Embrace Pet Insurance Blog

Pet Insurance 101: a wellness/illness split claim

It's been a very long time since I've written about the nuts and bolts of pet insurance. Since this is a pet insurance blog, let's blog about pet insurance!

Question: what happens to Embrace Pet Insurance claims where there are wellness and accident/illness items on the same invoice?

Answer: we create two claims - one for the wellness items and one for the illness items.

This way, we can keep track of the wellness costs separately, taking them out of your Wellness Rewards pot of money, while the accident/illness costs are taken out of your insurance benefits. We'll let you know that we've split the claim up when we send you your claim acknowledgement.

To maximize your payout, we'll assume that your office visit for the split claim applies to the Wellness Rewards coverage (we don't split it in half); however, if you are close to your annual Wellness Rewards limit (either $200 or $400, depending on what you picked), we will set the office visit to be taken care of in your accident/illness claim if that would give you more money back.

The exception to where the office visit applies is if your wellness charges were parasite control items only, such as flea/tick medication. Then the office visit will be taken care of on your accident/illness coverage since it is likely that you just picked up your flea/tick meds when you were in the office for an accident/illness split. Clear as mud?!

You may notice your Wellness claims are often processed faster than your accident/illness claims (not always but the majority of the time), which is because they are often more straightforward than the insurance claim and can be dealt with more quickly. We'll remind you about your outstanding accident/illness claim when we send you your wellness claim Explanation of Benefits. 

Questions or comments?

Background on Wellness Rewards:

Many of you know that we have the best pet wellness product on the market. If you need a quick reminder of exactly why it's the best (no deductible, no category sublimits, no copay), check out our Wellness Rewards page on our website.

One of the nice things about wellness is that Wellness Rewards is not insurance - yay! That's because there's nothing uncertain about it, nothing unknown, which is a requirement to be insurance.

The Embrace Wellness Rewards product is more like a health spending account where you get a pot of money to spend on wellness items such as spay/neuter surgeries, prescription diet food, and toe nail clipping.

Happy Fifth Birthday to Embrace Pet Insurance!

Happy Birthday to Embrace! This day five years ago, we sold our first policy to me and my cat Lily.

I distinctly remember when we got the go-ahead from our underwriters at the time, Lloyd's of London, and since I was out of the office on that day, I phoned in to purchase our first policy.

We'd been training our first 2 Embracers, Chris and Lea, on the phones by having people (including my mom) randomly call in to pretend to buy a policy so I didn't tell Lea, who happened to answer the phone this time around, that this was a "live" purchase until the end of the call. It was a giddy feeling for all of us when I told her to put through my real credit card info and really buy the policy.

A lot has changed since we sold that first policy but we remember our humble start fondly. We now have 24 Embracers, plus we're about to hire another 2. We broke even in June of this year and have insured thousands of cats and dogs and paid out millions in claim reimbursement. It feels really good to get to where we are now.

Here are some photos of the last 5 years at Embrace - do you have any fond memories of Embrace over the years you'd like to share? 

 

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Pet Insurance and Divorce

At Embrace Pet Insurance, a number of divorce or separation situations have come up and the following scenarios and solutions untangle the complexity so you can get what you need for you and your pets with minimal anxiety.

Scenario 1: you have sole custody of the pets and you have always owned the pet insurance policy yourself

Call into the pet insurance company to check your policy details for the following:

• Who is listed as the insureds on the policy? You can have two or more insureds on a pet insurance policy, all of whom can all make decisions about the policy, including cancellation and billing decisions. Make sure your policy is limited to the people you want to be making those changes.
• How is the policy paid for and by whom? Make sure you confirm the billing is your own credit card or bank account as soon as possible. You don’t want your ex cancelling the premium payments and lapsing the coverage. Make sure that if the payments come out of a bank account, the account is going to remain active going forward.
• Which addresses are listed on the policy? Several considerations here:
  • Your premium may change upon a change of address - not much you can do about this but don’t be surprised by an unexpected change when your next premium is billed
  • You don’t want your claim check going to your ex so confirm they are all going to your current location. Even better, have the claim reimbursement deposited into your own bank account so there’s no way for the money to go elsewhere by mistake
  • Make sure the email address on record is your current one. You don’t your email going to a defunct address or worse, your ex’s

Scenario 2: you have sole custody of the pets but your spouse owned the pet insurance policy before your split

If you are taking over the policy from your spouse, you’ll have to transfer it into your name as soon as possible. Call the pet insurance company to find out their procedure for transferring the policy as most will allow you to do it. You do not want to have to restart the policy as this might trigger new pre-existing conditions, which you do not want to happen. If you do not know which insurance company the policy is with, there's a handy list over at www.petinsurancereview.com (for the US and Canada). Call them all, starting with VPI (it's the largest at the moment) until you find the right one.

If the policy has lapsed because of non-payment, ask the pet insurer if the policy can be reinstated without restarting the policy. If it is just a week or so from lapsing, it’s a good bet they’ll reinstate your policy as long as you pay the unpaid premium. If it’s longer than that and the company says no, plead your case to the underwriter who issued the policy for some leniency (often different from the company you deal with on a day to day basis_. You will still have to pay unpaid premiums if the insurer agrees.

Once you have control of the policy, check the policy details in scenario 1.

Scenario 3: you are sharing custody and the finances of the pets

If you are sharing custody of the pets on the policy and want to share the cost of the policy and have the reimbursements go to the appropriate person, this gets tricky. Most pet insurance companies cannot handle multiple bank accounts or addresses for premium payments and claims reimbursement depending on who paid for the vet bill so you will need to coordinate the financials with your ex. You should include how you are going to handle this in your divorce settlement.

Note that if you just want to pay for your own policy to cover any vet bills you might have when you have the pets, your spouse does not need to get involved in your policy. It’s totally up to you.

Scenario 4: the pets on the policy go to different homes

Some insurers have multiple pets on a policy so it becomes complicated when some of the pets stay on the old policy and some go to a new home. The pets that are going to a new home will be split off from the old policy onto a new one, possibly trigger new pre-existing conditions for those pets. Ask the pet insurer if a special dispensation could be made so that the new policy does not trigger new pre-existing conditions. Most pet insurers will have no difficulty accommodating this request.

Finally...

Under all these scenarios, if something goes wrong with the policy and you do not get the solution you are looking for from your pet insurer, be sure to write to the insurance company that issued your pet insurance policy for a compassionate review. You can often get a positive response if you go right to the source.

Are you going through a divorce right now and are having to handle this situation? Let us know in the comments and I might be able to help.

Claim Example: bilateral hip dysplasia surgery in a Golden Retriever

Poor Two-Row. She's only 1 year old but had to undergo a $4,400 hip replacement surgery for both hips before the age of one. Hip dysplasia is a hereditary condition and must have been very severe for such aggressive surgery at such a young age. Thank goodness her owner thought to get pet insurance for her at a very early age to get this surgery paid for.

Since obesity is the theme of the month, it's worth noting that hip dysplasia can also be exacerbated by obesity (although I'm sure in Two-Row's situation, that was not the case).

Here are the details of the surgery charges:

ITEM	BILLED AMOUNT	COVERED CHARGES
1st exam	$68.00	$68.00
radiograph 14x 17 2-views	$155.00	$155.00
hosp	$35.00	$35.00
sedation	$95.00	$95.00
exam, sd- referral	$168.00	$168.00
rimadyl 75mg tab-14qty	$47.24	$47.24
tramadol hci 50mg-15qty	$11.65	$11.65
pelvis subcategory	$750.00	$750.00
surgery pack & o.r. fee	$369.00	$369.00
radiograph x2	$205.00	$205.00
anes- induction	$122.85	$122.85
anes-gas-iso/sevo @15 min	$595.32	$595.32
iv cath peripheral multi	$127.00	$127.00
fluids lrs 1 liter per bag	$26.00	$26.00
fluids initial iv set up	$17.00	$17.00
cri set up charge 250ml bag	$23.62	$23.62
hydromorphone 2mg/ml	$39.60	$39.60
ketamine 100mg/ml	$21.34	$21.34
lidocaine 2% cri, per ml	$22.13	$22.13
tpo locking plate 20, left	$310.20	$310.20
3.5mm cortex screw	$60.00	$60.00
4.0mm cancellous sc ft 22mm	$58.00	$58.00
hosp level II/shift	$200.00	$200.00
duramorph 1mg/ml inj	$94.07	$94.07
cefazolin inj	$28.92	$28.92
pcv/tp	$15.00	$15.00
profile nsaid's	$69.00	$69.00
lidocaine hci inj	$15.40	$15.40
glycopyrrolate inj	$15.64	$15.64
hosp level II/shift	$200.00	$200.00
cefazolin inj	$21.96	$21.96
hosp non icu-shift	$70.00	$70.00
sedation brief- 3 drugs	$81.90	$81.90
radiograph x2	$205.00	$205.00
recheck- sd, brief	$35.00	$35.00
hosp< 3hrs	$46.00	$46.00
Tax	$6.75	$6.75
	$4,431.59	$4,431.59

Two-Row's pet insurance policy had a $500 annual deductible, a 10% copayment percentage and a $10,000 annual maximum with the prescription drug coverage added. Her premium is $36.66 per month (she lives in MA).

The payout for this claim was $3,691.43, which is calculated as follows:

STEP 1: Calculate Potential Refund
Billed Amount:				$4,431.59
Covered Charges:	(see attached detail)			$4,431.59
Annual deductible remaining				$330.00
	subtotal			$4,101.59
Copay 10%	(your copayment)			$410.16
Potential Refund				$3,691.43
STEP 2: Compare potential refund against your annual maximums
Annual Maximum				$10,000.00
Prior refunds for this policy year				$0.00
Coverage remaining				$10,000.00
Your total refund is:				$3,691.43

Related Obesity Posts:
August is Obesity Month at Embrace Pet Insurance
Claim Example: bilateral hip dysplasia surgery in a Golden Retriever
How many calories a dog or cat should eat a day?
What does a healthy dog really look like?
National Holistic Pet Day

Cabela's Pet Insurance - insure your active outdoor dogs

 
Embrace Pet Insurance announces Cabela's Pet Insurance, pet health insurance for active outdoor dogs (and their sibling cats too!)  Protect your hunting, sporting and family dog against costly accidents and illnesses with the quality and superior customer service you have come to expect from Cabela's.

If you live on the East or West coast and never been to the great outdoors, you might not have heard of Cabela's, but for the rest of us, we know Cabela's as the World's Foremost Outfitter of hunting, fishing and outdoor gear and I'm a huge fan.

Nearly every annual trip to our family cabin in Minnesota includes a visit to Cabela's to stock up on fishing gear (and maybe a t-shirt or three). I love browsing through the entire store, including the aquariums filled with local aquatic settings displaying the local fish you might catch. Such a breath of fresh air - literally. 

Cabela's is a source of affordable, high-quality outdoor equipment and their stores are phenomenal. Just try to spend less than $200 everytime you step into one - it's just not possible (or is that just me...?)

Embrace is proud to partner with Cabela's and delighted to provide Cabela's Pet Insurance to Cabela's much loved customers.

To learn about Cabela's Pet Insurance and to get a free quote, go to www.cabelaspetinsurance.com.

 

Claim Example: cataract surgery in a Greater Swiss Mountain Dog

Gunner is a 4 year old Greater Swiss Mountain Dog who was diagnosed with Juvenile Cataracts this year. Juvenile Cataracts is a hereditary condition that strikes a number of breeds at younger ages.

As you may know, Embrace Pet Insurance covers hereditary or breed specific conditions as long as there are no clinical signs of the condition before the end of the waiting period.

The costs for the cataract treatment can add up. Here are the totals for Gunner's treatment so far. Note that the prescription drug coverage was not selected for Gunner's policy so take home drugs such as Otomax were not covered by his policy.

Date	Diagnosis	Status	Claim Amount	Paid
1/17/2011	Juvenile Cataracts	Deduct	$121.28	$0.00
1/21/2011	Cataracts	Paid	$194.00	$16.65
4/13/2011	Unilateral Cataract Surgery	Paid	$1,637.00	$1,381.50
5/24/2011	Post Op Recheck Exam	Deduct	$77.00	$0.00
			$2,029.28	$1,398.15

Here are the specifics on Gunner's surgery costs (FYI, he lives in Oregon)

ITEM	BILLED AMOUNT	COVERAGE TYPE	COVERED IN POLICY?	COVERED CHARGES
Catheter	$30.00	IL	Y	$30.00
Fluid Admin	$35.00	IL	Y	$35.00
Anesthesia	$225.00	IL	Y	$225.00
Antitbiotics	$18.00	IL	Y	$18.00
Dexamethasone Inj	$15.00	IL	Y	$15.00
Unilateral Cataract Surgery	$1,200.00	IL	Y	$1,200.00
NeoPolyDex Opth	$15.00	DD	N	$0.00
Diclofenac Sod Opth Sol	$30.00	DD	N	$0.00
PolyB Trimethoprim Opth Sol	$8.00	DD	N	$0.00
E-Collar	$12.00	IL	Y	$12.00
Cipro	$27.00	DD	N	$0.00
Tramadol	$10.00	DD	N	$0.00
Acepromazine	$12.00	DD	N	$0.00
	$1,637.00			$1,535.00

Gunner's claim payout was calculated as follows (the deductible having already been satisfied this year):

STEP 1: Calculate Potential Refund
Billed Amount:				$1,637.00
Covered Charges:	(see attached detail)			$1,535.00
Annual deductible remaining				$0.00
	subtotal			$1,535.00
Copay 10%	(your copayment)			$153.50
Potential Refund				$1,381.50
STEP 2: Compare potential refund against your annual maximums
Annual Maximum				$10,000.00
Prior refunds for this policy year				$16.65
Coverage remaining				$9,983.35
Your total refund is:				$1,381.50

Has your dog or cat had cataract surgery? How did it go?

Related Posts:
July is Eye Month at Embrace Pet Insurance
Guest Post: Why are my dog’s eyes turning gray?
Claim Example: cataract surgery in a Greater Swiss Mountain Dog 

Veterinary Inflation Observations

Have you been wondering recently why your veterinary care feels like it costs so much more than it used to? You are not alone.

I was digging into the inflation numbers over at the Bureau of Labor Statistics and I was fascinated by the difference between veterinary inflation (yes, they do track such a thing!) and the consumer price inflation.

For example (see graph below), if I look at January 2007 to March 2011 (just about as long as we've been selling pet insurance policies), while my wages went up 10% over that time (yay!), my vet bills went up 25% in the same period (ouch!). Vet bills are definitely taking up more of a bite out of my free cash than they used to. 

 
You can clearly see the impact of the Great Recession in the second half of 2008 in the CPI, with the year's inflation being practically zero (-0.1%); however, veterinary inflation chugged along at 7% that year and didn't slow down until 2009.

Another point to note, the Consumer Price Index is defined as the change in the prices paid by urban consumers for a representative basket of goods and services and Veterinary Services are just a subset of those goods and services. The representative basket of goods is based on typical family spending in 2007/2008 so changes in the types of veterinary services (such as more TPLO surgeries or MRIs) are not reflected.

So chances are, as veterinary medicine has grown in the last 3 years, and more complex and more costly procedures are more common, your veterinary spending increases are even more than those shown above.

It's amazing we can afford our cats and dogs at all, don't you think?

If you are wondering what impact veterinary inflation has on pet insurance premiums, check out my blog post on how inflation and other factors affect pet insurance premiums using Trupanion as a case study.

Just for fun, here's another graph for 2001 - 2011. It really shows the bite into your household income over the last 10 years.

 
For the data hounds out there, you can find the data on the BLS website:

• CPI - All Items US City Average Seasonally Adjusted
• Veterinary Inflation - Veterinary Services US City Average Seasonally Adjusted

Claim Example: allergies in a dog

What does 3 years of allergy treatment cost?  $2,500 and climbing. Ouch.

As an example of the cost of general allergies in a dog, I found Jack, a mixed breed dog born in 2005 who has suffered from allergies since 2008. He lives in Dallas TX, so while not an inexpensive city to live in for veterinary care, certainly not the most expensive.

Here are his charges related to allergies over the last 3 years (he tore his cruciate ligament early on as well - he's had a lot of health issues going on.)

Date of Visit	Claim Status	Diagnosis	Covered Amount	Paid Amount
4/8/2008	Paid	colitis	131.00	117.90
4/16/2008	Paid	allergies	99.00	89.10
5/7/2008	Paid	allergies, diarrhea, ear infection	164.50	148.05
6/13/2008	Paid	allergies	77.00	69.30
7/1/2008	Paid	allergic dermatitis	252.00	226.80
8/20/2008	Paid	allergy flare up	99.00	89.10
9/23/2008	Deduct	allergy flare up	44.00	0.00
11/1/2008	Paid	allergies	74.95	17.05
4/10/2009	Paid	Allergy Testing	265.00	238.50
4/24/2009	Paid	Allercept Allergy Initial Treatment	200.50	180.45
5/28/2009	Paid	Allergic Otitis	45.00	40.50
6/30/2009	Paid	Medications, Allergy	156.00	140.40
12/29/2009	Paid	Medications, Allergy	156.00	50.40
6/28/2010	Paid	Medications, Allergy	168.30	151.47
1/14/2011	Paid	Allergy Refill Treatment Set	165.50	58.95
1/20/2011	Paid	Skin Lesion, Pain Instability	117.00	105.30
3/22/2011	Paid	Allergy Flare Up	194.23	174.81
4/15/2011	Paid	Superficial External Otitis	83.20	74.88
Total			2,492.18	1,972.96

Jack's pet insurance policy costs $64.31 a month for a $100 annual deductible, 10% copay percentage, $10,000 annual maximum with prescription drug coverage.  

Are these the kind of expenses you are seeing with your dog allergies?

Related Posts:
May is Allergy Month at Embrace Pet Insurance
Guest Post: Allergies in Pets
Can dogs be allergic to bee and yellow jacket stings?
Claim Example: allergies in a dog

 

Press Release: new pet insurance coverage for The Great Chihuahua

At Embrace Pet Insurance, we cover a lot of interesting breeds. For example, in early March, we insured 7 Russian Blue Terriers for one breeder (they look just like beautiful blue Airedale Terriers!)

So I am delighted to announce though that we're the first pet insurer to add the Great Chihuahua to our covered breed list.

Per our press release today:

“I fell in love with the Great Chihuahua when a friend got one last year. Until I saw it, I was so sure it was a joke! Standing beside one makes you laugh so hard, it’s the ultimate dog therapy. As with any dog, veterinary costs are more than you think so it makes sense for Embrace to insure them just like any other dog breed.”

Our good friend over at Pet Connection, Christie Keith, renowned large dog expert and pet columnist, commented on the new breed:

"So many owners of small dogs tell me, as their tiny, barking, growling toys launch themselves in a frenzy at my giant breed dogs, 'He doesn't know how small he really is!' It makes sense that toy-dog owners would take that to the next logical extreme, and start producing dogs who are as big as they believe themselves to be."

Despite the dog's amazing size, the Great Chihuahua is quite the character but you do have to be careful with her around small children:

As you would expect from her roots as a Cartel protection dog, she is more than just candy coating, and she will fiercely protect her family if she perceives any threat to them. She may also chase cats or other animals, and her herding instinct can kick in around children as well. Be sure to teach her that bumping, chasing, and tackling children is not permitted before some serious damage occurs.

As with all purebred dogs, the Great Chihuahua is prone to some hereditary conditions you need to be especially careful of orthopedic conditions such as luxating patella and hip dysplasia. The vet bills can really grow since your veterinarian is unlikely to be familiar with this breed. 

 
To learn more about our new pet insurance for the Great Chihuahua, check out our press release: Not your Grandma’s lapdog. The Great Chihuahua turns heads and steals hearts across US.

Related Posts:
Press Release: new pet insurance coverage for The Great Chihuahua
Press Release: Embrace Pet Insurance Swims Upstream To Add Goldfish Coverage to Its Product Range

The Wonders of a $1,000 Deductible Pet Insurance Plan

I was looking at the high dollar claims that came in to Embrace today and here are a few that stood out:

• $1,308.78 Patellar Luxation claim  ($1,553.64 already claimed for this condition this year) in a 3 year old Golden Retriever
• $2,051.25 Congestive Heart Failure secondary to Hypertrophic Cardiomyopathy in an 8 year old mixed breed cat
• $1,636.24 Eyelid Mass Removal Left Eye in a 3 year old Doberman Pinscher

None of the people looking after these pets had any idea that they were going to be facing such high dollar claims for such young pets. Could that be you?

Since quite a few people question the cost of pet insurance, believing their pets will not have a claim, and certainly not a high dollar claim, I decided to do a quote for each of the pets above as if they had a $1,000 annual deductible - a much more affordable policy with still great coverage.

Here's the new Embrace Pet Insurance premium assuming $1,000 annual deductible, 20% copay, $10,000 maximum, and prescription drug coverage, all living in Cleveland OH: 

• $12.42/month for the 3 year old Golden Retriever
• $7.08/month for the 8 year old mixed breed cat
• $15.64/month for the 3 year old Doberman Pinscher

BONUS: if you were adding these to another pet already insured, you'd save another 5% off the new pet's premium, PLUS another 5% off the other pet. For example, if the other pet is a Golden Retriever, the savings could add up to another $3 per month.

You'd practically be getting your high deductible pet for free!

The point is, for the cost of one lunch out per month, you could be protecting yourself from some pretty serious veterinary surprises.

Food for thought anyway.