??'s About Actually Using Your Equine Medical Insurance...

[Sfbayequine]

I have had my medical on my girl the last few years. I have always chosen to pay my vet bills out of pocket as from what I have read here the insurance companies are rather finicky and they have not been worth putting through.

I am dealing with an intermittent lameness, which I am frankly sick of, and am ready to block the leg, pull films and ultrasound if necessary. I would like to use the insurance, but am still nervous about the policy being cancelled or the leg being excluded in the future.

What can you tell me about effectively using equine medical? My policy is with Diamond State / AEIG. I guess my main question is once you disclose and turn in diagnostics and charges for say a left front lameness issue, will that leg/injury be excluded in the future?

I have a call into my insurance guy, but thought you all may have some words of wisdom.

[GoForAGallop]

Yes, it may be excluded in the future depending on what you find.

Spent $4k of my/the insurance company’s money this summer diagnosing a lameness in my mare that ended up just being muscle soreness. I’m genuinely curious, come my renewal in March, if they’ll end up excluding anything.

[joiedevie99]

I would do the diagnostics and then decide. If you find minor arthritis - that you might treat with a joint injection - I would not submit it. Insurance doesn’t cover maintenance anyway, and I wouldn’t risk the exclusion for just an x-ray/ultrasound bill.

On the other hand, if you find a soft tissue injury that you want to treat with shockwave, PRP and therapeutic ultrasound (like I did), with monthly follow-up diagnostic ultrasounds, the payments are more than worth the exclusion.

Similarly, if you do the x-ray and ultrasound, and are no closer to an answer - submit those, and then send the horse for a bone scan or MRI and get the whole deal covered.

[GoForAGallop]

[QUOTE=joiedevie99;7796585]
I would do the diagnostics and then decide. If you find minor arthritis - that you might treat with a joint injection - I would not submit it. Insurance doesn’t cover maintenance anyway, and I wouldn’t risk the exclusion for just an x-ray/ultrasound bill.
.[/QUOTE]

Err, except that legally/morally you are obligated to inform your insurance company of ANY vet diagnostics beyond routine care on your yearly renewal form.

[Sfbayequine]

[QUOTE=GoForAGallop;7796601]
Err, except that legally/morally you are obligated to inform your insurance company of ANY vet diagnostics beyond routine care on your yearly renewal form.[/QUOTE]

I did an ultrasound on something to make me feel better last year that I paid for. On the renewals I told them I did the ultrasound and that it was to make me feel better and it was inconclusive and the lameness resolved with no other intervention. I was going in for surgery and wanted to know more. The insurance never mentioned it on my renewal and dropped my rate as I classified her as a dressage horse.

Different leg this time… I don’t think diagnostics get you bounced if inconclusive. It would just be an actual diagnosis of something that may prompt the exclusion. Thanks for all the input so far. It always feels wrong to pay for insurance that you are afraid to use… but definitely happy to have it if my issues get bigger.

[gottagrey]

This is one of the reasons you have insurance coverage is it not? If it is a chronic illness like arthritis they’re not going to pay for it one or the other. If it is an injury and horse recovers - your vet can provide information of it being fully healed, horse back to work etc. For instance a friend of mine had a fractured splint bone removed - horse out of commission for a few months, insurance paid for most of it, she renewed w/out any exclusions.

[GoForAGallop]

[QUOTE=Sfbayequine;7796620]
I did an ultrasound on something to make me feel better last year that I paid for. On the renewals I told them I did the ultrasound and that it was to make me feel better and it was inconclusive and the lameness resolved with no other intervention. I was going in for surgery and wanted to know more. The insurance never mentioned it on my renewal and dropped my rate as I classified her as a dressage horse.

Different leg this time… I don’t think diagnostics get you bounced if inconclusive. It would just be an actual diagnosis of something that may prompt the exclusion. Thanks for all the input so far. It always feels wrong to pay for insurance that you are afraid to use… but definitely happy to have it if my issues get bigger.[/QUOTE]

All fine, but the poster I responded to said “I wouldn’t risk the exclusion”…meaning, don’t tell the insurance company if it’s something small, which is called insurance fraud.

There’s nothing wrong with not submitting bills to your insurance company (although I really don’t see why you wouldn’t if they’re over your deductible), but you do still need to tell them about any findings, and they will make their own decisions about whether that results in any exclusions.

[Pocket_Pony]

Anything I’ve ever submitted a claim for has been excluded for the following year’s policy.

[ryansgirl]

Most things do get excluded when you go to renew if you’ve filed a claim - but sometimes only for the next year.

Legally you have to tell the insurance company if your horse has been treated by a vet for anything other than routine stuff (i.e. Vaccinations). You have a form to fill out and sign - if they find out you’ve lied you’re basically screwed so why risk it.

[gallopingmouse]

I’ve found it to be a Catch-22. I used my coverage for diagnostics (bone scan) & treatments (PRP, stem-cell, etc) & my coverage was basically dropped the next year. BUT, I wouldn’t have been able to afford the expensive procedures if I didn’t use the coverage, so I have a relatively sound but uninsurable horse now. It was worth it for me.

[Sfbayequine]

Thanks everyone for your stories. Appreciate the insight and it is all about what I expected. I will see how the diagnostics go… and figure out my plan. Cheers to all.

[ZELLA]

Whether you file a claim or not, any non-routine vet treatment done on the horse must be disclosed on your application each year and will be subject to possible exclusion. To knowingly fail to disclose this info when asked on the application is fraud. Really, you might as well make the claim, because the underwriter’s evaluation will be pretty much the same either way. If the lameness issues began before your current policy term, you may have difficulty in getting your expenses reimbursed. Your vets are bound to tell the insurance adjuster the complete history, so it’s really hard to get around that. Diagnostics coverage on equine policies are getting increasingly restrictive, so it’s better to use what you have now, which might be more that what’s available next term.

[Thoroughbred_in_Colo]

My experience with Markel has been that I’ve only had exclusions based on claims made. For care that I paid out of pocket for (but did list on my annual disclosure) I have yet to have anything excluded. That being said, most of the out of pocket things have been fairly minor injuries and not things with the potential to blow up into something bigger later.

Nobody likes dealing with insurance companies, but you’re paying for it, so you might as well use it!