insurance claims refused

Re: insurance claims refused

Gillian Mostyn — Thu, 11 Dec 2014 12:46:11 GMT

If insurance fraud didn't exist, none of this checking would be needed. Unfortunately there are many people, and a few vets, who will lie without guilt. I get frustrated by the requests for extra paperwork and by occasional refusals, but I rarely blame the insurance company for their checking. Unless it is AF or E&L of course....

Re: insurance claims refused

Martin Atkinson — Thu, 11 Dec 2014 09:51:38 GMT

[quote user="Stephen Courtney"]they might have their moments but they are basically fair minded - or am i being naive?[/quote]I think you're being naive! There was a time when PetPlan was a private company that it seemed that if in doubt they'd pay but times have changed. They are all in this to make a profit, not to be fair, but they are not stupid and while they may try and get out of paying if they can, they realise that unless a claim is obviously exaggerated or not within the terms of insurance that once pressured they have to pay.

Trouble is, as you say, too many clients accept this and its human nature not to want to make a fuss. While I sometimes resent the time taken on completing claim forms for trivial amounts, once the chips are down I will go out of my way to help the client against an unfair refusal of payment.

Re: insurance claims refused

Stephen Courtney — Wed, 10 Dec 2014 21:27:04 GMT

If you write a letter to Petplan advising that they look at the claim again, as in your opinion they have been unreasonable, and make it clear you will assist the client take them to the insurance ombudsman, your problems will evaporate. that approach even works with AF. Well, it did once...but how many clients don't make a fuss?

they might have their moments but they are basically fair minded - or am i being naive?

Re: insurance claims refused

Neil Wheadon — Wed, 10 Dec 2014 16:07:56 GMT

I've got a stitch up grumbling on and on.

Done OOH, it was a clean fresh cut

I even wrote on the history that if left it might lead to complications.

Presumably the OOH fee has spooked them, deciding it wasn't an emergency

Neil

Re: insurance claims refused

Martin Atkinson — Wed, 10 Dec 2014 13:28:17 GMT

[quote user="Richard Carter"]actually Petplan - have tried to talk to someone but gave up after 5 minutes on hold.[/quote]Petplan blow hot an cold. Some complicated claims sail through without a hitch yet other seemingly simpler ones they nit-pick over. I think they have different claims assessor teams and it depends which one your claim lands with. I suspect that like many customer service teams these days not all of these are in the UK and the assessors I've had the greatest issues with have all had very thick 'foreign' accents. It has got to the point that although we are 'signed up' to PetPlan I can't find it within myself to automatically recommend them. I have usually solved these issues if they can't be settled orally by writing a letter stating that in my opinion such and such a treatment was necessary and is a recognised method of treatment.

Re: insurance claims refused

Hannah Wynne Richards — Wed, 10 Dec 2014 12:25:31 GMT

Tell the owner to complain to the Insurence Ombudsman.

Wynne

Re: insurance claims refused

Richard Carter — Wed, 10 Dec 2014 11:53:17 GMT

actually Petplan - have tried to talk to someone but gave up after 5 minutes on hold.

If you follow this logic through then pyometra, mammary neoplasia, urinary incontinence (on the other side of the coin) all become an issue

Re: insurance claims refused

Sammy82 — Wed, 10 Dec 2014 11:31:59 GMT

Exactly my thoughts Bob! Although undoubtfully neutering has some benefits it is still an invasive procedure and must not become a "must" to be able to insure a dog.

[quote user="Bob Russell"]

This has to be a non-starter for the insurance company! Testicular tumours not covered as preventable. Toe tumours not paid for on the grounds that precautionary amputation would have prevented it. Tail injuries on the grounds that docking would have prevented the injury.

Lets guess! Animal Friends?

[/quote]

Re: insurance claims refused

Bob Russell — Wed, 10 Dec 2014 11:13:48 GMT

Lets guess! Animal Friends?

Re: insurance claims refused

Martin Atkinson — Wed, 10 Dec 2014 11:05:54 GMT

We have one in the pipeline with E&L so I'll keep you posted, they requested the full clinical history at the end of November over 2 weeks after receiving the claim form so already applying delaying tactics. However it did also have a weird scrotal lesion which would justify castration on its own anyway. One before this was with More Than earlier this year and they paid no argument but I didn't mention the word castrate just excision of the mass...ooh how remiss of me!!

Re: insurance claims refused

Anthony Dennison — Wed, 10 Dec 2014 10:39:19 GMT

We've had to write a letter to an insurance company before arguing that castration was a recognised treatment for perianal masses, never refused though!

Re: insurance claims refused

Hannah Wynne Richards — Wed, 10 Dec 2014 10:33:47 GMT

Which insurence company?

Wynne