How to Make a Pet Insurance Claim

How to Make a Pet Insurance Claim

Key points

  • Before you make a pet insurance claim, it’s important to understand what your pet insurance policy covers and excludes.
  • Provide an itemized invoice and receipt with your pet insurance claim, so it can be processed quickly.
  • Most claim payouts take two to three business days for direct deposit and up to seven business days for mailed checks.

Pet insurance can help offset the rising cost of veterinary care. To get the most out of your coverage, it’s important to know how to file a pet insurance claim successfully.

How do you file a pet insurance claim? 

How you file a pet insurance claim depends on your pet insurance company. Most insurers require you to pay first and then file a claim for reimbursement, but a few offer to pay covered expenses to the vet directly.

Pet insurance reimbursement

Here are some steps when it comes to pet insurance reimbursement claims. 

  1. Take your pet to the vet. After the appointment, pay the vet bill. Get an itemized receipt with a breakdown of all the costs.
  2. Fill out the claim form. Go on your pet insurance company’s website, app or portal and fill out the claim form with the necessary details of the vet visit. 
  3. Submit the claim form and required documentation. You should get a copy of the claim you submitted and keep it on file. Follow up if you don’t get a copy.
  4. Receive reimbursement. Your pet insurance company will send an explanation of benefits and reimbursements to you by check or direct deposit, depending on how you have your account set up.

Vet direct pay

Some pet insurance companies offer to pay the vet directly, but the way this works varies by company.

  • Pets Best offers direct vet pay, but not at checkout. Your vet will need to sign a reimbursement release form that you will submit along with your claim. After your claim is processed, Pets Best will send any eligible reimbursement to the vet and you will be responsible for the balance.
  • Trupanion offers vet direct pay at checkout, as long as your vet has Trupanion software. Once Trupanion pays the vet’s office directly for covered expenses you’ll only be responsible for non-covered expenses, like your deductible and coinsurance.

What you need to file a pet insurance claim

Here’s what you typically need to file a pet insurance claim.

  • Itemized receipt: The itemized receipt from your veterinarian’s office should include every charge, fee and tax, plus any discounts you’re eligible for. The receipt must show a zero balance unless you’re using vet direct pay.
  • Claims form: If you file a claim through your pet insurer’s online portal or mobile app, your personal details and information about your pet may pre-populate. If not, you might have to fill out a claim form with that information, plus details about the date, cause and reason for your pet’s veterinary visit.
  • Veterinary medical records: Pet insurers may require your pet’s medical records if you haven’t provided them or if this is your first claim. The records will allow the insurer to verify coverage and determine what may not be covered, like pre-existing conditions.
  • Bank account information: Direct deposit provides the fastest reimbursement. You will need your bank routing and account number to get reimbursement through electronic payment.

If your pet insurance company needs medical records or any other information to finalize the pet insurance claim, the insurer will typically reach out to you directly or to the veterinarian.

How much you can expect to be reimbursed for a pet insurance claim

How much you can expect from pet insurance reimbursement depends on:

  • Your plan. Coverage varies by company and by plan, so it’s important to understand what your pet insurance covers.
  • Your deductible. This is the amount you are responsible for paying before your pet insurance plan will start to reimburse you for eligible expenses. You choose this amount, such as $250, when you buy pet insurance.
  • Your reimbursement percentage. Similar to coinsurance, pet insurance plans generally pay 70%, 80% or 90% of eligible vet bills, after the deductible is met.
  • Your annual limit. This amount is your annual coverage cap, such as $5,000.  

For example, let’s say your dog is seen for a paw laceration that is not a pre-existing condition, and you have an accident and illness pet insurance plan. The total vet visit cost is $400, and you’ve already met your $250 annual deductible for the policy period. With an 80% reimbursement percentage, you’d get reimbursed $320. 

Tracking the progress of your pet insurance claim

“How to track the progress of a pet insurance claim varies by provider,” said Christie Ross, Pumpkin Pet Insurance customer care manager. “Claims can usually be tracked in the customer member center or account portal.”

If your pet insurance company has a mobile app, you can also track the progress there. If you don’t have any of these options, some providers will provide progress reports via email, advised Ross.

Wait time for a pet insurance claim payout

Claim payout wait times can vary by the pet insurance company, the complexity of the claim and the reimbursement method. 

According to Dr. Katy Nelson, senior veterinarian at Chewy, some reimbursements can happen instantly with direct deposit. For other insurance companies, it may take several business days. 

Pets Best typically takes as little as two days to deposit the claim payout after processing, said Melissa Gutierrez, SVP, General Manager Pets Best at Synchrony. A paper check can take anywhere from five to seven days.

For more complex cases or cases needing further documentation, reimbursement can take a week or more.

Mistakes to avoid when filing a pet insurance claim

You should file your pet insurance claim as soon as possible — the faster your claim is approved the quicker you’ll receive reimbursement. You should also provide complete and accurate information to avoid processing delays.

“The most important thing to do is read the fine print,” said Dr. Nelson. “By reviewing plan details in policy documents, pet parents can understand what is covered and what is not, before filing a claim.”

Handling claim denials or disagreements

Before contacting the pet insurance company if your claim is denied or you disagree with your payout, Ross advises you to look closely at your explanation of benefits (EOB) and insurance policy. The EOB will explain why your claim was denied or what services were approved and reimbursed.

According to Gutierrez, the most common reasons for claims denials are:

  • You have yet to meet your deductible, and the amount of covered expenses was applied to your deductible.
  • Your policy doesn’t cover the services your pet received, such as exam visit fees.
  • Your pet’s condition was deemed pre-existing.

You can appeal the decision with your pet insurance company. You should be prepared to provide additional context to substantiate your appeal to be successful.

If you still disagree with how the claim was handled or your payout amount, you can make a complaint with your state’s insurance department. Each state has a dedicated insurance department that regulates insurance companies and handles complaints and grievances.

Tips for maximizing your pet insurance claim

To maximize your pet insurance claim:

  • Review your pet insurance policy to make sure you understand what’s covered and what’s not.
  • Provide original itemized paid receipts if mailing or clear pictures or scans if submitting online. Keep copies for your records.
  • Don’t forget to complete your claim form, sign it and provide proof of payment in full.
  • Provide as much detail as possible when filling out claims forms, including complete medical records and veterinarian notes.
  • Ask your veterinarian questions during the appointment and take notes to make filing the claim easier.
  • Ask a staff member on your veterinarian’s team to help complete the claims form if needed.
  • Keep track of the claims process to promptly address anything the pet insurance company needs.

How to file a pet insurance claim FAQs

How long it takes to process a pet insurance claim depends on the pet insurance company and what your pet insurance covers, the type of claim, the details provided for the claim and the way you submit it.

Pet insurance companies using mobile apps with AI assistance can process claims within a few minutes, while others can take up to a week. It can take even longer if your claim is particularly complex or if you need to provide more documentation. Most pet insurance companies strive to process claims within a week of submission.

You can make pet insurance claims as often as needed, though you should only submit one claim per vet visit. For example, if your cat was seen for its annual visit and you have wellness coverage, you would submit a claim after being seen. If your cat ingests an object a few days later, you would submit another claim for that vet visit.

The most common medical conditions for dogs and cats according to the 2023 NAPHIA State of the Industry Report are:

  • Ear infections.
  • Vomiting.
  • Diarrhea.
  • Urinary tract infection.
  • Weight loss.

The most common pet insurance claims for puppies according to the ASPCA are:

  • Lacerations.
  • Bite wounds.
  • Ear infections.
  • Stomach issues.

The most common pet insurance claims for kittens according to the ASPCA are:

  • Back leg fractures.
  • Bite wounds.
  • Diarrhea.
  • Conjunctivitis (eye infections).