Your Guide to Pre-Approval in Pet Insurance

Vet bills can reach thousands of dollars. And if you already have pet insurance, you may assume that the entire amount will be covered.

The truth is that while pet insurance is there to help you pay for unexpected vet bills, there can be limits to it. If your policy is new, if your cat or dog has underlying conditions, or if the treatment isn’t covered by your plan, you might be left with out-of-pocket expenses.

If you want to know where you stand before your pet’s treatment, there may be a pre-approval option. By submitting a few details to your insurer, you can find out what’s covered before you agree to the treatment.

But what is pre-approval, and how does it work? Let’s take a look.

What is pet insurance?

The average cost of a vet visit in the US is $61.00. While this might not sound like a big deal, costs can skyrocket if your pet needs more extensive care.

For example, the cost of treatment for a dog with a broken bone averages $2,700, and for a cat, it’s $2,300. And if your dog has ingested a foreign object, you’ll pay around $3,500. For a cat, it’s $3,400.

Enrolling your cat or dog in a pet insurance policy can reduce the cost of veterinary treatments. By paying monthly premiums, you’ll get financial protection if your fur baby does get sick.

Keep in mind that there are exclusions and terms and conditions with pet insurance, so you should always read the fine print. 

Your base coverage will usually include medical treatment for accidents and illnesses. If this isn’t enough, you can boost your policy with wellness care, which includes vaccinations and other preventative treatments.

What is pre-approval in pet insurance?

Giving your pet the best possible treatment comes at a price. The average pet owner in the US spends just over $1,000 per year, per pet on vet bills and fees.

Fortunately, pet insurance can reimburse you for some of your pet’s medical experiences. But if their treatment becomes more complicated or if they need a serious operation, the thought of that final bill might still stress you out.

In pet insurance, pre-approval or pre-certification is there for these moments. You can submit a pre-certification form to find out exactly how much you can claim. 

Then, use this information to work out your budget and compare treatment options. For example, the amount you’re willing to pay could be the deciding factor between surgery and medication.

Why would you get pre-approval?

If you take your pet to the vet for a standard procedure, the claim amount and out-of-pocket expenses may be low. In this case, you may be happy to pay upfront and receive your reimbursement later.

However, there may be times when the necessary treatment isn’t straightforward. There can be multiple procedures and expensive, life-saving treatments to consider. Getting pre-approved means you’ll know exactly what’s covered – and what isn’t. 

With pre-approval, you’ll learn how much money you’ll get back so that you can make informed decisions about your pet’s care. 

And if you don’t have the savings in the bank, your pet insurance provider may pay the hospital directly. 

What are the requirements for pre-approval?

Before you submit an application for pre-approval, make sure you tick all of the eligibility boxes. 

Check what’s included in your coverage because your pet’s treatment might not be on the list. For example, there may be a pre-existing condition exclusion.

Alternative therapies and preventative care, such as teeth cleaning, spaying/neutering, heartworm tablets, and vaccinations, aren’t included in most standard accident and illness policies. If you want to make an insurance claim for these types of extras, make sure you have an add-on wellness plan.

If you’ve already hit your annual benefit limit or your policy is still in the waiting period, you won’t be covered.

Some veterinary hospitals have their own payment policies. For example, if the bill is over $1,000, the insurer may pay the clinic directly — so you won’t have to shell out the money on the spot.
Before you apply for pre-approval, get an estimate of the costs to help your financial decision.

How to get a pre-approval

The pre-approval process can vary between insurers, but the steps are usually similar. 

Keep in mind that if the situation is an emergency, you won’t have time to wait. You can try to contact your pet insurance company via a helpline, online chat, or urgent email. 

Here’s a rundown of how to get a pre-approval.

1. Download the pre-approval forms

First, you’ll need to download the paperwork. You won’t be able to ask for pre-approval over the phone or via email – your pet insurance company will have specific forms you need to complete. 

If there’s an online portal, you can log in to your account to access the pre-approval documents. Print out the files and fill in your personal details. Alternatively, you can forward these documents to your veterinary clinic.

2. Ask your vet to fill out the documents

If you print the claim forms, the next step is to take them to your veterinary clinic or animal emergency hospital. There’ll be a section for the clinic to complete, which will help the insurance company make the final decision.

For example, your vet will include a list of treatments and their costs. If possible, ask your vet to attach a copy of an itemized estimate. The more information you provide, the quicker your claim can be processed.

The hospital will need to include its stamp or letterhead on all claim forms for the insurance company to verify it’s a licensed clinic.

3. Include your pet’s medical history

The insurance company will also need to know about your pet’s medical history. Why? So they can determine whether your cat or dog has a pre-existing condition that may be excluded from your coverage.

This step is especially important if it’s your first time making a claim, as it helps the insurer get to know your pet and gives them a full picture of their health.

Some pet owners keep a log of their pet’s vet visits, including vaccinations, injuries, and chronic conditions. If you don’t, your vet should be able to provide you with a copy.

Don’t forget to attach the medical history to the claim form.

4. Submit the application

Once you’ve completed the forms and double-checked the details, it’s time to submit your application. Make sure there are no missing items, as this might delay the process.

Your options will depend on your insurance provider. For example, if the provider has an online portal or app, you can upload the documents there.

Alternatively, some insurance companies accept pre-approval claim forms via email or fax.

Remember, if your pet needs urgent treatment, contact the helpline to fast-track your application. For standard applications, approval can take up to five business days — which might be too long for your furry friend to wait.

5. Complete the treatment

Once you’ve received the pre-approval agreement in writing, your pet’s treatment can start. 

You’ll know exactly what your eligible expenses are before you make a financial commitment. You can focus on getting your pet the care they need so that they can recover and get back to doing the things they love.

Of course, not everything will be set in stone. For example, you may have to pay a gap if there are items that aren’t covered by your policy. Or, if your pet’s health status changes, your vet may include additional services.

Then there are annual deductibles. When you enroll your pet, you’ll choose how much you’ll pay before your pet insurance kicks in. Policies with higher deductibles typically come with lower premiums.

Pet insurance FAQs

Want to know more about pet insurance? Here are answers to some of the most commonly asked questions.

What is a pre-existing condition?

When you enroll your fur baby in a pet insurance policy, you’ll be asked about any pre-existing conditions they have.

For example, if your pet has a chronic condition such as diabetes, hip dysplasia, or cancer, that’ll be considered pre-existing — and it won’t be covered by your insurance policy.

There can be curable pre-existing conditions, too. A broken bone, urinary tract infection, or respiratory infection won’t be covered until your pet has fully recovered.

And the pet insurance company won’t just take your word for it. Most insurers will ask your vet for your pet’s medical records before approving the policy.

If you enroll your cat or dog while they’re still young, you’ll get the most out of your pet insurance policy.

Will your pet insurance go up if you claim?

Yes, your pet insurance premiums may go up if you make a claim. There can be multiple variables to this, so you should always check with your insurance company for accurate advice.

For example, your premiums can depend on the type of treatment your pet receives and whether they’re at risk of future illness. The cost of the treatment can also impact the premiums.

Furthermore, your premiums can increase as your pet gets older. If your cat or dog is over five years old, for instance, their risk of getting an illness will gradually increase – and so will your premiums. 

Can you use your preferred vet?

Most pet health insurance providers let you choose your own veterinary clinic. As long as the vet is licensed, you can take your cat or dog to whatever clinic you feel most comfortable with.

Unlike human health insurance, you’ll usually pay the price upfront. The pet insurance company will then reimburse you.   

As long as the vet provides services that your pet is covered for, you’ll get at least some of your money back.

When you build a relationship with your vet, your pet will get consistent care throughout their life. And if you don’t already have a pet insurance policy, you can ask your vet for advice.

Can you get pre-approval straight away?

When you enroll your pet in a new policy, there’ll usually be a waiting period. For example, Pumpkin has a short, 14-day waiting period for accidents and illnesses.

This timeline can vary between insurers, and certain problems, such as knee conditions, ligament issues, and orthopedic issues, can have extended waiting periods.

You won’t be covered if your pet gets sick during the waiting period. And you’ll need to wait until your policy kicks in before you can ask for pre-approval.

Understanding pre-approval in pet insurance

When your pet needs veterinary care, you’ll do just about anything to get them home safely. But the cost of treatment can add up quickly, in an already overwhelming time. Even if you have pet insurance, you may not know whether the treatment your fur baby needs is covered and how much the payout will be.

This is where pre-approval comes in. If the cost of treatment isn’t in your budget, you can ask your provider to tell you exactly how much you’ll be covered for. Depending on the animal hospital and your financial situation, the insurer may even pay the vet directly.

If you want to apply for pre-approval, there are a few steps to follow. You’ll need to download the pre-approval form and ask your vet to fill out the finer details. 

Once the application has been assessed, you can decide which treatment option is the best fit.

Remember, pet insurance plans are there to protect your finances and your pet. The right policy will reduce your vet bills and support your cat or dog so that they can live a long and happy life.

Want to learn more about pet insurance from Pumpkin? Get in touch today.