What Happens After You Submit A Claim?
Your pet received veterinary care, fortunately you have Pets Best pet insurance, and you submitted a claim for reimbursement. Now what? In this article we will explain what happens to your claim after you submit it and how it’s processed.
A critical part of processing a claim correctly is verifying the condition being claimed does not pre-exist the insurance policy. Unlike human medical insurance, pet health insurance does not cover pre-existing conditions. Exclusions like this help to reduce the overall price of pet insurance for all policy holders. The cost of pet insurance would increase dramatically if every condition that occurred before the policy was in effect were covered.
To verify a condition is not pre-existing, Pets Best will often request your pet’s medical records from your veterinarian. Medical records are often requested after you submit a claim. This means that the veterinary practice identified on the claim will receive a message from Pets Best requesting your pet’s medical records. Requesting medical records ensures that:
- The condition is not pre-existing as explained above
- The claim is processed as quickly as possible
Updating a Claim
After you submit your claim, if you notice that you forgot to upload a document or proof of payment, you can update your claim in your customer portal. You can add documents by selecting the Claims Center tab and clicking the Update a Claim option. From this point you will see recently submitted claims that are available to update.
Claims that require medical records are held in a queue until the records are received. Once they are received, the claim is entered into the Pets Best claim adjudication system for processing. It’s from this point that our expert claim staff, which consists of licensed veterinarians and veterinary technicians reviews the details of the claim and the coverage provided by your pet’s policy to determine if it is eligible for reimbursement.
Once your claim has been reviewed by our expert staff, an approved or denied decision will be made. If your claim is approved, you will be reimbursed according to the reimbursement level you chose, less the deductible amount of the policy and any ineligible items. Reimbursement will be made directly to the bank account of your choosing if your direct deposit information has been added to your policy. If you have not entered your bank information through your Pets Best Customer Portal, the payment will be made by check and mailed to the address on file.
Terms and conditions apply. See policy for details.
Deductibles and Claim Denials
In the event your claim is not reimbursed or denied, there are several reasons why this could have occurred:
- You have not met your deductible and the amount was applied towards the policy deductible.
- The services provided to your pet are not covered under your current policy. For example, exam fees are not covered unless your policy includes optional exam fee coverage.
- The condition(s) were deemed pre-existing.
If you feel an error has been made regarding your claim or the decision reached, please contact us.