vet failed to put claim in due time with insurance

woebetide

Hi

I'm not 100% sure if this is the correct forum so feel free to move if needed.

The story:
My dog has a lifetime insurance which renews yearly on June 20th.

Last year in July he had a tumour removed which proved to be cancerous, he was refered for scans at a specialist vet and scanned clear; all this was paid upfront and reimbursed minus the excess by ASDA insurance.

In February of this year he went for further scan where we had arranged (over the phone with the vet) for the veterinary practice to collect direct payment from ASDA insurance.
They failed to put in a claim within the 60 days limit.

In August this year he went for further scans and a biopsy which showed the cancer had metastasized in the lymph nodes and he subsequently had an operation where the offending nodes were removed.

Upon being asked for a signed claim form by the vets we queried the amounts due and they seemed anomalously big from what we had been quoted.
After receiving a written statement of accounts it turns out that the veterinary practice has only claimed for the February scan bill at the same time as the August scan which means that the £1688.13 bill has now come from this year £7500 cover rather than from last years meaning we are now short of cover by this amount for the current year and probably already owing money to the practice.

So my questions are:

1. Can I try and get the insurance company to change the billing so that I am not short of cover this year?
2. Failing that what are my recourse in trying to get the vet practice to recognise their fault and make good on the loss I suffered? (bearing in mind continuous check and treatment will be required and I don't want to fall out with them ideally)

sheramber

Did you hand in a claim form for the February treatment?

Your vet would not be able to submit a claim without it.

woebetide

No, the veterinary practice insurance claim person never contacted us to ask for one, neither when we we took him for the scan nor subsequently.
They only asked for a claim form when we took him for the latest scan in August, and once again when we took him for his operation.
Had I been aware they needed one back then I would have supplied one, but they obviously had some contact with the insurance who told them they would get paid as they didn't chase it and the insurance paid for the February scan when they submitted the claim in August despite this being long after the claim timeframe they stipulate.

sheramber

When my vet claimed for treatment that scanned two premium years Petplan split the amounts to each year. However, Petplan do have a longer timeline for claiming.

Perhaps ASDA could do the same.

Or did your vet claim for it all under the August as one claim?

I think you need to establish why the vet didn't claim in February and did they show both dates of treatment on the August claim or did they claim it as all under August.

woebetide

sheramber wrote: »

When my vet claimed for treatment that scanned two premium years Petplan split the amounts to each year. However, Petplan do have a longer timeline for claiming.

Perhaps ASDA could do the same.

Or did your vet claim for it all under the August as one claim?

I think you need to establish why the vet didn't claim in February and did they show both dates of treatment on the August claim or did they claim it as all under August.

Thanks for this.
The vet only put in one claim for both scans in August, I am not sure whether they made it clear that this covered 2 periods on 2 separate years of insurance cover.

I will put this out to the vet and ask them to contact ASDA about it to see if they can arrange it as they said they would deal with it all.
I will also query why they did not claim earlier (6 month seem like a long time to not claim to me).

greyteam1959

I would politely tell your vet that as the error is of their own making that they should contact the insurance company & sort it out.
I think you would be better staying out of it.
My opinion only of course.

sheramber

It looks like they realised they had not claimed the February bill and lumped it in with the August one since it was too late to claim it for February.

Penelopa.Pitstop

greyteam1959 wrote: »

I would politely tell your vet that as the error is of their own making that they should contact the insurance company & sort it out.
I think you would be better staying out of it.
My opinion only of course.

I agree with that opinion. If they didn't claim in time, it's their error and should swallow the cost themselves. You shouldn't pay for this, you had insurance and supplied all details to vet and they agreed to claim directly.

woebetide

greyteam1959 wrote: »

I would politely tell your vet that as the error is of their own making that they should contact the insurance company & sort it out.
I think you would be better staying out of it.
My opinion only of course.

sheramber wrote: »

It looks like they realised they had not claimed the February bill and lumped it in with the August one since it was too late to claim it for February.

Penelopa.Pitstop wrote: »

I agree with that opinion. If they didn't claim in time, it's their error and should swallow the cost themselves. You shouldn't pay for this, you had insurance and supplied all details to vet and they agreed to claim directly.

Thanks all.

This is what I think too.

I already pointed out the fear in a previous email that I would lose on cover by outlining the insurance yearly renewal date but they have so far ignored/not commented on this and mostly contacted via phone (so it's clear: the insurance is in my ex-partner name and she gets all the phone calls) their latest email showed clearly that we have suffered a loss.

I will now that I have calm down word an email outlining this; what I wonder is how to go about claiming it if they decide to dispute this and try not to antagonise them as our dog will need more treatment and they have been very good on that front.

woebetide

Does this sound reasonable enough?

Hello,

thank you for this, please invoice me promptly for the £85 excess so I can pay it.

As I have received no reply to my other email I will take the matter up here:

as I was afraid, your failure to put in a claim with ASDA insurance in due time back after the 22nd February scan of Jiffy means that I am now finding myself short of insurance cover for the current year (the insurance renews on June 20th) by the sum of £1688.13 through no fault of my own.

I hope you can take this up with ASDA insurance and get my level of cover for the current year back to the level it should be at.

woebetide

reply from the vet:

Hello Miss Rayner,

Apologies if I have missed any emails you have sent to me and any errors with figures.

To clarify, we sent a claim for treatment date 10.08.18 for £1628.88. Asda have confirmed they paid £1543.88 to you in September 2018. £85 was deducted.

A claim was then sent on 28th August for treatment dates 22.02.19 - 20.08.19 for £3781.13. A total of £3696.13 has been paid to us. £85 was deducted as this falls after your policy renewal date.

I have also submitted a claim for treatment dates 29.08.19 - 01.09.19 for £2355.14.

An invoice has been sent to you regarding the £85 and you should be receiving this within the next few days.

I hope I have cleared up any confusion made.

As this had a different figure to before it looks like ASDA did indeed split the outcome over the two year.

Felling relieved but I'll chase it with ASDA to make sure though.