A question came up from a potential policyholder last week on our description of the pre-certification process in our Terms and Conditions. To paraphrase her question:
What is the pre-certification process all about? In your terms and conditions, it is confusing because it looks like it's optional but then it seems to imply it's mandatory. What's the real story?
Answer:
Yes, you are right. The way we have it written now is confusing and we've cleaned that up. Here is the new wording:
PRE-CERTIFICATION FOR CERTAIN TYPES OF PROCEDURES
To avoid coverage surprises, we strongly encourage you to complete a pre-certification form and submit it to us before your Veterinary Provider orders any of the following procedures:
(1) magnetic resonance imaging (MRI) scan,
(2) computer-aided tomography (CT) scan,
(3) partial or complete hip replacement,
(4) tibial plateau leveling osteotomy (TPLO),
(5) home visits because your Pet is unable to travel to the usual location of the Veterinarian,
(6) any time the anticipated costs of a course of Treatment are expected to go over US$1,000.We will let you know how much of the Treatment is covered under the terms and conditions of your certificate within 5 working days of receiving your Pet’s full medical history and the itemized estimated charges and procedures in question, and a completed pre-certification form signed and dated by your Veterinarian.
In case of a medical emergency, please contact us as soon as possible after Treatment has begun if you would like to request a pre-certification.
So, the answer to the question - is it required or not - no, it is not but we recommend you do it just so you know upfront where you stand for larger claims.
