My cat needed emergency surgery last month. Total bill was $4,800. I submitted the claim and they denied it saying the condition was pre-existing. But she was never diagnosed with this before! The vet just noted in her records once that she had some mild symptoms 2 years ago. Thats it. No diagnosis, no treatment. Is this even legal? Has anyone appealed a denial like this and won?
7 Comments
You can absolutely appeal. Get a detailed letter from your vet explaining that the previous symptoms were unrelated or that no diagnosis was ever made. The insurance companies count on people not appealing. Many denied claims get overturned when people push back with documentation.
how long does an appeal take? i already paid the vet on credit card and interest is adding up
typically 2-4 weeks for appeal review. faster if you can get your vet to call them directly. some vets have insurance liaisons who deal with this all the time
My spouse works in insurance (not pet but similar). The initial denials are often done by algorithm based on keywords in the vet records. "Mild symptoms" probably triggered an automatic flag. Appeals go to actual humans who can use judgment. Definitely worth appealing.
I won an appeal last year for a similar situation. Key was getting my vet to write a specific letter saying the conditions were clinically distinct and that previous notes did not constitute a diagnosis. Took 3 weeks but they reversed the denial and paid in full. Dont give up!
Also consider filing a complaint with your states insurance commissioner if the appeal fails. Pet insurance is regulated in most states and they take complaints seriously. Companies often settle quickly once a state regulator gets involved. Its free to file and you dont need a lawyer.
just wanted to update - i had a similar denial last month and won my appeal in 2 weeks. the key was getting my vet to write a very specific letter stating 1) no formal diagnosis was ever made 2) the previous symptoms and current condition are clinically distinct 3) current condition developed after policy enrollment. be very specific in the language. good luck!