Pet insurance ordeal riles dog owner
PetCare denies claim, then pays, citing miscommunication
A Vancouver pet owner is going public to warn others about the perils of buying health insurance for their pet.
"If I were to buy another dog or get another pet I would not buy insurance. I would take my chances," said Ralph Eastman. "The customer service was absolutely terrible — and there was not even an apology."
Eastman paid well over $6,000 for health insurance for his two dogs, Chester and Ted, in monthly payments over a 10-year period.
However, after his dog Chester became ill this winter with diabetes and then cancer, PetCare insurance denied his claim for $8,000 in veterinarian bills.
"For several weeks and months we were at the vet quite often," Eastman said. "Vet bills can get high, and you think insurance is a great idea because you never know. Only there's a whole bunch of things that [Chester's] health insurance didn't cover."
Claim paid after going public
After Go Public got involved, the company reassessed the claim and couriered Eastman a cheque for $1,877, because Chester had cancer, which is covered by the policy. Eastman said the company also waived his $250 deductible because of the problems with his claim.
PetCare is a subsidiary of Pethealth Inc., an Ontario-based company selling pet insurance in Canada, the United States and the United Kingdom. It says it is the No. 2 provider of pet insurance in North America.
Submit your story ideas:
- Go Public is an investigative news segment on CBC TV, radio and the web.
- We tell your stories and hold the powers that be accountable.
- We want to hear from people across the country with stories they want to make public.
Pethealth's company information says it provides free software to animal shelters that agree to promote its insurance products. Its brochures are also displayed in several veterinary clinics, including Eastman's.
"When we bought the insurance originally it was at the recommendation of a vet," Eastman said. "You trust your vet."
PetCare said Eastman's claim was initially denied because his vet had not provided enough information to confirm Chester's cancer diagnosis.
"Claims assessment in the pet insurance industry, similar to human health insurance, must be a collaborative effort between medical professionals, adjusters and pet owners," read a statement sent to CBC News from PetCare's vice president of insurance, John Warden.
"All parties involved must make every effort to keep the best interest of the client and their pet a priority throughout the treatment and claims process."
More info needed
PetCare insisted that Eastman was told when he called in March to complain about the claim being denied that he needed to "clarify" the cancer diagnosis for Chester.
Eastman admitted he wrongly presumed PetCare could and would do that with the information already submitted by his vet.
"I was under the assumption — probably falsely — that they would re-examine my claim. That didn't happen. Obviously they had already made up their mind."
He pointed out that PetCare's April 26 letter saying his claim had been denied says nothing about needing more information.
"We should have called the vet," PetCare marketing VP Susan Arts told CBC News, "There was a gap here — a miscommunication."
Chester was euthanized not long after his cancer diagnosis.
PetCare admitted it also failed to cancel the deceased dog's policy, as Eastman's had requested. Instead, the company cancelled the policy for Ted, his surviving dog, while continuing to bill Eastman for Chester.
He caught the mistake three months later when he decided to cut his ties with PetCare and cancel Ted's policy.
Billed after dog died
"Essentially I'd been paying health insurance for a dead dog. Had the other dog gotten ill, I wouldn't have been covered," Eastman said. "I purchased insurance as peace of mind. I've had anything but."
A Vancouver lawyer who specializes in animal law says she hears many complaints about pet insurance not covering what owners expected.
"Many people — the ones I end up talking to — are not happy," Victoria Shroff told Go Public. "I think you need to be wary. You need to be extremely careful and scrutinize that policy."
Shroff said she's heard of policies where as little as 10% of the veterinary bill was covered. Canadian pet owners are particularly vulnerable, she said, because they are not accustomed to scrutinizing private health insurance as Americans are.
"People are not told up-front what's in that policy and what they are going to get coverage for and what they are not going to get coverage for," Shroff said.
Coverage has caps
"There are certain caps on how much is going to be covered. The devil is in the details. It's insurance."
Because of what she's learned from clients, Shroff said, she didn't buy pet health insurance for her cat. Instead, she suggested pet owners put the dollar amount they would pay in premiums into the bank every month to cover future vet bills.
PetCare's statement said, "Since we started providing insurance in 1999, we have paid over $165 million in claims in Canada, the United States and the United Kingdom."
"Pethealth Inc. has always, and will continue to make the well-being of companion animals and their owners the priority at all times," said the statement.
In Eastman's case, the maximum coverage for cancer — one of the few conditions Chester had that was covered — was 80 per cent of the bill, minus his deductible.
Eastman said only one other small claim was paid, several years ago. Several other claims he submitted were denied, he said, for both of his dogs.
"They tell you what they do cover. They don't list all the things they don't cover," he said. "I should have read all the fine print on the policy."
Even with the payout he is now getting, Eastman said, pet insurance cost him thousands of dollars more than he got back.