I have insurance, how do I make a claim?
All pet insurance companies handle claims differently, some can be handled entirely online, some require a paper form and some require you to contact your insurance company to start the claim initially. It is best to contact your insurer first to find out how to claim.
You can submit a claim to us through our website here, most claims can be submitted online. If your insurance company does require a paper claim form you can download this from their website or call to request one from them. Fill in your section of the claim form and be sure to fill in the policy number and sign the form. This can then be scanned and submitted to us or handed to reception.
What do I need to pay?
If you have settled your bill entirely with us there is no charge for us to process your claim form. Mark the box on the form to ‘pay policy holder’. You can bring in a claim form at any time, but most insurers require a form within 6 months of the claim dates.
If you would like the insurance company to pay us directly you will need to do a direct claim. A direct claim means that the insurance company will pay your veterinary practice for any treatment covered by your policy, barring your excess, your copayment, any exclusions on the policy and our direct claim administration fee. In order for us to process your claim, you will need to pay us your excess, copayment and a £35 charge per claim submitted, plus any exclusions you are already aware of. You will also need to settle any balance which is above the maximum amount your insurance company will pay towards a condition. Details of exclusions, excesses and maximum payments can be found in your policy documents. Please ensure we have received a claim submission in advance or within 7 days of treatment starting and mark the box on the form to ‘pay vet’.
How do I do a direct claim?
Direct claims are only suitable in certain circumstances, and a member of our team will be able to advise you on whether the claim you would like to make using this service meets the requirements. We reserve the right to refuse to do a direct claim if based on our assessment (using details provided by you, your insurance company and on your policy documents) we have any reason to believe that your insurance company may not cover the condition or the treatment. In some cases you will need to speak to your insurance company to give them permission to discuss the details of your policy with us. Reasons we may refuse to allow use of our direct claim service include but are not limited to us believing that the condition may be a pre-existing condition, or is related to a condition which is excluded on your policy, or if we do not believe you will meet the requirements of your insurance company for the claim to be covered. This is not exact, as it is always at the discretion of your insurance company to determine what they will cover under your policy terms. In these cases, you will need to settle the balance with us in full, and the claim will then be marked to pay to you.
What happens now?
Direct Claims (paid to vet)
We will begin processing your claim immediately, we are unable to hold on to your claim for more than a few days. Once your claim has been submitted we will contact you with confirmation of the treatment dates we have claimed for. Further treatment after these dates, even for the same condition, will require you to submit another claim to us https://heathfieldvets.co.uk/insurance-claims/. This is the policy of your insurance company. Please note if you wish to submit another direct claim for further treatment this will incur a £35 fee per claim. If you prefer, you are able to settle the outstanding balance with us, and then have the insurance company pay you – this will not incur any additional fees. If you would rather do this, please contact the practice within 48 hours of submitting your form to settle your balance and allow us to process the claim. After 48 hours we will process the claim per the terms described above.
Please note that the account holder remains liable for any outstanding balance on the account at all times. In the event that your insurance company decline to pay all or part of a claim, or they take more than 8 weeks to process the claim, you will be asked to settle the outstanding balance in full immediately.
Regular Claims (paid to policy holder)
If you wish for us to hold off on submitting your claim until treatment is completed please speak to a member of our reception team to confirm this, otherwise it will be processed straight away.
Each submitted claim will cover a period of treatment. We will let you know what date we have been able to claim until. Further treatment after this date, even for the same condition, will require you to submit another claim to us. This is the policy of your insurance company.
How much is my excess/copayment and when do I need to pay it?
Most insurance companies require you to pay your excess the first time you claim for each new condition, or for each ongoing condition at the start of a new policy year. There may also be a requirement for you to pay a percentage of the final bill (often known as a copayment). You will need to call your insurance company or check your policy documents for this information.
How will I know when the insurance company has paid?
You should receive a letter or email from your insurance company to tell you the result of your claim. You may also be able to track the status of you claim online through your insurer’s website. If your claim has been paid directly to us we will contact you if there is an outstanding amount to be paid or if your account is in credit.
What is a pre-authorisation?
A pre-authorisation is submitting the plans for treatment for your pet (with an estimate of costs and their full medical history) to your insurance for them to determine in advance whether they will cover a potential claim or not. It is useful in cases where you are unsure whether insurance will cover a claim. You may also wish to have it done if there are exclusions on your policy such as some dental procedures or there are limits on your policy for certain treatments (e.g. there is a cap on diagnostic testing or hospital fees). It has to be done before treatment is carried out.
Why do a pre-authorisation?
It allows you to plan your finances in order to pay for the treatment yourself if the insurance will not do so, or to cover the items they will not pay out for over a certain amount.
Does the insurance company have to pay if they have pre-authorised a claim?
If the pre-authorisation was done for a condition that they will cover and when the diagnosis and treatment has been carried out it becomes evident that it is all related to a condition that they will not cover, then they are not under any obligation to pay out on the claim.
How do I request a pre-authorisation?
Insurance companies set their own policies for pre-authorisations, for example some insurers will only do them for treatments where the estimate is over a certain amount. You will need to contact your insurer to find out how to have a pre-authorisation done. Some companies may require you to download a form and some may have the facility to submit one online, please note this will be different to a regular claim submission. You will then need to ask your veterinary practice to process the form or online submission and send this through to your insurer along with an estimate of the proposed treatment and full clinical history.