Visiting Veterinarian

Premium pets

By Michele Gerhard Jasny V.M.D. - June 21, 2007

Insurance. To tell the truth, the whole system seems a little perverse to me. You bet the insurance company that something bad is going to befall you, something that costs more than the total amount of money you have been giving them month after month. If something bad does happen, you win the bet and they pay. If nothing bad happens to you, you lose...and the insurance company keeps your money.

If, God forbid, you get seriously ill, your house burns down, or there is some other disaster, you may well be glad you bought that insurance. Or you may be shocked to find that you didn't read the fine print and the particular sticky situation in which you find yourself isn't covered. Not to impugn my friends who work in the insurance business, - after all, insurance is a necessary and generally helpful part of our society - but it kind of reminds me of a gambling casino. In the long run, odds are the house wins.

Why in the world am I, a veterinarian, talking about this? Because people often ask my advice about insuring their pets. Pet insurance has been available in the United States since 1982. In spite of 25 years of marketing, and a growing number of pets, only about two percent of Americans insure their animals. This is far less than in some other countries. In dog-crazy England, 20-30 percent of the pets have coverage, and Swedes reportedly insure a whopping 50 percent of theirs. As pets become a more and more important part of our families and as veterinary care becomes increasingly sophisticated and expensive, the idea of buying health insurance for them becomes increasingly appealing.

So what do I think? A lot depends on your financial situation, ability to save, and relationship with your pet. Consider your dog, Blackjack. Consumer Reports recently did a piece on pet health insurance and concluded that in most situations, you are better off saving your money and paying for Jack's health care yourself. "How can this be?" you ask. "I take him to the vet all the time, and it ain't cheap!"

Fido as a Ford?

First, most pet health insurance functions like property insurance rather than like human health insurance, viewing pets as property, not people. Think of it like automobile insurance, rather than coverage for your kid. The main focus is on situations where your "property" is damaged by accident, injury, or illness. Routine expenses such as vaccinations, worming, heartworm pills, and the like are not covered, except in plans where you pay a hefty extra for that benefit. The older Jack is, the higher the premium, which may also be affected by where you live, and the average veterinary fees in your area. Most policies exclude congenital, hereditary, and pre-existing conditions and carry deductibles, co-pays, and annual caps.

"Jack doesn't have any congenital, hereditary, or pre-existing conditions," you say. Think again. Is Jack a German Shepherd with hip dysplasia? Hereditary. If he needs arthritis medication, radiographs, surgery, insurance probably won't cover it. Does he have an umbilical hernia? Congenital. How about allergies? Pre-existing. You would be amazed by what may be denied on these exclusions.

The place where pet health insurance may be useful is if Blackjack has a catastrophic injury and illness. Without insurance your options are to pay out of pocket, go into debt, or consider euthanasia. If you are not great at saving on your own and know you would want to take advantage of the most advanced medical options no matter what, pet insurance may be right for you.

Research your options. Not all companies cover all species and the range of available plans is broad. Insure Jack when he is young and has minimal pre-existing issues. Check what congenital and hereditary conditions are common to his breed. Be prepared to have claims concerning these to be denied. Read the fine print. Get the most cost-effective coverage for your specific circumstances. For example, one company offers a rider for extra coverage for cancer. If you have a breed that is prone to tumors, such as a boxer or golden retriever, it's worth paying for that (after making sure the company doesn't exclude cancer coverage in these breeds as "hereditary"). If you have many pets, look for multiple animal discounts. Have five Yorkies or a kennel full of greyhounds? It may be worth getting the dental plan, but be sure it covers routine cleanings. You get the picture.

The main complaints reported about pet insurance are that they do not reimburse the amount that people expect. They may have fixed benefit schedules with limited payouts, and there may be ambiguity about what is excluded, leading to denial of claims. Find out how the company defines "pre-existing." If Blackjack is prone to skin problems, will they deny a claim if it flares up every spring? And don't be shocked when your veterinarian does a long and pricey list of diagnostic tests, and none of them get paid for when the ultimate diagnosis turns out to have a hereditary component.

Bone up on the details

Do your homework. I have seen policies that exclude behavioral problems and alternative medicine. Most do not cover elective procedures like spaying or neutering. Find out how a company handles a chronic condition that develops during the term of the policy but continues year to year. In other words, say you buy a policy in 2007 and Blackjack develops diabetes in 2008. Your expenses are covered initially. So far, so good. What happens in 2009? Do they cover diabetes-related bills for the rest of Blackjack's life? Or do they call it a pre-existing condition after the first year? What about if Jack develops cataracts or kidney failure secondary to the diabetes. Is that covered? The more you research in advance, the less likely you are to be disappointed.

Unlike human health plans, where the doctor has the headache of the paperwork, with pet insurance, it's generally up to you. All the veterinarian has to do is fill in a diagnosis on the form and hand you the bill. You pay the vet, then file the claim, and hopefully the insurance company reimburses you. You can use any veterinarian you choose, except in very few programs that are more like HMOs and limit providers to veterinarians who are enrolled as part of the "network."

Now I am good at pilling cats, patting dogs, talking people through complicated medical decisions, and stuff like that. I can even balance my checkbook. But you do not want me to be the one explaining the fine print of insurance. Give me those charts with Fee Schedules, Deductibles, Cap per Accident, Annual Cap, Special Allowances, Co-pays, Standard Plan vs. Superior Plan, and so on - and my hair stands on end, my eyes make psychedelic spirals, and steam comes out my ears. I would much rather just stash a few dollars in the cookie jar every week for a rainy day. But if you are not good at saving and Blackjack is your most dearly beloved, then pet health insurance may make sense.

For some, it is worth it to have the peace of mind, to know that, should something awful occur, you will not have to make a medical decision based on finances. With pet insurance, you will be far less likely to ever face losing Blackjack to what has been called "economic euthanasia." Without insurance, odds are, if you're lucky, that you will spend less. It all depends on the cards you are dealt, and how you play your hand.