Insurance claim query for potential dental work.

wannabepennypincher

My diabetic cat has been diagnosed with something called chronic ulcerative stomatitis, his mouth flares up and he gets really bad mouth ulcers and it can get infected. The normal treatment is steroids, painkillers and anti-biotics however because he is diabetic he can't have steroids so the vet thinks we might have to take all his back teeth out. His teeth are healthy but the vet says that although extreme it can help long term esp as he can't use steroids.

He advised me to talk to petplan about the dental work as sometimes it's not covered however as it's not cosmetic he thought it should be. I called petplan and got told that they exclude comsmetic dental work (scale and polish) but would look at it and see once the work was done- the advisor told they didn't tell people over the phone if something would be covered in advance, only once it had been treated.

So really I want to know if anyone has had this treatment paid for or if they had any issues. Or if there is anyway I can get them to tell me in advance yay or nay. We have the option of paying it over time so it's not a case of him not recieving the treatment if they won't pay out I'm just a bit of a stresshead I just want to know one way or the other what will happen.

Sorry if I rambled.

olias

Tell them that their answer is not good enough. You are entitled to know if a certain treatment comes under the terms of their policy, and they should provide you with that information, particularly if the course of treatment may be one that would not neccessarily be reccommended by another vet (eg a pet plan one!)

If you don't get anywhere, then I would escalate your query to a supervisor of claims manager.

Olias

elsien

I've found in the past that petplan won't give a definitive answer until the claim form goes in. I think a lot of it does depend on how the vet words the claim and the information they give - if he will clearly say that it isn't cosmetic then going on past experience with petplan they're pretty good at paying up.

To give an example, mutt has an exclusion on her insurance for all foot conditions due to having cysts on her feet from before she got insured. Last year she got a tumour on her toe and had to have it amputated. Petplan refused to say whether they'd pay or not as they said they needed full disclosure from the vet to reach a decision - it was over £1000 and I was fretting! Because the vet clearly said that the tumour was unrelated to any previous conditions and could have happened anywhere on her body, they paid up.
This is one of the reasons I think petplan are worth paying more for - other insurers would have had good grounds for wriggling out of paying.

If your vet will definitely say that the operation is needed for medical reasons and isn't cosmetic, and as long as there aren't any other exclusions, I would say you stand a fair chance. I think the reason petplan won't say in advance is because they're getting the info third hand from you instead of direct off the vet, and some people do mishear what they're being told by the vet.

Edit - which policy do you have with them? They do say the pet should have an annual dental check, but my annual visit for boosters generally covers that, even if they just do a quick look.

albacookie

The vet can fill in a pre authorisation form - they give the details of the condition and the proposed treatment and Petplan say whether or not they will cover it. Once the treatment has been carried out they can invoice Petplan without filling in a claim form.

You can download the form here -

http://www.petplan.co.uk/assets/pdf/CFPre-Authform.pdf

wannabepennypincher

Thanks very much, our vets are excellent when we spoke about the possibility of the op he went through his entire history and said there was nothing there that should give them reason to say no and explained that they have to print off the whole history and send it off and thats how they decide. The vet said in his opinion there was no way of preventing it- typical causes like fiv and leukemia are out as he was tested last year when he first got sick and as an indoor cat now he couldn't possibly have been infected since then. He is more likely to need the dental work because of how the mouth issue can mess up his diabetes- infection messes up his blood sugar and if his mouth is too sore to eat he can get really ill- and the diabetes is covered anyway.

We have the petplan covered for life budget- going to get the pre-authorisation form filled in for my vet in the event we go ahead.

Thanks very much for the quick replies.

KVet

The most common cause of ulcerative stomatitis/gingivitis in cats is Calicivirus, usually infected when very young. Best way to help (there is no real cure, only certain treatments to help to go "into remission" as it is a waxing and waning disease) is def, first off, removing the teeth in the affected areas. Also, the use of Interferon can be amazingly good but it is expensive so glad you're insured! Sometimes changing the food to a high protein diet can help as well, will also be fab for the Diabetes (Bozita tinned, Applaws, Natures Menu etc) Diane Addie wh taught me at Uni is very keen on all cat viruses and has LOADS of info on her website http://www.dr-addie.com/stomatitis.html

wannabepennypincher

KVet wrote: »

The most common cause of ulcerative stomatitis/gingivitis in cats is Calicivirus, usually infected when very young. Best way to help (there is no real cure, only certain treatments to help to go "into remission" as it is a waxing and waning disease) is def, first off, removing the teeth in the affected areas. Also, the use of Interferon can be amazingly good but it is expensive so glad you're insured! Sometimes changing the food to a high protein diet can help as well, will also be fab for the Diabetes (Bozita tinned, Applaws, Natures Menu etc) Diane Addie wh taught me at Uni is very keen on all cat viruses and has LOADS of info on her website http://www.dr-addie.com/stomatitis.html

Thanks for the link to Dr Addie, it was a really good read. Good tip about changing his food. I always used to feed him bozita- it was a case of eat it or leave but after a 5 day stay at the vets last year (pancreatitis cause of his diabetes) we couldn't get him to eat so put down a pouch of felix AGAIL and the fussiest cat in the world was born! He knows now that if he walks away from a plate of food I will put something else out as I know he needs to eat so his sugar doesn't get messed up. Might try Nature's menu though as it comes in pouches and I seem to have better luck with pouches over tins. I feed orijen dry to conteract the junk but he refuses to eat dry.

bethie

if it helps, petplan paid out for my cat to have a dental/teeth removed.


no 'official' diagnosis on the teeth front, but they think it was a combination of ulcerative glossitis/stomatisis.


and, since his teeth have been removed, his gums have been much better! (still has other issues (which petplan have paid out for again) but that is a whole other topic... )


oh, and i found my cat can't really eat nature's menu that well after having his teeth out - it is a bit too dense for him to work through.

tankgirl1

albacookie wrote: »

The vet can fill in a pre authorisation form - they give the details of the condition and the proposed treatment and Petplan say whether or not they will cover it. Once the treatment has been carried out they can invoice Petplan without filling in a claim form.

You can download the form here -

http://www.petplan.co.uk/assets/pdf/CFPre-Authform.pdf

I used to deal with vet insurance claims, and I second that if you are with PP - get a pre auth form filled in by your Vet/VN prior to treatment - if PP agree to it then they will pay. Speak to your Vet/VN about it