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Pet Health Insurance - dubious exclusion

post #1 of 12
Thread Starter 
As a result of the considerable veterinary expenditure on my late pet, I've been researching pet health insurance. In the process I've come across an exclusions clause in the policy offered by the Australian Royal Society for the Protection of Animals (RSPCA), which is of a a kind I think needs to be highlighted.

Of course, most people on this forum won't be in Australia, but everyone might want to check their pet health policy terms. The RPCA's policy document is here

https://www.rspcapetinsurance.org.au...et(102007).pdf

Exclusion 11 says

"11.diagnostic tests, unless they result in a diagnosis of a
Condition which is covered under Your policy;"

Whoa there! You mean if the vet does an expensive test, and it comes up negative, then you won't pay?

A difficult diagnosis can involve tests that successively rule out various diseases. Depending on interpretation, this exclusion may be denying payment for each test that is negative, or it may be denying payment for all the tests if the pet eventually dies without a real diagnosis (as mine did).

I've asked the RSPCA whether that's really what they intend, and haven't received an answer yet, but at the moment, I wouldn't touch their policy with a barge pole, nor any other with a similarly worded exclusion, at least not without a clear statement in writing as the the true intent of the exclusion.
post #2 of 12
this is one of the reasons I dont have pet insurence .... my vet has the pamphlet but said dont bother they cover things you dont use ( like yr vac _
post #3 of 12
Thread Starter 
I've received a reply from the insurer's representative (remarkably quickly!)

"I have discussed this clause with the senior claims assessor here and this clause is based on having elective procedures so if for example you took your pet to have it’s annual vaccinations and said to the vet, lets have some blood tests to make sure all is ok then it would not be covered. In the case that you have given the where the pet is showing obvious signs of an illness and the testing is used to try to determine what is wrong and nothing is found then this would be covered."

Which is fair enough, because there's no point in covering things that will occur in the normal course of events - that's not insurance. However, it's far from being what the exclusion wording says, IMHO.

I'd want the quoted statement in writing (i.e., on paper, and signed) before I'd insure with them.
post #4 of 12
Not sure how the policies do work (here in US or overseas) but IMO I dont' see the worth of them. I guess if you have a sick cat with extensive med problems, it might pay, but I've been lucky so far the no one really has had major surgery, etc.

Other then Charlie's UTI, I've never had to really put out much more then normal shots. An occasional problem with infection (Amoxicilian) has been the worse. So for me, buying insurance would not pay in the long run.
post #5 of 12
Thread Starter 
Over the years, my cat suffered two paralysis ticks on separate occasions, needed knee reconstruction, had a broken tail bone (apparently from a bite), and the final episode leading to her death cost about $2000 (still waiting for the final bill).

All of these would have been covered by the pet health insurance (note, some exclude tick paralysis - always read the exclusions carefully).

If she'd been luckier, much of this expense would have been avoided, and the premiums would far have exceeded the payouts. Of course, things could have been worse, and the reverse would have been true. Such is the nature of insurance - it's about spreading the risk. It's also about ensuring that when difficult decisions have to be made, at least money doesn't play a big part of that (there's usually some excess, or proportion, to be paid by the pet owner). There could be nothing more upsetting to me than having to euthanase my pet because I couldn't afford the treatment to cure her, or at least manage her disease. It's like insuring your house against fire - you really hope that you'll pay the premium and never make a claim - but it's a great comfort if the worst happens, because it makes it a lot easier to carry on.

It's a mistake to think of pet health insurance in terms of reducing the costs of the routine medical care that a pet will need over its life - check-ups, vaccinations, teeth cleaning, and so on, because they're not the subject of risk - they happen in the normal course of events. There's no way an insurance company could possibly reduce the cost without being a charity.

Now I'm starting to sound like a pet health insurance salesperson, which is not the intent - I'm just calling it as I see it.
post #6 of 12
Well and succinctly put. It's not about routine care; it's to help you with extraordinary costs.
post #7 of 12
That is a very good way of looking at it - when Pebbles had problems last year, my vet was more willing to suggest things due to insurance, and she knew she could mention specialists over Tiger due to it - I would find the money regardless, but my vet does seem concerned about me spending lots of money!! I have had Molly insured for over a year now and not had to claim a penny (I have yearly bloods done on her, but can only claim that back if there is a health problem, as it is done as a routine thing), but at 15, I know there is a chance at some point she will become ill, and I would hate to have to let them go cos I couldn't afford treatment.
post #8 of 12
Quote:
Originally Posted by SylviaE View Post
Such is the nature of insurance - it's about spreading the risk. It's also about ensuring that when difficult decisions have to be made, at least money doesn't play a big part of that (there's usually some excess, or proportion, to be paid by the pet owner). There could be nothing more upsetting to me than having to euthanase my pet because I couldn't afford the treatment to cure her, or at least manage her disease. It's like insuring your house against fire - you really hope that you'll pay the premium and never make a claim - but it's a great comfort if the worst happens, because it makes it a lot easier to carry on.
That's how I see it too. When my Magpie was taken ill with a thrombosis in his neck 2 years ago the vets bill was about $4000 even though he was only at the vets overnight. It would have been nearer $7000 if he'd had some injections he was going to have, but he deteriorated before they could give those. He didn't make it but at least I know everything that could have helped was tried. If I hadn't had insurance I'd have had to have him pts at the start and would have spent the last 2 years wondering whether I could have saved him if only I'd had the money.
post #9 of 12
Also keep in mind that most don't cover preexisting conditions. DH and I spent almost $500 for one vet visit recently when Scotty developed a really bad UTI. Had he not had a UTI two years previously, I would have jumped on isurance then, just to have him covered. But because he did have one two year previously, they would have labeled it preexisiting and we would have paid out of pocket anyway. *shrug* We don't even know how high the emergency vet bill has climbed, so the total cost is going to be way more than $500. :/
post #10 of 12
That is why i recommend people get their pets insuread as soon as they get them, and do the checkup after the 2 weeks has passed.
post #11 of 12
If you have the will power, put $20 every month in a cookie jar or savings account or CD fund and in time you will have a great nest egg for your cat that you can use if needed. If your cat never has an expensive illness then you get the money back for another use (or another cat), which is not the case with insurance.
post #12 of 12
That is a good idea for young cats, I do that to spread the cost of the cats annual blood tests adn boosters, but Tiger cost me over £1000 this year, I officially adopted her in Jan (she had been a foster since last August) and I lost her at the end of Nov, and I had a similar situation with Pebbles, I had her less than 2 years and last year alone she cost me over £1000, so I would have struggled without insurance, and happily pay it for healthy cats just in case - an MRI scan at my vets specialist would cost £2k, I could never save that kind of money, and while I have a credit card for the cats, I would prefer not to have to rely on it.
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