How To File A Pet Insurance Claim

What you'll need when filing a pet insurance claim

Here’s what you generally need to include when filing a pet insurance claim:

• Itemized invoice. The vet bill should include all fees, taxes, discounts, and other costs. Make sure to have a look at your invoice at the time of payment to verify that the balance is zero dollars.
• Veterinary medical records. You will also need to send your pet's medical records (SOAP records) with your initial claim. These medical records help identify any health issues the pet had before coverage started because pre-existing conditions are typically not covered by pet insurance.
• Insurance claim form. Complete the claim form describing your pet’s treatment and make sure to follow the instructions completely.

How to file a pet insurance claim with your provider

Once you have all the necessary documents, it’s time to file a pet insurance claim. While the specific instructions will vary by provider, here are the general steps you need to follow.

Step 1: Go to the insurance company's website

Visit your provider’s website or mobile app to check your policy documents and see if you are covered for the claim you want to file. Depending on the insurer, you might be able to file your claim entirely online or you may need to give them a call to start the process.

Step 2: Obtain a pet insurance claim form

Some providers require you to download and print out a pet insurance claim form, while others use digital forms that you can submit online, via email, or directly through your account portal. For instance, to file a claim with Nationwide Pet Insurance, you’d go directly to the Pet Account Access Page, and to file a claim with Embrace Pet Insurance, you’d log into MyEmbrace.

Step 3: Provide as much detail as possible

The information you’ll be asked to supply will vary based on the pet insurance claim form, but you’ll most likely need to provide the following details:

• Pet name, breed, and species
• Medical history*
• Date of the incident
• Reason for your visit to the vet
• Name, location, and phone number of vet
• Medical diagnosis
• Recommended treatment plan
• Itemized expenses paid for out-of-pocket

*If you’ve never filed a claim with your pet insurance provider before, they may request to see your pet’s medical history leading up to the date of the incident to confirm your claim is unrelated to a pre-existing condition.

Remember that each insurance company is unique in terms of the information they require to process claims. For example, to file a claim with Lemonade Pet Insurance, you will be asked to submit a short video explaining what your pet was treated for, what happened during the vet visit, and any other relevant details.

Step 4: Attach supporting documents

Confirm which supporting documents you need to submit along with your pet insurance claim. Some examples might include a bill of service, invoice or quote, receipts of payment, and signed medical records.

Your provider may also request the SOAP transcript, or a written report by the attending vet that provides a detailed account of the treatment your pet received. The SOAP notes are often included with your medical bill, but you can always request them from your vet at the end of your appointment.

Some pet insurance companies allow you to digitally upload photos of these documents directly from your smartphone, while others request they be scanned and sent my email, fax, or snail mail.

Step 5: Submit the form to your insurance provider

Confirm all of the information you filled out is complete and without error, then double check the requested documentation to ensure it is included. Finally, once you verify that everything is in order, submit the claim to your insurance provider. Once you've submitted your paperwork, it’s a good idea to keep copies of all your documents on hand until the claim has been paid.

Tips to speed up the reimbursement process

There are certain steps you can take in order to make sure the pet insurance claims process goes smoothly, so you can get repaid sooner rather than later:

Follow the instructions.

Verify that you’ve followed the pet insurance claim instructions to the T so you can avoid delays caused by skipping steps or missing information.

Submit your pet insurance claim as soon as possible.

It is in your best interest to get the ball rolling as soon as possible, especially for first-time filers whose pets will require a medical history review. Be mindful of your provider’s claim expiration window, or the amount of time you have to file a claim after an incident occurs. For most companies, the window ranges between 60 and 270 days.

Provide all medical records.

Regardless of whether you are submitting a pet insurance claim for the first or fifth time, you may need to include a copy of your pet’s medical records. Your provider might request this from the vet directly, but saving them a step could prevent any administrative delays at the front desk.

Stay on top of communication.

If you notice your claim submission is pending or under review, call your insurance provider to find out what the hold-up is and how to move the claim along. This will help you keep track of the progress and promptly address any issues they may have, which typically relate to missing or incomplete details. Promptly provide them and ask how long you can expect to wait for reimbursement.

If they determine they do need information from your veterinarian, give your vet office a call to alert them to the situation. Let them know your pet is a patient there and that your insurance company is requesting information from their last visit. If they don’t send it over by the end of day, follow up with a reminder in 24 to 48 hours.

Enroll in direct deposit.

If it’s an option with your insurance provider, be sure to enroll in direct deposit so you can get your reimbursement sooner. Rather than waiting for a check in the mail, this payout method allows you to have access to your money within a few days of your pet insurance claim being approved.

Understanding the outcome of your pet insurance claim

To ensure you’re satisfied with the outcome of your pet insurance claim, it’s a good idea to re-familiarize yourself with the specific details of your policy. If you don’t know your exact policy terms, you might be surprised by the amount insurance agrees to repay you, since only a few companies will cover 100% of veterinary bills and most require you to pay a deductible before your pet insurance coverage starts to kick in.

That said, here are a few things to keep in mind when filing a pet insurance claim and how you can expect your plan to work for you:

• Waiting period: All pet insurance companies require you to wait a specific period of time before your coverage starts. If you file a claim during this waiting period, your insurance provider will not cover any expenses.
• Eligible expenses: Only costs related to the medical conditions outlined within your policy are eligible for coverage through pet insurance. This generally excludes pre-existing conditions that were already evident before the policy was purchased, as well as elective procedures, and wellness services. Furthermore, the veterinary services that are eligible for coverage can vary depending on the provider and the type of plan you select. For example, Accident-Only plans will exclusively cover injuries only — not illnesses or breed-specific issues. If you had this coverage when filing a pet insurance claim for an acute sickness, you might be out of luck.
• Deductible: This refers to the amount of money you must spend out-of-pocket before your insurance policy will begin to cover eligible expenses at the vet (unless you have a $0 deductible). Some policies have an annual deductible, whereas others have a per-incident deductible. If your annual deductible was $100 and your vet bill was $500, you would pay the first $100 and then your pet insurance coverage would kick in for the remaining $400 and immediately at all vet visits within the year of that policy term – unless your deductible applies for each incident, in which case, you would pay $100 for each unrelated incident.
• Reimbursement rate: Pet insurance plans reimburse a percentage of the vet bill once your deductible is met. The rate of reimbursement typically ranges from 60% to 100% of the bill, leaving you to cover the remaining amount portion out-of-pocket (otherwise known as co-insurance, co-pay, or cost-share). Sticking with the example above, if you had an 80% reimbursement rate and $400 in eligible expenses, you would be reimbursed $320.
• Payout limit. This is the maximum amount of money your policy will payout for pet insurance claims. Depending on the provider, the ceiling may be set per policy term or for the lifetime of your pet. Once you reach the maximum amount specified by your policy, you’ll be responsible for all additional vet costs until the payout limit resets (if applicable). Some providers offer unllimited payouts for life, but these plans can be expensive.

How to appeal a denied pet insurance claim

When you file a pet insurance claim, a claims adjuster will review your submission and determine whether insurance coverage applies and in what amount. However, if you're not happy with the payout sum you were awarded, or your claim is rejected altogether, you can try to appeal the verdict.

Look for a section titled "Claim Review" or "Appeal" within your policy’s fine print and follow the guidelines for the appeal process. You can usually find these instructions on your provider’s website, as well. If they find your reimbursement amount to be fair and you’re still not satisfied, you can file a complaint with the insurance department in your state. These agencies are tasked with policing insurance companies and keeping track of complaint patterns to protect consumers.