Claim Reimbursement Examples

Pet Insurance Reimbursement Examples

Reimbursements are based on your actual veterinary bill. We determine the total of the covered treatments and multiply that by your reimbursement rate. We then subtract your remaining annual deductible. Once your annual deductible is met, you will receive reimbursements for a greater portion of your vet bills for the remainder of the year. The Healthy Paws plan comes with no caps on claim payouts for the lifetime of the policy with an annual deductible, which helps you get more back over the life of your pet.

For Example:

$1200
x 90%

Covered Treatments
Your Reimbursement Level

$1080
-$100

Remaining Annual Deductible

$980

Reimbursement Amount

For it to provide a good consumer value, your pet insurance plan should reimburse you based on your actual bill. Understand that some policies use benefit schedules or hidden terms, like usual and customary fees, that will reimburse you based on what they think treatment for a specific condition should cost, and that will reduce your reimbursement percentage and amount. If you have any questions, call us. We want you to be confident that you're committing to a plan you can trust to protect your pet and your finances.

Our customer care commitment

We strive to make sure you get reimbursed for your pet insurance claims as quickly as possible. We will work hard to process your claim usually within two business days, depending on how quickly your vet clinic provides us with the records we need to complete the claim process. And if you ever have any questions or concerns, please don't hesitate to contact us.

Click on each of the links below to see some more detailed claim examples:

Claim Example #1: Your dog has had diarrhea for several days

You're not sure what's wrong and she doesn't seem to be getting any better. So you take her into your vet for a check-up.
Your Vet's Diagnosis: Diarrhea, cause undetermined.

Your veterinarian visit would normally include:

Total Veterinary Bill:	$269.74
Reimbursement Summary:
Treatments	Services Covered	Not Covered
DIAGNOSTICS and TREATMENTS Intestinal Parasite Exam (Lab work) SQ Fluids (fluids given under the skin)	$115.00
PRESCRIPTION MEDICINES RX of Metronidazole, antibiotic and dewormer RX of Kaopectate (Bismuth Subsalicylate)	$97.20
Canned Bland Diet		$6.54
Office Visit (Veterinary Exam)		$51.00
Total Covered	$212.20
Multiply by Reimbursement Level: 90%	$190.98
Minus Remaining Annual Deductible: $100	$100.00
Your Reimbursement:	$90.98

After paying your veterinarian for your dog's treatment, simply take a photo of the vet bill and submit it using our app or online customer center. We take your covered charges and multiply it by your reimbursement level and then apply whatever remains of your annual deductible. Since this was your first claim, your full annual deductible was applied. Your pet's deductible is annual, meaning it must be satisfied only once per policy year and resets on the anniversary of your pet's enrollment. Future claims within that same policy year would not be subject to the annual deductible since the deductible was already fully met for the rest of the coverage term.

Claim Example #2: Your cat has been straining to urinate

Your Vet's diagnosis: Urinary Obstruction.

Your veterinarian visit would normally include:

Total Veterinary Bill:	$769.64
Reimbursement Summary:
Treatments	Services Covered	Not Covered
DIAGNOSTIC TESTS X-rays Chemistry Profile (Lab work) Urine Culture & Sensitivity (Lab work) Urinalysis & Critical Care Profile (Lab work)	$344.25
TREATMENTS DURING HOSPITALIZATION In-Patient Hospitalization Antibiotic Injection In-Patient Doctor Exam	$79.40
PRESCRIPTION MEDICINES RX: Amoxicillin, antibiotic	$18.82
SURGERIES Gas Anesthesia IV Anesthesia Relieve Urinary Obstruction Surgery Placement of Indwelling Urinary Catheter	$257.09
Office Visit (Veterinary Exam)		$63.00
Other Limitations including pet food		$7.08
Total Covered	$699.56
Multiply by Reimbursement Level: 90%	$629.60
Minus Remaining Annual Deductible: $100	$100.00
Your Reimbursement:	$529.60

After paying your veterinarian for your cat's treatment, send us the clinic invoice along with our one-page claim form. We take your covered charges and multiply it by your reimbursement level and then apply whatever remains of your annual deductible. We will work hard to process your claim within 10 business days.

Claim Example #3: You noticed that your little dogs back legs seem wobbly

You're not sure what's wrong, but there seems to be a problem with your dog's back or back legs. When standing, he falls to one side and walks kind of funny. You take him to your primary veterinarian for evaluation.
Your Vet's Diagnosis: Back pain, suspect IVDD. Refer to a Specialist.

Your veterinarian visit would normally include:

Total Veterinary Bill:	$196.60
Reimbursement Summary:
Treatments	Services Covered	Not Covered
DIAGNOSTIC TESTING X-Ray	$99.00
PRESCRIPTION MEDICATIONS RX: Metacam, pain reliever	$46.60
Office Visit (Veterinary Exam)		$51.00
Total Covered	$145.60
Multiply by Reimbursement Level: 90%	$131.04
Minus Remaining Annual Deductible: $0	$0.00
Your Reimbursement:	$131.04

Your regular veterinarian refers your dog to be seen by a specialist:
Specialist Diagnosis: Intervertebral Disk / Laminectomy.

Your bill for this veterinarian visit would normally include:

Total Veterinary Bill:	$4,455.93
Reimbursement Summary:
Treatments	Covered	Not Covered
DIAGNOSTICS X-ray, 1st Plate Complete Blood Count (Lab work) Blood Chemistry Tests (Lab work) Myelogram X-ray, Additional Plates	$921.40
HOSPITALIZATION Hospitalization Level II, x 2 Physical Therapy Nurse, x 7 Physical Therapy Level II Hospital Care Additional, x10 Hospitalization Level I Physical Therapy Level I	$1,050.49
SURGERIES IV Catheter Placement IV Catheter & Fluid Therapy Acepromazine Injection Diazepam/Valium Injection Hydromorphone Injection Propofol Anesthesia Isovue Inhalation Anesthesia Neurosurgery Procedure Blood Pressure Monitor, x 5 IV Fluid Catheter Monitor Fentanyl Injection Ranitidine Injection Surgical Supplies O.R. Room / Equipment Use Fee Biohazards Fee	$1,866.54
PRESCRIPTION MEDICATIONS RX: Dasiquin RX: Clavamox, antibiotic RX: Tramadol, pain reliever RX: Pepcid AC RX: Phenoxybenzamine RX: Metacam, pain reliever	$222.50
EXAM Emergency Fee Consultation Exam Physical Therapy Consult		$395.00
Total Covered	$4,060.93
Multiply by Reimbursement Level: 90%	$3,654.84
Minus Remaining Annual Deductible: $0	$0.00
Your Reimbursement:	$3,654.84

After paying your veterinarian for your dog's treatment, send us the clinic invoice along with our one-page claim form. We take your covered charges and multiply it by your reimbursement level and then apply whatever remains of your annual deductible. We will work hard to process your claim within 10 business days.

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The claim scenarios described here are intended to show the types of situations that may result in claims. These scenarios should not be compared to any other claim. Whether or to what extent a particular loss is covered depends on the facts and circumstances of the loss, the terms and conditions of the policy as issued and applicable law. Insureds providing testimonials in this report have not received compensation for their statements. Facts may have been omitted to protect the privacy of the parties involved.