Pet insurance has become increasingly vital for pet owners as veterinary care costs continue to rise. If you’re considering pet insurance for your beloved dog or cat, a primary concern is understanding how pre-existing conditions are handled. Specifically, you might be wondering: can pet insurance find out about pre-existing conditions and will these conditions affect your pet’s coverage?
Navigating the complexities of pet insurance policies can be daunting, especially when it comes to pre-existing conditions. This article will delve into how pet insurance companies determine pre-existing conditions, what it means for your coverage, and how to choose the best plan for your pet’s needs.
What Exactly Are Pre-Existing Conditions in Pet Insurance?
A pre-existing condition in pet insurance terms is any illness, injury, or symptom that your pet showed signs of, was diagnosed with, or received treatment for before your pet insurance policy’s effective date. Essentially, if it happened before coverage started, it’s likely to be considered pre-existing.
Here are some clear examples of what pet insurance companies typically classify as pre-existing conditions:
- Chronic Illnesses: Diabetes, cancer, arthritis, and heart disease diagnosed prior to the policy start date.
- Injuries: A fractured leg that occurred and was treated before enrollment.
- Recurring Issues: Allergies that have caused symptoms or required veterinary care in the past.
It’s important to note that some pet insurance policies have specific clauses regarding hereditary conditions like hip dysplasia. These policies might have age restrictions for enrollment or may exclude coverage if symptoms of hip dysplasia appear within a waiting period after the policy becomes active. Always carefully review the policy documents and FAQs to understand these specific exclusions.
Will Pet Insurance Cover Pre-Existing Conditions?
Generally, most pet insurance policies do not cover pre-existing conditions. This is a standard practice in the pet insurance industry. However, the definition of “pre-existing” can vary between companies, and there can be exceptions, particularly for curable pre-existing conditions. Understanding how each insurer defines and treats pre-existing conditions is crucial.
Let’s break down different types of conditions and how they are typically viewed by pet insurance companies:
Hereditary and Congenital Conditions: Understanding Coverage
Many pet insurance providers will cover hereditary and congenital conditions if your pet showed no signs or received no diagnosis before the policy’s start date. Some insurers even offer specialized add-on policies specifically for “hereditary and congenital coverage.”
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Hereditary Conditions: These are genetic conditions passed down from parents, common in purebred animals. Examples include:
- Hip dysplasia (alt: X-ray showing hip dysplasia in a dog, a hereditary condition often excluded by pet insurance if pre-existing)
- Elbow dysplasia
- Cherry eye (entropion)
- Patellar luxation
- Intervertebral disc disease (IVDD)
- Allergies
- Certain cancers
- Thyroid disease
- Diabetes
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Congenital Conditions: These are conditions present at birth, though symptoms might not be immediately obvious. Examples include:
- Hernias
- Congenital heart disease
- Certain liver diseases (portosystemic shunts, copper-associated hepatopathy)
- Nervous system issues
- Brachycephalic airway syndrome
Curable Pre-Existing Conditions: Is There Hope for Coverage?
Curable pre-existing conditions are illnesses or injuries that your pet has been treated for and has fully recovered from. Many pet insurance companies offer a pathway to coverage for these conditions, but it requires a symptom-free waiting period.
- Symptom-Free Period: Most insurers require a period of 180 days (about six months) where your pet shows no symptoms and needs no treatment related to the condition. Some companies may require a full year.
- Examples of Curable Conditions:
- Ear infections
- Urinary tract infections (UTIs)
- Upper respiratory infections
- Vomiting or diarrhea not linked to a chronic condition
If your pet experiences one of these curable conditions before you get insurance but remains symptom-free for the required period, some policies will then cover it as a new condition should it recur after the waiting period. Always confirm the specific waiting period and conditions with the insurance provider.
Incurable Pre-Existing Conditions: Typically Not Covered
Incurable pre-existing conditions are chronic or ongoing health issues that cannot be cured but require ongoing management. Unfortunately, most pet insurance plans will not cover incurable pre-existing conditions diagnosed before the policy’s effective date.
- Examples of Incurable Conditions:
- Arthritis (alt: Older dog with arthritis, an example of an incurable pre-existing condition often not covered by pet insurance)
- Certain cancers
- Allergies
- Diabetes
- Hip dysplasia
- Many heart diseases
- Torn cruciate ligament
- Epilepsy
- Disc disease
- Urinary blockages, crystals, or idiopathic cystitis
Bilateral Conditions: Understanding How They’re Handled
A bilateral condition is a health issue that can affect both sides of the body. Hip dysplasia is a prime example, as it can occur in either or both hips.
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Bilateral Exclusion: If a bilateral condition is diagnosed on one side of the body before your pet insurance coverage starts, most policies will exclude coverage for both sides, even if the other side develops the condition later.
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Example: If your dog had left hip dysplasia diagnosed before enrollment and later develops it in the right hip, neither hip would be covered.
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Other Bilateral Conditions:
- Torn cruciate ligaments
- Glaucoma
- Uveitis
- Patellar luxation
- Cataracts
Insurance companies exclude bilateral conditions due to the increased risk of the condition developing on the other side. The underlying genetic predisposition or compensatory mechanisms (like a dog shifting weight due to hip dysplasia) make it more likely for the second side to be affected.
However, some bilateral conditions that are considered curable might be covered. For instance, if your dog had a right ear infection before insurance but gets a left ear infection after the policy starts, the left ear infection could be covered if the right ear infection met the symptom-free waiting period criteria. Always clarify bilateral condition policies with your insurer.
Can Symptoms Be Considered Pre-Existing Conditions? The Importance of Medical History
Yes, even without a formal diagnosis, symptoms documented in your pet’s medical records before coverage can be considered pre-existing conditions. This is a crucial aspect of how pet insurance companies operate.
- Symptom Documentation: If veterinary records show symptoms that are indicative of a condition, even if undiagnosed, insurers may consider related future claims as pre-existing.
- Example: Allergies: If your pet’s records show excessive paw licking before insurance, and allergies are later diagnosed, related claims might be denied as paw licking is a known allergy symptom.
- Example: Curable Conditions: Conversely, symptoms like head shaking and ear scratching (signs of ear infections) might not lead to pre-existing condition exclusions if ear infections are considered curable by the insurer, and the waiting period is met.
How Do Pet Insurance Companies Know About Pre-Existing Conditions? Medical Record Review
This brings us directly to the core question: Can Pet Insurance Find Out About Pre Existing Conditions? The answer is a definitive yes. Pet insurance companies have a robust process to identify pre-existing conditions, primarily through medical record review.
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Medical Records Request: When you enroll your pet, insurance companies require you to submit your pet’s veterinary medical records.
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Veterinary Review Teams: Insurers employ teams of trained veterinary professionals (veterinarians and veterinary technicians) who specialize in reviewing these medical records.
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Pre-Existing Condition Identification: These experts meticulously examine records for any documented conditions, symptoms, treatments, or medications prior to the policy’s start date. This is how they determine if a condition is pre-existing.
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Vet Exam Requirement: If your pet has no prior veterinary history or recent records, the insurance company will often require a veterinary exam before enrollment. The records from this exam are then used to assess for any pre-existing conditions.
This thorough review process ensures accurate coverage assessment and helps the insurance company manage risk and premiums effectively. It also ensures that pet owners are reimbursed appropriately for covered conditions as quickly as possible.
Should You Get Pet Insurance Even With Pre-Existing Conditions? Absolutely!
Even if your pet has a pre-existing condition, pet insurance is still a worthwhile investment. Don’t let concerns about pre-existing condition exclusions deter you.
- Coverage for New Conditions: Pet insurance will still cover accidents, injuries, and new illnesses that are not related to the pre-existing condition. This can provide significant financial protection against unexpected veterinary bills.
- Wellness Care Options: Some pet insurance plans also offer wellness add-ons that cover routine care like vaccinations and preventative medications, regardless of pre-existing conditions.
- Financial Peace of Mind: As pets age, they are more prone to developing serious and costly conditions like cancer, kidney disease, or heart disease. Pet insurance provides crucial financial support to ensure your pet can receive the best possible treatment without you facing overwhelming costs.
In conclusion, while pre-existing conditions are generally not covered by pet insurance, understanding how they are defined and identified is essential. Pet insurance companies can and do find out about pre-existing conditions through medical record reviews. However, even with pre-existing conditions, pet insurance remains a valuable tool for managing pet healthcare costs and ensuring your furry friend receives the care they need. Do your research, ask detailed questions about pre-existing condition policies, and shop around to find the best pet insurance plan to protect your pet and your finances.
References
Find Pet Insurance. NAPHIA.
WRITTEN BY
Amber Souza, LVT
Veterinarian
Amber became a licensed veterinary technician in 2007 while earning her Bachelor’s degree in Science at the University of Nevada Las…
