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Surgery Coverage in Comprehensive Pet Insurance

While some pets experience illnesses and accidents, others may live relatively free from diseases or unexpected vet trips. The reality is that it is generally difficult to predict how a pet will live its life. Having an ill pet requiring surgery is often unpleasant for most pet owners. This is because the cost of pet surgeries can quickly stack up to hundreds or thousands of dollars. An easy way out is often to get pet insurance that covers surgery. Unfortunately, not all surgeries are covered under most pet insurance plans.

This article will serve as a comprehensive guide to pet insurance coverage for surgery. Let's get started.

Does pet insurance cover surgery?

Some pet insurance policies may cover a pet's surgical operations. However, various factors can determine whether an insurance policy will cover a specific surgical procedure. They include the following:

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Type of insurance

There are various types of insurance coverage, each offering varying degrees of coverage. The following describes the typical coverage for the most common types of insurance policies:

  • Accident and illness policies. This insurance may cover veterinarian fees for unforeseen diseases, such as mass removal, fracture repair, and foreign body surgery, or accident diagnosis, treatment, and hospitalization. Surgery for different diseases and disorders may also be included.
  • Accident-only policies. The accident-only insurance policy only covers unexpected injuries and accidents, such as fractured bones, scratches, and poisoning. However, some surgeries, such as a fracture repair, may be covered.
  • Wellness policies. This insurance may cover routine procedures/wellness expenses like dental cleanings and vaccinations. Some wellness policies also cover the cost of spaying and neutering, often included in a package.

Condition history

Most pet insurance companies will not cover preexisting conditions. So, your insurance likely won't cover the surgery if your pet has a prior history of the ailment it's designed to address. For example, if your dog has a history of luxating patellae (kneecaps), then surgery to correct this would not be covered.

Exclusions

Different insurance policies cover different things; some plans include exclusions that others do not. Surgeries for pets on the insurance company's list of non-covered procedures are nearly never reimbursed. Also, some breed-related surgeries may not be covered. For example, the insurance may not cover stenotic nares surgery for bulldogs. Your pet's health insurance may cover necessary surgical procedures, but most insurance policies often do not cover elective or cosmetic operations like ear cropping, tail docking, or medically unnecessary declawing. These surgeries are regarded as entirely cosmetic.

Surgical procedures covered by pet insurance for surgery

A surgical procedure must be deemed medically necessary before a pet insurance policy can cover it.

Insurance typically covers surgical operations necessary to treat unanticipated medical issues or accidents. Some of these procedures include repairing fractured bones and ligaments and removing tumors, infected teeth, and foreign objects. High-cost surgical procedures, such as hip and knee replacements, may also be eligible for reimbursement.

However, insurance coverage for surgical procedures might vary widely across insurance policies and providers. Although most pet insurance plans exclude pre-existing conditions, some may cover curable diseases in remission for a specific period. Most plans also require a waiting period before the coverage begins. Furthermore, waiting periods for accidents and illnesses may differ from one insurance firm to another.

Read the small print on your pet insurance policy to understand the treatments, restrictions, and exclusions covered in your policy. This is because various plans and insurance providers may offer varying coverages for dogs and cats.

Common types of surgery in dogs

Many animals, including dogs, need regular surgical operations. The common types of surgery in dogs include the following:

  • Spaying and neutering
  • Skin tumor removal
  • Skin laceration repair
  • Emergency surgery for Internal bleeding
  • Fractures repair
  • Cruciate ligament repair for torn ACLs
  • Bladder stone removal/cystotomy
  • Abdominal exploratory due to Intestinal obstruction, including foreign body removal
  • Ophthalmic surgery
  • Splenectomy or removal of the spleen, usually due to bleeding tumors cancer

Common types of surgery in cats

The following surgical procedures are relatively more familiar with cats:

  • Abdominal exploratory due to intestinal obstruction, including foreign body removal
  • Spaying and neutering
  • Ophthalmic surgeries
  • Skin abscess or laceration repair
  • Fracture repair
  • Emergency surgery for internal bleeding
  • Tumor or mass removal
  • Bladder stone removal or relief of urethral blockage

Surgical procedures that aren't typically covered by pet insurance

Pet insurance does not usually cover elective or cosmetic surgeries, including declawing, ear cropping, and tail docking. While certain wellness coverage providers include coverage for spaying and neutering, most pet insurance policies do not.

Furthermore, not all insurance companies cover surgical treatments for postpartum complications. Policies that do not cover breeding-related costs may not cover emergency Cesarean sections.

As previously stated, most pet insurance plans exclude coverage for pre-existing illnesses. As a result, if your pet had a prior ailment that was assessed and treated before you purchased the policy, the insurance is unlikely to cover the costs. So, you should study the policy specifics carefully since some pet insurance may cover treatable pre-existing illnesses after a waiting period.

How does pet insurance work for surgery?

Most insurance policies that cover pet surgeries utilize a reimbursement model. So, pet owners typically pay for the surgery procedure out of pocket and, after that, file a claim with their pet insurance carrier for reimbursement. Furthermore, pet owners must also pay a deductible before the insurance policy makes the payments. Following the deductible payment, the insurance provider will reimburse you for a portion of the permitted vet expenses for your pet, often between 70% and 90%.

For example, if your pet requires a $5,000 emergency surgical procedure and your insurance policy has a $500 deductible and an 80% reimbursement rate, you will have to pay 5,000 up front and then file a claim. You'll cover the first $500, and afterward. Afterward, the insurance company would cover 80% of the remaining $4,500, which is $3,600. This means you would be liable for the remaining $900 of the $4,500. So, overall, you would be responsible for a $1,400 out-of-pocket payment, which includes the initial $500 deductible and $900 in coinsurance for the $5,000 surgery.

How to file a pet insurance claim to recover surgery costs

Getting your pet's surgery bills reimbursed by insurance is often straightforward. Here is a detailed step-by-step guide to filing a pet insurance claim to recover surgery costs:

  • Pay for the surgery upfront. Most pet insurance plans use reimbursement as their principal mode of operation. This means you have to pay for the procedure upfront. As a result, you should budget for the surgery in advance.
  • Get a detailed invoice from your veterinarian. Request a comprehensive bill after the surgery. This record should contain the date of the surgery, a thorough description of the procedure, and the total cost of the treatment.
  • Submit a claim. Most pet insurance companies allow you to file a claim through their official websites or mobile applications. Fill out the form and attach a copy of the detailed invoice you received from the veterinarian to make a claim.
  • Wait for approval. After reviewing your claim, the insurance company will determine how much of the overall surgery cost it will bear, depending on your insurance policy.
  • Receive reimbursement. Once your application is accepted, you can cash in on your reimbursement. Although there may be some wiggle in the schedule, the average period is between two weeks and one month.

Pet insurance companies that cover surgeries

Although insurance coverage varies by insurer and plan, most pet insurance policies cover specific surgical procedures. Read the small print of the insurance policies you want to purchase; this is to ensure you obtain the proper coverage for your pet.

Lemonade

Lemonade, a renowned home and renter insurance policy provider, also offers low-cost coverage for pet surgeries. The insurance provider provides conventional pet insurance coverage covering sickness and accident costs. These costs include various medical services, including inpatient stays, outpatient visits, laboratory tests, emergency treatment, prescription medicines, and surgical procedures. Additionally, it has an easy-to-use smartphone app that allows you to monitor your pet's health, file claims, and see how much you owe and your coverage.

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Spot

Spot Pet Insurance offers reasonably priced accident-only coverage. Clients can customize the plans the firm offers to their requirements, with yearly limits ranging from $2,500 to an infinite amount. Only surgical procedures that fall under the specific plan are covered under both Spot's accident-only and accident-and-sickness plans. Accident-only isn't going to cover a mass removal. On the other hand, Spot's accident and illness plan offers more extensive coverage for surgical procedures associated with conditions such as dental disease, heart disease, cancer, diabetes, and others.

Trupanion

Trupanion covers injuries and illnesses that are unrelated to pre-existing conditions. This insurance provider offers deductibles ranging from $0 to $1,000. Additionally, unlike other suppliers, Trupanion may pay your veterinarian directly. By choosing this reimbursement option, you will only have to pay the deductible and copay at the veterinarian's office. So you won't have to worry about paying the bill, making a claim, and waiting for reimbursement again. However, before you seek compensation for your pet, please talk with your veterinarian. This is because not all veterinarians accept direct payments from insurance providers.

ASPCA

ASPCA Pet Health Insurance is well recognized and regarded as a significant source of pet insurance due to its extensive coverage and over 15 years in the market. It provides a modestly priced accident-only plan and a more comprehensive Complete Coverage plan with a higher monthly premium. The ASPCA's Complete Coverage Plan provides better surgical procedure coverage than the other plans. While the Complete Coverage plan covers a wide variety of medical bills (including cancer treatments, hip dysplasia surgeries, digestive disorders, heart problems, and more), the accident-only plan only covers treatments, operations, diagnostics, and tests linked to the accident.

Fetch

Fetch provides comprehensive pet insurance coverage that protects against sickness and accidents. This comprehensive plan covers various conditions, including injuries, chronic illnesses, genetic problems, etc. Furthermore, up to the yearly limit, it covers multiple medical treatments for dental problems, cancer, diagnostic tests, gastrointestinal ailments, and others. Fetch is one of the few pet insurance providers that covers unorthodox and specialty treatments, such as stem-cell therapy, homeopathy, and acupuncture.

Final thoughts

When looking at pet insurance, pay close attention to the policy terms, particularly the types of medical services covered. Although the details differ from one insurance provider to the next, most pet insurance providers cover various surgical treatments. Ultimately, pet insurance can be a worthwhile investment for some pet owners. In general, it covers multiple medical treatments and may assist you in ensuring that your pet has the best care available while remaining within budget.

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