Insurance claim confusion?

TreeDog

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I am going to be sending my horse for a CT scan, the vets said I should speak to insurance first and then they would get me booked in. I put a claim through the insurance and they asked me to send the vet referral report and any invoices. The only invoice I have at the moment is for the initial examination. Insurance just got back to me to say the claim is below my excess and therefore not payable - I rang to ask about the referral for further investigation/treatment and they said they don't pre authorise any treatment/costs. Is this normal?

*edited to correct to CT scan*
 
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be positive

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I think it fairly unusual for an MRI to be the first diagnostic tool used, most horses that are insured will tend to be referred after the basic diagnostics have been done so would already be over the excess limit, has yours had nerve blocks and xrays to pin point the area of concern and to rule out a minor issue, one here turned out to have an abscess which was not clear at the first two examinations and only showed up at the 3rd visit when referral for MRI had been discussed as the next option, by then he had been nerve blocked, xrayed, rested and had his foot tested several times showing no reaction so the vet believed it was tendon or ligament damage.

I don't think they will be happy to authorise anything without a clear requirement that it needs doing and the reasoning behind the referral.
 

TreeDog

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Its a head scan (which I've just remembered is actually a CT not mri, my mistake) as dentist had a concern about smell from nostril/mouth, suspects tooth issue, vet came to sedate to get a clearer look but couldn't see anything visually wrong. She said they could do xrays but if they show nothing they'll do a CT, if xrays do show a problem with a tooth he'd need to go to hospital anyway.
 

be positive

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That makes more sense, I think the insurance company would probably prefer to pay for xrays than a CT scan which may not be required if something is clearly shown on the xrays, your vets approach is fair enough but it is the more expensive option to go for.
I would get the xrays done and then you will have a clearer picture of the way forward, it may cost more overall and be a bit more hassle but could be something that can be sorted out easily and not need a trip to hospital.
 

TreeDog

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That is really annoying to hear because when I booked the vet visit they said the vet would come with a portable xray machine in case xrays were needed but she didn't :(
From speaking to the insurance before though it sounded like they don't agree to pay for anything up before it's done though, not just in this case. Just wondered if anyone else had experienced similar. I can see the logic though as it would put people off doing lots of 'unnecessary' investigative work just because they know insurance will pay for it. Its just extra stress I'd rather not have to worry about!
 

milliepops

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I've never had full authorisation for any tests or surgery beforehand, I've had an agreement in principle to the claim but i've never had anything saying they will definitely cough up for any treatment or investigations - until the cheque arrives.
 

criso

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Depends on the insurance company, some want to pre authorise more expensive diagnostics, some don't. The vets wouldn't necessarily know all the policies but has probably had to send information on why they are taking that step in the past.

Even if my insurance doesn't explicitly say it want informing in advance, I tend to tell them with plenty of time to query so they can't say I went ahead without checking.
 

Red-1

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I applied for pre-authorisation for an MRI too. They turned it down, so I was glad I checked first as I am not sure it wold have made any difference.

The horse had field rest and a steroid injection, which would pretty much have been the treatment for whatever was wrong. The MRI may have given me more idea of how successful the treatment was likely to be, but at that price I was happy to do the treatment and wait to see. Besides, even with a MRI no one would still have known for sure.

So, yes it can be done. It was sent to the underwriters and I think took around 10 days.
 

Muddywellies

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Insurers won't pay for any initial investigative work. You need to have the problem investigated and then once you have a clear diagnosis and treatment plan, then providing it's covered, insurers will (possibly?) pay out. Often though not always, once you have a diagnosis, insurers may then include the investigative work as part of your claim.
 

ycbm

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Insurers won't pay for any initial investigative work. You need to have the problem investigated and then once you have a clear diagnosis and treatment plan, then providing it's covered, insurers will (possibly?) pay out. Often though not always, once you have a diagnosis, insurers may then include the investigative work as part of your claim.


A friend is having investigations done for unspecific performance issues and her insurers are paying.

.
 

Lady Jane

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My insurers don't pre-authorise but I always tell them for the really expensive diagnostics as if you are actually not covered they will tell you. I have recently had extensive x-rays, bone scan and MRI, plus normal scans and it was all payed for even though it didn't reveal what they expected - although did find a completely different problem in a very early stage. Who are you insured with?

My circumstances sound similar to ycbm's friend.
 

eggs

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Whenever possible I let my insurers (NFU) know up front if we are about to start on investigations before I submit a claim. They always say that they cannot confirm that they will definitely cover the work but always have paid out once the claim has been submitted.
 

Muddywellies

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A friend is having investigations done for unspecific performance issues and her insurers are paying.

.
I'd be interested to know who her insurers are. Most investigative work is excluded
 

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TreeDog

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I am with e&l. I rang again to clarify today and they confirmed they don't agree on anything prior to treatment, only once the invoice is received, as it means they don't agree to pay out then receive an invoice that includes extra fees not discussed, and the complications that creates.
They did say if there were any exclusions based on the medical records I have provided I would be notified, and that sometimes investigative work isn't covered, but is if there is a clear reason /cause /diagnosis. Which leaves me feeling they might not pay out if the scan doesn't show anything, but if it does and treatment is required they will as it all comes under that claim for that issue.
 

TreeDog

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I'd be interested to know who her insurers are. Most investigative work is excluded

That specifies investigation for behavioural issues, with the exclusion being if the behavior is not caused by a physical issue. (ulcers would be a physical issue that may cause behavioural issues, and therefore I would think scoping would be covered by insurance, but maybe only if ulcers were actually found)
 

criso

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I'd be interested to know who her insurers are. Most investigative work is excluded

Your screenshot just excludes investigations for behavioural problems not associated with a physical issue.

I've had investigations covered where the symptoms have been subtle and unclear what it was but the vets has been happy it's physical. That's with NFU, Shearwater, Amtrust/Equicover and SEIB. NFU definitely wanted to pre approve an MRI and a bone scan and I inform others as a courtesy.

The bone scan needed pre approval and was covered but done because the vets were at that point puzzled as to where the problem was never mind what. It showed a hot spot which was then further investigated, diagnosed and treated. However that was 7 years ago so they may not require pre approval these days.

I do remember someone (and I think it was E and L) being required to do a bute trial to establish the issue was physical and not behavioural before giving the go ahead for further investigations but I never have been.
 

Muddywellies

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Your screenshot just excludes investigations for behavioural problems not associated with a physical issue.

I've had investigations covered where the symptoms have been subtle and unclear what it was but the vets has been happy it's physical. That's with NFU, Shearwater, Amtrust/Equicover and SEIB. NFU definitely wanted to pre approve an MRI and a bone scan and I inform others as a courtesy.

The bone scan needed pre approval and was covered but done because the vets were at that point puzzled as to where the problem was never mind what. It showed a hot spot which was then further investigated, diagnosed and treated. However that was 7 years ago so they may not require pre approval these days.

I do remember someone (and I think it was E and L) being required to do a bute trial to establish the issue was physical and not behavioural before giving the go ahead for further investigations but I never have been.

Indeed, wrong screenshot. More haste less speed. I'm with NFU and they refused to pay initial investigations until the issue was confirmed. Then the cost of the initial investigation was covered. Basically it was suspected ulcers due to her erratic behaviour. If they had scoped and found no ulcers, the scope wouldn't have been covered. (it was ulcers, and NFU were superb and paid eyewateringly expensive vets fees).
 

criso

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I wonder is scoping for ulcers is the thing that is the exception as they can manifest as behavioural issues - it's one of the things I haven't had direct experience of.

However I have had other diagnostics that have been paid for but have not revealed anything. Usually they have excluded things and we have eventually got to a diagnosis in the end. The bone scan was NFU and followed a full day of other lameness diagnostics which revealed nothing other than we were looking in the wrong place.

In fact recently I have just had about 1k in liver diagnostics paid for that revealed absolutely nothing. We did have raised enzymes though no physical symptoms hence the tests but all that expensive little hospital visit has done is tell us 3 things it's not.

ETA I think the overall lesson is to discuss anything expensive with your insurer before you go ahead.
 

doodle

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I was also with nfu when soli racked up £3000 and 3 day stay at vets, in investigations where all they found was ulcers.
 

Tiddlypom

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I took the late maxicob in for investigations after he began p1ssing off in canter. The vet thought that it was probably behavioural, but agreed to give him a workup.

SEIB were upfront and said that if no physical issues were found, they would not pay out on any of the workup fees. Maxicob was diagnosed with bilateral PSD, SEIB paid up for the workup and the following years treatments and assessments.
 

Limbo1

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I am going to be sending my horse for a CT scan, the vets said I should speak to insurance first and then they would get me booked in. I put a claim through the insurance and they asked me to send the vet referral report and any invoices. The only invoice I have at the moment is for the initial examination. Insurance just got back to me to say the claim is below my excess and therefore not payable - I rang to ask about the referral for further investigation/treatment and they said they don't pre authorise any treatment/costs. Is this normal?

*edited to correct to CT scan*
My horse had a seemingly minor kick, treated by the vet and healed - no insurance needed. Then 2 months later developed unidentified symptoms (of what turned out to be nerve damage). My vet refered me straight to the vet hospital for a CT, xrays and investigations. So the first the insurance knew was me submitting a claim for the injury 2 months after and informing them we were off to hospital. Luckily they paid out on all. The CT, xrays, endoscope and related sedation etc cost £800. I thought this was pretty good value as a whole day at hospital. I did have the letter from the vet refereeing to Bristol.
 

teddypops

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Insurers won't pay for any initial investigative work. You need to have the problem investigated and then once you have a clear diagnosis and treatment plan, then providing it's covered, insurers will (possibly?) pay out. Often though not always, once you have a diagnosis, insurers may then include the investigative work as part of your claim.
My insurance company (Petplan)definitely do pay for all the investigations. I have several ponies insured with them and they have always paid my claims in full.
 

twiggy2

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Indeed, wrong screenshot. More haste less speed. I'm with NFU and they refused to pay initial investigations until the issue was confirmed. Then the cost of the initial investigation was covered. Basically it was suspected ulcers due to her erratic behaviour. If they had scoped and found no ulcers, the scope wouldn't have been covered. (it was ulcers, and NFU were superb and paid eyewateringly expensive vets fees).
Because you were investigating behavioural issues, behaviour issues can be due to poor training, housing or the owner/trainer so they won't cover it.
 

ester

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Scoping is one of those things that I have heard about not being covered if clear.

It’s not unusual for insurers to not pre authorise, I certainly wouldn’t expect E&L to. Do your vets know that is your insurer, I wonder if as much as anything they are trying to protect themselves though speaking to the insurer is always a good idea. I always have but I don’t think we’ve ever got pre authorisation for diagnostics.
 

TreeDog

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Scoping is one of those things that I have heard about not being covered if clear.

It’s not unusual for insurers to not pre authorise, I certainly wouldn’t expect E&L to. Do your vets know that is your insurer, I wonder if as much as anything they are trying to protect themselves though speaking to the insurer is always a good idea. I always have but I don’t think we’ve ever got pre authorisation for diagnostics.

Yes they know E&L are my insurer, they're happy to deal with them and vets are happy to be paid directly from them if they accept the claim. When I phoned vets to say the insurance would only decide on the claim once an invoice is recieved they sympathised that that was annoying!
 
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