Vets 4 Pets problem

markyuleuk

My wifes dog had an operation on it`s rear leg which was covered by petplan , after the first operation the vet said he needed the same operation on the other leg. We stated that we could afford to pay for the second operation but were informed by a person at vets 4 pets that petplan had said that they would pay. We have that`s persons name.

Well what I thought would happen happened and petplan refused claim stating same condition maximum amount already claimed.

I have spoken to vets today and asked for the pre-authorisation details that they would have had as per them saying that petplan would pay, but surprise surprise they don`t have one.

Would I have a case (court ? or small claims? ) with reference to them getting us to agree to the second operation and not have authorisation from petplan and us ending up with a £3000 bill

The operation was not life threatening and he didnt have a problem with that leg.

krlyr

What cover does your plan have? I would have thought it would be your responsibility to ensure your plan covers the expected bills, afterall the contract is between yourself and PetPlan, and yourself and the vets. I know many vets are willing to deal direct with the insurers, but even when my vets have done direct claims, I've asked for copies of the bills or the value of the claims so that I could keep a mental note of how much of my annual 'allowance' I've used up.

If you feel that the vets pushed a non-essential operation onto your dog on the basis that insurance would pay so they'd get their money, then I would speak to the head of the practice and/or to the RCVS, who are the regulatory body for the veterinary profession.

elsien

If you suspected that was what was likely to happen, did it not occur to you to check directly with Petplan yourself?

MrsTinks

Unless you have some kind of evidence of the conversation then it's likely to be a he said/she said - it could have been a simple mis understanding or it could have been bad advice. It could have been they said one thing and you interpreted it as something else. The onus would have been on you to ensure with your insurance company that this additional operation would have been covered as you are the policy holder.

Most vets including Vets 4 Pets will deal direct with your insurance company in so far as they will send the bill to them and not you if you instruct them and give them authorization - but when that is rejected it is your bill to settle and you should always consider this when committing to a service.
I would actually argue with Petplan in this instance - try debating if the issue should be considered separate as this was a different leg.

At least your beloved family pet is not in pain which is I guess something to be grateful for - and I'm sure the vet wouldn't have suggested an operation of that scale unless there was cause either immediately or very imminently?

If you think they operated without cause then you should go through the official complaints process though

Tiddlywinks

markyuleuk wrote: »

My wifes dog had an operation on it`s rear leg which was covered by petplan , after the first operation the vet said he needed the same operation on the other leg. We stated that we could afford to pay for the second operation but were informed by a person at vets 4 pets that petplan had said that they would pay. We have that`s persons name.

Well what I thought would happen happened and petplan refused claim stating same condition maximum amount already claimed.

I have spoken to vets today and asked for the pre-authorisation details that they would have had as per them saying that petplan would pay, but surprise surprise they don`t have one.

Would I have a case (court ? or small claims? ) with reference to them getting us to agree to the second operation and not have authorisation from petplan and us ending up with a £3000 bill

The operation was not life threatening and he didnt have a problem with that leg.

Firstly, as a responsible owner who cares for your animal did you not question why the vet thought the operation was necessary if you say the dog did not have a problem with the other leg?

Whenever I've had to make decisions about operations for my animals I have thoroughly questioned the vet and then researched the issue myself so that I understood the risks vs benefits etc.

Why authorise the operation without knowing how necessary it was?

Why authorise the operation without checking if it would be covered by the insurance company? You are the insurance policy holder so it is your responsibility to ensure appropriate authorisation is obtained.

Before the operation you would have signed a consent form - this would have outlined the procedures etc and you would have been signing to say that you would be responsible for the costs.

Unless you have something in writing from the vet confirming that the procedure was authorised by the insurance company then I don't think you have a leg to stand on.

Pets rely entirely on their owners to take care of their health and welfare - I find it incredible that some owners don't take that responsibility seriously enough to check on a medical condition BEFORE authorising an operation.

sheramber

Petplan, along with other companies, treat the same condition arising in another part of the body as the same condition.

So, if the cost of the first operation was the amount of cover taken out then there will be no money left for the operation to the other leg. If you have a lifetime policy the vet fees amount will reinstate at the start of the new policy year .

Cheaper policies are cheap for a reason which is usually little cover and limited time of cover.

e.g a cruciate repair on one leg , then on the other leg, is considered one condition for insurance cover. Any consequential arthritis arising from the repair is considered as arising from that condition and is linked to it as the same condition.

Hence , having claimed for a cruciate repair on one leg , if I change companies and my dog develops arthritis in that leg or she needs a cruciate repair done on the other leg ( there is a 60% chance the cruciate ligament in the other leg will need repair) it would be considered a pre existing condition and be excluded by the new company.