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Vet care can be very expensive, and lots of people purchase pet insurance to soften the financial burden.
At ManyPets, we receive thousands of claims each year, and most of them we accept and pay out for. That said, claims are sometimes denied, and pet owners can get understandably frustrated when this happens.
To avoid facing denied claims, your best bet is to learn why certain types of claims are ineligible for coverage. Whether you're searching for a policy or in the process of making a claim, we've put together a list of some of the most common reasons why pet insurance claims get denied.
You've claimed for something that isn't covered
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You should always read the policy wording before purchasing insurance. It's vital that you understand the terms and conditions of your policy and double-check anything that's unclear. Whether you have an existing policy or you're deciding between potential providers, it's never a bad idea to call customer service with any questions.
Pet insurance companies include the definitions of important words in their policy documents. When taking out your policy, read it thoroughly. You shouldn't assume the meaning of certain terms based on their everyday use or your previous experience with a different company. Once you’ve agreed to a particular set of terms, claims may not be covered if they include something that isn't contained in those terms.
Your policy does not cover pre-existing conditions
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Pet insurance companies generally don't cover pre-existing conditions. With ManyPets, a condition is pre-existing if any of the following have taken place within the past 18 months or during your initial waiting period:
Your veterinarian has diagnosed or provided medical advice for the condition
Your pet has received veterinary treatment for the condition
Your pet has displayed signs or symptoms consistent with the condition
You should always research how your pet insurance provider defines existing pre-existing conditions, as this may vary by company. ManyPets, for example, may drop exclusions for a condition that's been free of symptoms, diagnosis, and treatment for 18 months prior to your policy effective date. (Certain conditions will always be considered pre-existing even after 18 months: Hip dysplasia, cruciate ligament conditions, and–in some states–IVDD.)
When it comes to pre-existing conditions, coverage is only excluded for the specific condition in question (and any related complications). In other words, once your insurance coverage is active, any new condition that isn't related to the pre-existing one may still be eligible for coverage.
You've claimed during your initial waiting period
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Pet insurance policies generally only cover new conditions that develop after a waiting period has passed. (This waiting period can vary by company and location; with ManyPets, it's 15 days in most states.)
However, unlike some competitors, ManyPets may (in certain circumstances) waive your waiting period if you're switching your pet from a different pet insurance company.
If you're unclear on the official start date of your coverage, always consult your own state's policy document or speak with a customer service agent.
Your policy does not provide coverage for "routine treatment"
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Pet insurance is designed to cover accidents and illnesses, not preventative care. As a result, you'll find that routine care isn't covered under your insurance policy. Routine wellness exams and vaccinations, parasite prevention, preventative dental cleanings, spaying and neutering, pregnancy-related issues, and vitamins/supplements for dogs and cats are all considered preventative care.
You'll need to keep your pet up-to-date on routine care to keep your pet eligible for accident and illness coverage. (We’ll discuss this more in the next section.)
If you want to go beyond accident and illness coverage, you might consider looking into the optional, non-insurance ManyPets Wellness Plan, which is designed to reimburse you for some of the costs of routine care.
Your pet's routine care has been neglected
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If a lack of check-ups, vaccinations, or other routine care is proven to be a direct factor in your pet's injury or illness, many pet insurance companies won't offer coverage for those conditions. To keep your pet eligible for ManyPets' accident and illness coverage, you'll need to provide your pet with routine care, including annual health and dental check-ups and vaccinations.
Again, if you're looking for ways to save on preventative care, ManyPets offers an optional, non-insurance Wellness Plan that you can add on to your insurance policy.
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Your pet needs certain kinds of dental care
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Dental coverage varies by company. As we mentioned above, routine and preventative dental treatments –like professional dental cleanings–are not commonly covered by any company's pet insurance policies, though they are partially reimbursable under ManyPets' Wellness Plan.
Something else that's worth noting: ManyPets policies MAY include coverage for dental injuries and illnesses, including periodontal disease. While most pet insurance companies do cover dental accidents, not all of them cover dental illnesses like ManyPets.
Your pet's a working or commercial animal
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Pet insurance companies generally won't cover working animals (including service animals), or pets who are used for commercial purposes like breeding, racing, security, etc. These animals aren't considered pets.
If you're unsure whether your furry friend falls into this category, make sure to double-check with any potential insurance company before buying a policy.
Your pet's details are not up-to-date
Tell your company about any changes to your pet’s circumstances, including moves to a new zip code or a change in ownership.
ManyPets covers pets who are traveling temporarily anywhere in the US or Canada for up to 90 days – but after 90 days, the move is no longer considered temporary and must be reported to ManyPets. That's because moves can affect your premium and ability to claim.
Meanwhile, ownership can't be transferred from person to person–any new owner will need to purchase a new policy for coverage to remain active.
Your pet's medical records are incomplete
ManyPets requires you to submit at least the last 18 months of your pet’s medical records—or all of their medical records if they’re younger than 18 months. You’ll only need to send these records the very first time you submit a claim for your pet, unless we specifically request additional information.
Your pet's medical record should include:
Identification details: your pet's name, breed, age, and other identifying details, such as microchip number.
Vaccination history: records of all vaccinations given, including dates and types of vaccines.
Medical history: all past and present health conditions, treatments, and procedures.
SOAP notes: These “Subjective, Objective, Assessment, and Plan” details from your vet help us keep track of treatments over time for claims you submit.
Medication records: details of current and past medications, dosages, and duration.
Veterinary visits: dates and reasons for all vet visits, including routine check-ups and emergency consultations.
Diagnostic test results: results of any blood tests, X-rays, ultrasounds, etc.
Preventive care records: information about flea, tick, and heartworm preventatives, as well as any other routine preventive care.
ManyPets won't cover any claims until we have this information*. Fortunately, our first course of action will simply be to request the missing records. A claim would only be denied over missing records if you didn't submit these documents even after we asked you to.
*ManyPets analyzes every claim on its own merits, subject to the terms and conditions of your policy. Exclusions apply, including those for pre-existing conditions. Only claims unrelated to an excluded treatment or condition are eligible for coverage. See your policy for details.
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