurance will not pay for dental stuff, but the occasional claim gets paid.

The dental guys may disagree, but most dental problems are the owners 'fault' and caused through lack of proper homecare.