Table of Contents
- You can sign your pet up for pet insurance at any time, but that doesn’t mean everything will be covered
- Most pet insurance will cover non-elective surgery if the pet was insured before the condition was diagnosed
- All pet insurance policies have waiting periods, some even have extended waiting periods for common orthopedic conditions needing surgery
- Like forms of insurance, early enrollment is key, the best time to get pet insurance is before your pet actually needs it
The Importance Of Early Enrollment For Pet Insurance
Pet insurance is one of the best ways to be prepared for any health issues your pet may face during their lifetime. It can help pet owners save thousands on veterinary bills, especially during emergencies, which about one out of three pets face every year. But to reap the full benefits of pet insurance, early enrollment is key.
Some pet owners decide to delay pet insurance for pets that are young and healthy, but even young, healthy pets end up having accidents or illnesses. Your puppy could end up jumping off the couch and hurting its leg, or your kitten could come down with a respiratory infection, two unfortunately common scenarios. Once any health conditions have occurred, you’re looking at more coverage exclusions once you do enroll in a pet insurance plan.
Unfortunately, no pet insurance covers pre-existing conditions. This includes any diagnostics or treatments associated with the pre-existing condition. Enrolling your pet early is the best way to ensure they are covered for any medical treatments they may need in the future. This includes surgery, which is often a costly endeavor for pet owners without insurance.
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How Pet Insurance Surgery Coverage Works
Pet insurance covers a wide variety of surgical procedures for both cats and dogs, but there are several stipulations pet owners need to be aware of. If you’re thinking about getting pet insurance before your pet’s surgery, here’s everything you need to know about its potential coverage and limitations.
What Surgeries Are Covered By Pet Insurance
In order for a surgery to be covered by pet insurance, the procedure must be deemed medically necessary. This includes common things like fracture repairs, tumor removals, splenectomies, and much more. Unless a procedure is specifically excluded from your plan or linked to another exclusion (such as a hereditary or congenital condition), most pet insurance will cover it if your veterinarian deems it medically necessary.
Some pet insurance policies do have limits on coverage for specific procedures, such as they will only cover one foreign body removal or one cruciate ligament repair per pet. Most elective procedures such as spays and neuters are also typically not covered unless you’ve added an optional wellness plan. Most pet insurance also won’t cover c-sections, as medical costs associated with breeding are not covered. It’s important to read through all of your policy’s exclusions to avoid any surprise claim denials.
Finally, like all pet insurance, the biggest stipulation of all comes down to pre-existing conditions. Unfortunately, whether they were deemed medically necessary or not, procedures to treat any pre-existing conditions will not be covered.
Pre-existing Conditions & Surgery Coverage
Pre-existing conditions are any injuries, illnesses, or conditions that your pet had before the start of coverage. For example, if your dog had bladder stones before the insurance policy’s effective date, any treatment related to that condition would be excluded from coverage. This would include surgery to remove the stones, even if the surgery takes place after the policy’s effective date.
Even if a condition has not yet been diagnosed, potential symptoms can sometimes be enough to have it excluded from future coverage. For example, a dog with a recent history of limping could be denied a future orthopedic surgery. This is why it’s so important to insure your pet as early as possible before they develop any conditions.
During the enrollment process, your pet insurance provider will screen for any pre-existing conditions by way of a medical records review and/or a veterinary exam. This is why it is not possible to get insurance right before surgery and have it covered. Some pet owners have been tempted to withhold records or provide false information to get better coverage but be forewarned, this would be a big mistake! Insurance fraud, whether pet, human, or property, can be a felony and include hefty fines and even prison time.
Extended Waiting Periods For Surgery
Pet insurance typically comes with a waiting period. These tend to range from 2 to 5 days for accidents and from 14 to 30 days for illnesses, but some pet insurance policies also include condition-specific waiting periods.
Condition-specific waiting periods in pet insurance tend to correlate with conditions needing surgery. These usually apply to orthopedic conditions like hip dysplasia or cruciate ligament tears and can last from 6 to 12 months. Even though your policy may be active, if your pet develops a condition that has an extended waiting period, it will not be covered.
Post-Surgical Care
While it’s already well-established that pet insurance won’t cover surgery for any conditions the pet had before coverage or developed during the waiting period, post-surgical care is one area that sometimes can be confusing.
After surgery, if the pet has a long recovery phase that may include rehabilitation therapy, that will not be covered. Similarly, if additional diagnostics are needed like x-rays to check a healed fracture, these items also will not be covered. Any medications that are prescribed to manage pain from the surgery or supplements to help with the condition your pet had surgery for will also not be covered.
Options To Cover Surgery Without Pet Insurance
If your pet needs surgery, and it’s not covered by pet insurance, there are some options that may help make it more affordable:
- Veterinary Financing – Offered through credit plans like Care Credit, Scratchpay, Wells Fargo, and others, many veterinary clinics offer payment plan options through third-party healthcare lenders. In emergency cases especially, these can be helpful for getting financial assistance right away. Inquire with your veterinary office about which of these financing options they work with.
- Low-Cost Veterinary Clinics – If your pet’s surgery is not urgent, and you have time to shop around, inquire about low-cost veterinary clinics in your area. They are typically operated by local rescues and animal shelters, the online tool Pet Help Finder can help you search. These clinics may be able to do the procedure for less thanks to volunteers, grants, and donations. They may have limitations to the types of procedures they can perform and there may be a waiting list, but it’s worth inquiring about if you need help funding your pet’s surgery.
- Veterinary Discount Plans – Offered as an alternative to pet insurance, veterinary discount plans like Pet Assure and United Pet Care are monthly memberships that can save pet owners 25% to 50% on their veterinary bills. You’ll have to see a veterinarian who is in your membership network, but many offer specialty care, including surgeries.
- Crowdfunding – Many pet owners opt to try fundraising for their pet’s surgery. Crowdfunding apps like GoFundMe and Waggle are very popular. Pet owners can create and share a fundraising page with their friends and family through social media, email, and more. Of course, there’s no guarantee you’ll receive enough donations to cover surgery, but it may help.
- Financial Assistance Grants – If you are facing financial hardship and cannot afford your pet’s care, there are grant programs that may be able to help. Organizations like The Brown Dog Foundation and The Pet Fund offer grants for pets in need of surgery and other lifesaving treatments. Owners will need to go through an application process, which includes providing proof of financial hardship. The Humane Society of The United States offers online resources with a full list of programs.
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While these resources can be quite helpful when you are in a bind, if you’re just looking ahead at potential options, consider insuring your pet before they end up needing surgery (or any other costly treatments). When it comes to covering your pet’s medical bills, pet insurance is still the number one option, and there are many affordable plans to choose from.
Frequently Asked Questions (FAQs)
Can’t I Just Get Pet Insurance And Not Tell Them My Pet Needs Surgery?
Besides the ethical implications, falsifying insurance documents or withholding pertinent information to gain coverage for a pre-existing condition can land policyholders in hot water. Your pet will lose their coverage and likely become uninsurable. You may also face serious fines and legal implications. In some cases, pet insurance fraud can result in a felony charge and prison time. Contrary to popular belief, pet insurance fraud is treated just as seriously as other types of insurance fraud.
What If My Pet Insurance Denies My Pet’s Surgery?
If the procedure was denied due to a clear pre-existing condition or exclusion in your policy, there’s not much you can do. Unfortunately, it won’t be covered. However, if the procedure was denied due to either potential prior symptoms or an uncertainty of whether it was medically necessary, you may be able to file an appeal.
The steps for filing an appeal will vary based on provider, so you’ll need to read through your policy for guidance. Most appeals will likely need to include a letter outlining your request and supporting documentation as to why you think your pet’s procedure should be covered. Depending on the case, you may need to get your veterinarian involved to provide additional information on your pet’s condition.
What’s The Best Pet Insurance For Surgery Coverage?
Most of the top pet insurance providers offer similar surgery coverage, so deciding which one is best will depend on many other factors like overall coverage, reimbursement rates, and premiums. Pet insurance can also vary by state, so it’s important to look at your individual options. What may be the best plan in California might not offer the same level of coverage in New York.
If you have a breed prone to certain conditions that typically require surgery, like a Labrador prone to cruciate ligament tears, you’ll want to take that into consideration as well. Look for plans without breed-specific exclusions or condition-based waiting periods. It’s also important to consider how much you are willing or able to pay out-of-pocket. If you’re concerned about large upfront costs for surgery, look for policies that offer direct-vet-pay options.
Does Pet Insurance Cover Elective Surgery?
Most pet insurance only covers surgeries that are deemed medically necessary. These are procedures intended to treat an injury or illness and include things like repairing a broken bone, removing a tumor, stopping internal bleeding, and much more.
Elective surgeries, which commonly pertain to preventive care or cosmetics, are not covered by standard pet insurance. These include procedures like spays, neuters, gastropexies (GDV prevention), benign growth removals, tail docking, and some dental procedures. Coverage for these types of procedures is sometimes covered under wellness plans, an add-on offered by some providers specifically for preventative care.
Find out more
- Is Pet Insurance Worth It? – Evaluating the value of pet insurance for your companion.
- How Much Does Pet Insurance Cost? – A guide to understanding pet insurance pricing.
- List of Pet Insurance Companies – Comprehensive overview of pet insurance providers.
- What is Pet Insurance? – Basic understanding of pet insurance policies.
- Pet Dental Insurance – Coverage for your pet’s dental care needs.
- Accident-Only Pet Insurance – Focusing on accident coverage for pets.
- Are Wellness Plans Worth It? – Assessing the benefits of wellness plans in pet care.
- Embrace Review – Detailed look at Embrace’s pet insurance services.
