Insurance payouts for inconclusive diagnostics?

Ambers Echo

Ambers Echo

Still wittering on
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I want to scope Ginny and co-incidentally a local vet practice is running a 1/2 price scoping clinic. I was not sure whether the insurer would pay if I chose to scope without a vet seeing Ginny and recommending that. So I rang up. They said if ulcers were found they would pay for the scope and any resulting treatment. If not, they wouldn't. So I said 'ok so I need my own vet to examine and if they recommend the scope, the scope and consultation fee would be covered?' They said regardless of whether a vet recommended a scope, they would only pay out if a diagnosable condition was identified. I asked if that was true of ANY form of diagnostics - scans, xrays etc. And they said yes: claims have to get put against a diagnosed condition. No diagnosis, no payout. I am with NFU. Is this normal practice?
 
Yes, my insurer said the same (SEIB). I was getting a scope and bone scan done. The scope showed mild ulcers so they paid for that no issue and the following GG. If no ulcers had been found I would have had to pay for the scope.

They were very adamant that if the bone scan showed no cause for what we were investigating for they wouldn't be obliged to pay. The bone scan and a following neck X-ray showed no cause, however they actually paid for it because they said they felt it was a reasonable investigation given the symptoms she showed.

They did however then exclude a whole host of things that the bone scan showed up due to minor hotspots which the vet said was no more than he would expect to see on any working horse. Meh. So now I have a horse with nothing wrong with her but half of her excluded!! Still, I'm still glad we got her checked out.
 
I do quite often wonder why I bother insuring.... with 3 horses the annual cost is huge. Putting that all to one side to cover the big bills might work out cheaper? Once you factor in exclusions, caps on costs, high excesses, refusals to payout for one reason or another etc.
 
Yes ,if you think it out the reason is a good one . A half price gastric scope won’t cost much just be grateful it not an mri she needs .
 
BTW - they might not pay out if there is no positive diagnosis, but they may well exclude from the future. I had a bit of a 'discussion' with KBIS over excluding something that had been investigated and found not to be there. They took the exclusion off in the end, but it was the cheek of putting it on that bugged me.
 
Is this really happening? I can understand not paying out for tests done without vet recommendation/a good reason to do them but not paying out for negative diagnostics?!? If you already know the answer what's the point in doing the test? And if the animal recovers before a definitive diagnosis is reached what is the point in doing further tests in order to reach one? Or as we were taught at vet school there is no such thing as a "negative" test result, you've just narrowed down your list of differentials by ruling it out which is a positive thing!
 
That didn't sound right. Soli had 2 days if tests which found nothing. On 3rd day they scoped and found ulcers. Insurance paid the full bill.
 
If they find a diagnosis they will pay out for all the tests - even the inconclusive ones. But if they never find anything they won't pay anything. I checked and double checked with NFU. Even asking what happened if the horse was clearly lame and had a full lameness workup. They said they would not pay unless they diagnosed a cause. They said it was because all claims had to be 'put against' a diagnosis so if there was no diagnosis there could be no claim. Ginny scoped clear which is great. I'd rather pay and her not have them!! But it seems a crazy policy in general. And makes testing far riskier financially as so often nothing is found.
 
Yes I think that is pretty normal, and in part why people keep going with the diagnostics.

I would be careful though as I am sure people have said they have had scopes, where nothing was found but because they are on record insurance assumes there was an unidentified gastric problem and exclude as a result.
 
ester said:
Yes I think that is pretty normal, and in part why people keep going with the diagnostics.

I would be careful though as I am sure people have said they have had scopes, where nothing was found but because they are on record insurance assumes there was an unidentified gastric problem and exclude as a result.
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Honestly they get you every which way!! I had my dog on a health-plan at the vet where you got a free yearly check up. Casual enquiries about ear cleaning at that appointment - not even a vet appointment just a 'I'm here so I'll ask' got a much later ear infection requiring surgery excluded. Grrrrrr
 
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