|Questions & Answers
|Making a Claim
We as a practice accept that often the matters discussed below are dealt with in the small print of the policy; we are also aware that this is often not read. A little ground work at the start can save a lot of heartache latter down the line.
Whilst it is rare for any insurance company to refuse referral to a hospital or specialist practice different companies approach the issue in different ways. In an emergency situation where referral is a matter of life and death then there is rarely a problem. All companies should as a matter of courtesy be informed of an emergency referral as soon as is reasonably possible, either that day or the next working day.
Referral for non-emergency matters however is often different. Some insurers request that you inform them before hand so that they can approve the referral. (Please note approving the referral does not mean they will necessarily pay for it). In most cases referral to a recognised referral centre will be approved without question. Sometimes referral to specialist private practice may be questioned and occasionally alternative referral centres may be suggested.
Referral to see specialist individuals e.g. a dermatologist, will again often need to be approved first. Similarly referral for elective surgery should be approved first especially if an anaesthetic is to be administered.
We feel it is always worth informing your insurance company and recording the details of the call as soon as you know you will need a referral. Knowing your companies policy concerning these matters can prevent problems later down the line.
As veterinary medicine advances so diagnostic techniques improve and alter. It is now common to send horses for Gamma scintigraphy and MRI scans along with an array of other investigative techniques that are offered at specialist centres. Policies vary and an understanding of your chosen company's policy concerning these techniques is essential.
Some policies may not cover certain diagnostic techniques or only partly cover them whilst others may have a limit upon the amount of the claim that can be assigned for diagnosis. We have encountered this in the past where there is an upper limit that the company will pay for investigation leading to a diagnosis.
It is our belief that a full and correct diagnosis is essential in order to target treatment accurately. We feel that you should be aware of any limitations or restrictions on your policy when you take it out and not find out about it when you need to refer.
Most policies will have an upper age limit for insurance cover typically sixteen years old though this does vary and some policies offer cover to a much greater age. Often when an upper age limit is reached insurance will remain but with limited cover offering insurance against trauma but not illness or medical conditions. You will need to decide what level of cover you require for your horse now and as it ages.
The amount of veterinary fees covered per claim can vary from policy to policy and with different companies. This can be from as little as £1000 per claim up to £5000 per claim and possibly more. Though the latter sounds like a large sum it is worth pointing out that a referral for surgical colic is likely to cost between £2500 and £3500 without all the aftercare costs and initial visiting veterinary costs. Similarly extensive investigations into lameness or unusual medical conditions followed with surgery can easily mount up to £5000+.
Remember this is the maximum amount of cover per claim not per horse. We are not aware of policies that limit your cover to an annual amount in total. It is not uncommon for two separate claims to be submitted within a twelve month period sometimes at the same time. This is not normally an issue with insurance companies but we are aware of practices that include refusing to renew a policy when its renewal date is due because two claims have been submitted within a twelve month period and significantly increasing premiums despite writing in exclusions for the conditions claimed for previously. The decision to offer insurance or not and to pick and choose is of course an insurance company's right but we feel this is something that you should be aware of.
Every time you submit s claim for veterinary fees you will need to pay an excess to your veterinary practice. This is common in all types of insurance and is your contribution to the overall claim. The amount of excess will vary depending upon company and policy. Often a higher excess means a lower premium.
Typically excess amounts range from £100 up to £500 and are usually one off payments per claim, however some companies charge excess as a percentage of the total claim. This means that your excess will increase as your claim amount increases and is impossible to accurately assess at the start of the claim. Usually this type of policy will have a minimum excess for you to pay and then you may be approached to pay the difference due following the claim being settled by your company.
We have tried to give an example of how this works below. This is a rough example to highlight how much extra you may have to pay above and beyond your initial excess fee. The example given below is not taken from any insurance company and the calculations will vary depending upon the percentage charged and the company's initial fixed excess for bills below £1000.
If the excess percentage is 20% of the claim your excess up to £1000 would be £200. This would be the same if your total bill is £275 or £999 i.e. you would be liable for £200 of the total bill. All amounts above the limit of £1000 would be charged at 20% so for every additional £1000 you would pay £200 additional excess. Often the excess up to the first £1000 of a claim is fixed at a lower amount say £120 and then the percentage calculation applies above the £1000 mark.
Whatever method your insurance company offers you need to be aware of the implications and costs to you should you submit a claim.
Some policies will cover additional fees like hospital livery charges, transport costs and carcase removal costs. If you wish to be covered for these eventualities you will need to check with your company if they are included or if they can be provided on the policy.
The use of other complimentary forms of treatment and the employing of other para-professionals like farriers and dentists is often covered by insurance companies provided that there involvement is authorised and approved by your veterinary surgeon. Do not assume however that this cover is automatically there. Please also be aware that an insurance company has the right to refuse payment if the persons involved are not properly qualified.
We would suggest that you discuss with your insurance company the level of this cover, whether it is paid separately and in addition to veterinary fees, or whether it is included in your total veterinary fees amount.