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foxyflugel

Pet insurance claim declined

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Hi everyone

 

My cat had to go into the vets for an op and the insurance company have declined the claim. I took him to the vet as he was having trouble eating - dropping food etc. They said his teeth were ok and his gums looked fine but he did have two lumps - one on the inside of either cheek - which he was subsequently biting on. They gave him some painkiller and antibiotic and said to bring him back if that did not work.

 

I took him back as it worked for a couple of days and then he regressed. The vet (another vet) said that the best course of action was to have him in and do a biopsy on the lumps - with possible removal of teeth as they could sometimes be the cause (they develop a reaction to their own teeth). I mentioned to the vet that teeth and gums were not covered on his insurance and she said it would be fine as the lumps were in his cheeks - and I would need to pay for the teeth extractions - to which I agreed. She reassured me that they dealt with a lot of insurance companies and this would be fine.

 

She gave me an itemised estimate of treatment which was over £900. (on the estimate it says the reason is oral mass biopsy (=/- extractions) On the morning of the op I took him in and it said that he was in for a dental - which I questioned - and they said it was classed as a dental as they used the dental machine.

 

When I collected him - they had taken a biopsy of the cheek lumps and also one from his tongue - when I questioned this the vet said it was done because it didn't look right - and also did blood tests for feline HIV and another one that mentioned gingivitis - when I questioned this (gum exclusion??) she said it was just the wording of that blood test. Apparently the dental machine broke down and they could only take half of his teeth out - they were gong to take them all out.

 

I settled all the bill via my credit card and gave my claim form to the vets. All the biopsies and blood tests were clear. After 3.5 weeks of chasing they finally submitted it and it had been declined by my insurance as the vets have stated the reason is stomatitis. This was never mentioned to me and having looked into it - stomatitis IS an immune reaction where they start to reject their own teeth.

 

My thinking is that 1) His teeth were not neglected/had a massive tartar build up - as confirmed by the vet 2) his gums were fine - as confirmed by the vet - he went in initially for the lumps inside his cheeks - NOT on his gums. They also charged me £72 for a dental!! - which I had pointed out that morning that he was not in for a dental! (and it was not on the initial estimate)

 

He only has his 4 fangs and small front teeth remaining - and they charged £72 to clean these? Or they did them all - knowing they were going to pull all his molars out (until the machine broke down).

Someone from the insurance company is meant to be calling me back today - and also the insurance person from the vets is going to be calling me back today - neither have called yet. Views on where I stand on this would be appreciated please guys.

 

Thanks Foxy

Edited by honeybee13
Paras.

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Hello Foxy. I'm sorry about your kitty and the other problems.

 

I've merged your threads to the pet forum rather than have duplicates running, it causes confusion.

 

HB


Illegitimi non carborundum

 

 

 

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Insurers will stick to what the policy excludes, so if after the tests it was found to be dental related, then they will exclude the claim.

 

In my opinion, the Vets practice should have told you that the tests might reveal a dental issue that the Insurance would not cover and asked you whether you wanted to proceed based on no Insurance claim being possible.

 

If there is a complicated medical explanation as to why the Insurance company are not correct that it is dental and it is a disease or body condition that just happens to cause teeth to be rejected, then your Vets should write a letter of explanation to the Insurers. The Insurers should then refer to their own vetinery experts to check.


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You need to get back to your vets. It's possibly in the way they've worded it and I find this can be more of a problem with the chains. They will have logged your cats problems under the most convenient section on their billing system. Ask them to resubmit giving a proper account of the procedures.

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