Having a pet insurance claim denied can be discouraging and frustrating, and we understand that.
That frustration could compel you to look around for different coverage for your pet—we understand that, too.
Things like waiting periods, exclusions for pre-existing conditions, and policy limits and deductibles are standard across the industry, and you’d likely encounter similar conditions, no matter which insurer you go with.
Here are just a few things to consider after you’ve had a Lemonade Pet claim denied.
Pet insurance is so much more than one denied condition
It’s possible you had a claim denied because a condition was considered pre-existing or was defined as a bilateral condition.
Chances are, if you were to move to a different carrier, those conditions wouldn’t qualify for coverage either—plus, any new conditions or injuries your pet experienced while being covered by Lemonade would be considered pre-existing by your new carrier (or by Lemonade if you decided to purchase a new policy with us after canceling).
As far as coverage goes, the provider you’re with now is likely the provider who will be able to cover the most.
Waiting periods
Maybe your claim was denied due to the fact that the relevant waiting period on your pet’s policy hadn’t passed yet.
Waiting periods are designed to protect our Lemonade pet insurance community from someone who buys a policy just to cover one procedure—and then drops out. Waiting periods help keep your coverage fair and affordable.
Keep in mind that waiting periods can vary depending on your state, so it’s important to check your policy details.
Waiting periods are a feature of most pet insurance policies, and if you cancel your Lemonade Pet policy, you will likely be subject to the waiting periods of a pet insurance policy with a different carrier.
Plus, if you were to cancel and reapply for Lemonade Pet again down the line, the waiting periods would reset, potentially expanding the list of illnesses and conditions that would be considered pre-existing.
But, if you were to stick with your Lemonade Pet policy, your waiting periods are over and done with—they only apply when you first sign up for a policy, and don’t reset or repeat each year.
Preventative Care limits
Maybe your claim was denied because you went beyond your per-item limits on your Preventative Care package.
The per-item limits in your Preventative Care package will depend on your co-insurance amount. You can see examples of per-item limits broken down here. These limits reset every year at your policy renewal.
You can always check out your available Preventative Care reimbursement amounts anytime on your policy section on the Lemonade app.
Keep in mind that for Preventative Care claims, your annual deductible does not apply.
Why prices can go up at renewal
We sometimes need to change premium prices in order to offer pets the same great coverage.
Please keep in mind that filing claims or having claims denied will never result in a rate change to your Lemonade Pet policy.
There are a few reasons why your pet insurance rates might be increasing, including:
- The age of your pet. Younger pets tend to pay less to account for less expensive and less frequent medical care expenses
- Changes within the pet insurance industry as a whole
- Inflation, dreaded inflation
You can learn more about Lemonade Pet renewals here.
Your deductible & co-insurance
Maybe your claim was approved, but you didn’t receive reimbursement because you haven’t met your annual deductible yet.
Your deductible and co-insurance represent your participation in eligible claims, and are a feature of most pet insurance products. At Lemonade, deductibles are annual (as opposed to per claim or per condition), so once you’ve exhausted your deductible for the year, you won’t have to pay it again until renewal.
Your co-insurance represents the percentage that Lemonade will pay towards eligible claims. With Lemonade, you can choose co-instance of either 70%, 80%, or 90%.
So all that being said, it might take a few claims for you to begin to receive reimbursement.
How, exactly?
Let’s say you chose a $250 annual deductible with a co-insurance of 80%. You take your cat to the vet and the bill is $100. Out of this total, $40 are for the standard vet visit fees, which you’ll pay out-of-pocket since those aren’t covered by your pet insurance (unless you have the vet visit fee add-on!). Note that the vet visit fee will not be applied toward the deductible if the policy does not include the vet visit fee add-on.
Now that leaves you and your cat with a remaining $60 fee for eligible services. Your deductible isn’t met yet, so you’ll be responsible for paying this full $60. But how much will it take off your deductible? It’s not a full $60. We’d calculate $60 x your co-insurance of 80%, which comes to $48—that’s how much your deductible will be lowered.
It can feel frustrating to have an approved claim without any money making its way back to you, but keep in mind that within a couple of covered vet visits, you’ll likely meet your deductible and start being reimbursed.
