Upset with PetPlan USA and need advise..

[zinchik]

Just get off the phone with PetPlan USA and extremely upset -- not only was our claims denied and Kika's HCM was written under "pre-existing condition" -- I also feel they done so wrongly just not to pay and is very upset.

We got Yorik end of January and having 2 kittens in the house I finally gave up and decided to protect myself with pet insurance. After many board readings and plan comparison I decided on PetPlan USA and got policy for both of them which went in effect on 2/9..
on 2/16 we had regular first check up with Yorik at the vet and mentioned to the vet that Kika is (still) coughing -- he suggested to do x-rays and put it in the medical history.

on 2/23 we took Kika for x-rays and that where we learn that her heart is enlarged and were advised to to cardio sonogram.

on 2/28 we did sonogram and learned about her HCM condition. While we were discussing the condition and meds, cardiologist specifically told us that for felines -- cough is never related to HCM and we should do some other tests to figure out the source of coughing..
---------------------
According to PetPlan rules our policy went in effect 14 days latter.. which is exactly on 23rd. However we are denied claim on the grounds that she was coughing on 2/16 and coughing is sign of HCM and since than HCM is pre-existing and not being covered anymore.

I am not sure if I should call cardiologist and try to get a letter from him specifying that cough in felines is not related and is not a sign of HCM? Or should I just forget and send email cancellation of policy to them as I feel already cheated and better just opening bank account for Kika's medical bills and put money aside..

What do you think? Fortunately never before I had to deal with insurance and right now feel very cheated and upset.

Also -- I do not have anything written from them -- not in the email or snail mail. I called today finally to find out why I am not getting anything and that how I learned about their decision.
They promised me email right away -- about an hour ago and nothing has arrived - I guess they do not want to put it in writing now?

 

[zinchik]

And by the way -- I think we figured out the coughing issue -- the dry air. We kind of got used to it, but when we moved to our place first we had to keep humidifier on all the time.
So someone suggested to me that cats may have the same issue and the day I turned on humidified again -- Kika almost stop having her coughing fists.. but I am thankful that I learned of her HCM early enough to monitor and hopefully keep it under control

 

[Zeke8888]

I am so sorry. The letter from the vet would be great to cover your bases, though. I have never had pet insurance and, of it's anything like human insurance, well - good luck. I have a daughter with special needs and am constantly in a fight.

 

[Snowball]

Just get off the phone with PetPlan USA and extremely upset -- not only was our claims denied and Kika's HCM was written under "pre-existing condition" -- I also feel they done so wrongly just not to pay and is very upset.

We got Yorik end of January and having 2 kittens in the house I finally gave up and decided to protect myself with pet insurance. After many board readings and plan comparison I decided on PetPlan USA and got policy for both of them which went in effect on 2/9..
on 2/16 we had regular first check up with Yorik at the vet and mentioned to the vet that Kika is (still) coughing -- he suggested to do x-rays and put it in the medical history.

on 2/23 we took Kika for x-rays and that where we learn that her heart is enlarged and were advised to to cardio sonogram.

on 2/28 we did sonogram and learned about her HCM condition. While we were discussing the condition and meds, cardiologist specifically told us that for felines -- cough is never related to HCM and we should do some other tests to figure out the source of coughing..
---------------------
According to PetPlan rules our policy went in effect 14 days latter.. which is exactly on 23rd. However we are denied claim on the grounds that she was coughing on 2/16 and coughing is sign of HCM and since than HCM is pre-existing and not being covered anymore.

I am not sure if I should call cardiologist and try to get a letter from him specifying that cough in felines is not related and is not a sign of HCM? Or should I just forget and send email cancellation of policy to them as I feel already cheated and better just opening bank account for Kika's medical bills and put money aside..

What do you think? Fortunately never before I had to deal with insurance and right now feel very cheated and upset.

Also -- I do not have anything written from them -- not in the email or snail mail. I called today finally to find out why I am not getting anything and that how I learned about their decision.
They promised me email right away -- about an hour ago and nothing has arrived - I guess they do not want to put it in writing now?

I wouldn't neccessary cancel with PetPlan USA. I would still try to fight it by getting a letter from the doctor and faxing it to them because if you do switch over to another pet insurance (I have VPI pet insurance), they most definitely will not cover HCM, and will still call it pre-existing, so you might as well try to fight Pet Plan about the coverage. If you can fight it, then try to but if faxing the paper from the doc doesn't work out, I hightly recommend VPI pet insurance. I know you feel cheated and upset but most pet insurance companies are slimes. I've never heard of Pet Plan USA until just now. I've heard of VPI pet insurance and it is highly recommended by majority of the vets' I've visited. I hope everything works out with you. Keep us in the loop!

 

[ilovemysphynx]

I manage a doctors office and work with human ins. daily.
You need to first read your policy and see what it says about pre existing conditions? Some can go 1 year back since HCM does not happen over night they can say it was pre existing but undetected until now.
It is uncommon for cats to have a cough but not unheard of with HCM it is more common for dogs to have a cough with HCM. Depends what they are going by.
There has to be something in your policy for this and I would read it carefully, usually you can get around it. A letter from the vet is a great start stating how long he thinks the HCM has been present if early stage then you should be fine and it can get covered but if it is later stage then it would fall under the pre existing clause.

This all can become overwhelming and what I swear the insurance companies wish for so they don't have to pay.

 

[zinchik]

ohh.. I got a call yesterday from PetPlan USA -- apparently they seen my post in my blogs , reviewed the case and revised the decision.
they will not cover x-rays and coughing, but they will cover sonogram and HCM will not be counted as pre-existing.
So I can't tell you how much I relieved that they reverse their decision.

For those who wonder.. I do not have a blog, I mean I do have few.. but. However I did feel very strongly that their vet-technicians were not competent enough due to what my cardiologist explicitly said and what they said, so I did complained rather out loud on facebook and tagged them in the post, hoping that someone in the management will see and take a 2nd look.

The funny part -- due to workload -- missed two calls from Kika's cardiologist yesterday -- I left a message that I need a letter from him and asked him to call me back.

 

[shengnes]

Well good for you. The squeaky wheel sometimes gets greased.

 

[Inflamed]

Very happy for you that they changed their minds! Sometimes they just need a little push to do the right thing!

 

[Snowball]

This is a really late response because I have been rather busy and didn't have the time to get online, but I am very happy they revised their decisions!

 

[MyJezebel]

I just saw your post and I am glad your insurance company reversed their decision. I have Trupanion and they initially declined to cover Finn's echo cardiogram too because it was noted in his chart that during his first vet visit at three months old that my vet "possibly heard a grade 1 heart murmur but could not reproduce." Trupanion said that they were treating this as a preexisting condition because a murmur is a symptom of HCM. No murmur was ever heard at any of Finn's subsequent visits, so my vet wrote a letter of dispute. Finn's internist also wrote a letter of appeal because the echocardiogram was ordered because Finn's heart appeared enlarged on an xray, not because of a murmur. Even though the cardiologist heard a slight murmur, he noted in his report that it was benign and unrelated to the mild HCM symptoms he had found, so that report was submitted too. After all this was sent to Trupanion, they did reverse their decision and have since reimbursed me for the echo. It was a giant pain though and I was beside myself when they first refused to cover it since he will be needing follow-up echos in the future. I guess all of this was really just a long way of saying that I've been where you were too, so I know exactly how you were feeling.

 

[zinchik]

I just saw your post and I am glad your insurance company reversed their decision. I have Trupanion and they initially declined to cover Finn's echo cardiogram too because it was noted in his chart that during his first vet visit at three months old that my vet "possibly heard a grade 1 heart murmur but could not reproduce." Trupanion said that they were treating this as a preexisting condition because a murmur is a symptom of HCM. No murmur was ever heard at any of Finn's subsequent visits, so my vet wrote a letter of dispute. Finn's internist also wrote a letter of appeal because the echocardiogram was ordered because Finn's heart appeared enlarged on an xray, not because of a murmur. Even though the cardiologist heard a slight murmur, he noted in his report that it was benign and unrelated to the mild HCM symptoms he had found, so that report was submitted too. After all this was sent to Trupanion, they did reverse their decision and have since reimbursed me for the echo. It was a giant pain though and I was beside myself when they first refused to cover it since he will be needing follow-up echos in the future. I guess all of this was really just a long way of saying that I've been where you were too, so I know exactly how you were feeling.

Ohh.. sounds like you went exactly through the same! I think thats a shame that we have to fight them on such technicalities -- they do use every possible way not to pay for thing... but good thing we won : )
We also will be having another follow up echo at the end of the summer. Good thing to know we will be covered!

 

[susi794]

Woohoo! A victory for the good guys! Woohoo! I'm proud of you for fighting and getting them to reverse their decision. Sometimes, things have just gotta go right! Thankfully this was one of them.
Much love,
Susi and the gang