Sadly, our beloved GSD (3 years old) has just been diagnosed with hip dysplasia in both hips. The vet has suggested she is a good candidate for surgery. I’ve had pet insurance through Epona since she was a pup, but haven’t had to use it yet. I checked the fine print and it seems to suggest that this should be covered, as it wasn’t known at the time we got the insurance.
My questions are - does anyone have any experience in getting insurers to pay for major surgery? Should I approach the insurer first before the surgery to check? Or do I just send them the bills and try and fight it after the fact? The vet has said the best way to do the surgery would be in two parts - each hip separately. Would this count as two claims, and thus two potential fights to get reimbursed?
My largest fear is that the insurer will cancel the policy once they get wind that the dog will need surgery (as it is then high risk). As per my policy I believe I am required to disclose this (which I plan to do asap), so I want to develop a bit of a battle plan going in. We will no doubt pay for the surgery anyway, but since we have insurance I’d like to maximize my chances of actually using it.....
Thanks in advance for any help! I really appreciate it.
Sorry to hear about your dog. I do not have experience but to be honest you have a valid claim. This is the exact idea behind insurance and the reason you got it at the first place. I do not see any reasons for them to refuse. I think it is always good to contact the insurance upfront and let them know what the vet suggested and what the plan is.
Like all pet insurance it will say something like "congenital stuff" not covered. Some breeds have hip dysplasia as congenital and some not.
It was not Epona but we had this exact fight for our dog with a patella luxation. Husband fought for months and went all the way to the insurance obdusman and got it paid (roughly 6K).
I am sorry you are going through this - aside from the worry for the pup, the admin fight sucks.
Sorry to hear about your dog. Did you sign up for the additional congenital disease or breed specific diseases policy? I don’t think it would be covered by their basic offer.
I’m with Epona for my cat, and they have the worse reaction time ever. I’m still waiting for my money back for a bill sent in January. Actually they’re so inefficient that I cancelled my policy for next year...
So, we should be covered. Of course there is a whole bunch of small print that I need to read through carefully. There is a section that states some breed-specific diseases are excluded, and it lists out a few - however hip dysplasia and GSDs are not on this specific list. I may just pay for a professional translation just to be sure I’ve got everything clear.
@Kri - yes it does seem they have a bad reputation. Interestingly the vet said that Epona was one they had dealt with without too many problems. Of course this could be a case of the bar just being pretty damn low for insurers in general . Regarding the Ombudsman, was this a painful process that I should read up on / prepare for or relatively simple?
Thanks again for all the help guys. If anyone else has recent experience with similar things I’m all ears!
We have insurance with Epona for our pup, a Labradoodle. We had her spayed, electing to go with Keyhole surgery as she would heal faster. Epona covered half of the cost, I made the claim online and they reimbursed directly into my bank account. I think the op cost around 1200 CHF and I got half of it back. I admit that I'm terrible with such things and tend to just pay. I'm not sure what the threshold is, or if they would have paid in full had we elected cheaper surgery (eg. not keyhole) - I paid, I made a claim online and within days they reimbursed me directly.
I don't have insurance so can't speak from personal experience. However, an anecdote to show how a friend 'did battle' in a similar situation:
She adopted a young adult GSD, I think she was the third owner, not much background information on the dog was available. Later the poor dog was diagnosed with HD, and surgery was needed.
The insurer - and it must be said that I do not know which insurance company this was so no assumtions should be made - at first refused the claim, citing high incidence of HD in the breed.
However, thanks to AMICUS, my friend was able to find out who the breeder was. She contacted the breeder and got the parents' hip scores - which were quite good, so there was no reasonable cause to suspect inherited HD at the time she took out the policy. With that information, she was able to win the battle.
(The Swiss requirement to register all changes of ownership from birth to death can come in handy in all sorts of ways...)
Hope this gets sorted out with the insurance - and far more importantly, I wish your dog a successful surgery and speedy recovery.
ETA:
If you are unsure how to proceed with making a claim, speak to whoever handles insurance matters at your vet practice. It's usually either the practice manager or one of the TPAs. They have likely seen similar situations, and might be able to adviise you.
@Traubert - it is good to know you had a good experience. My guess is the reason you paid half was due to the deductible and the 10% co-pay. The maths seems about right that this would be around 600 CHF.
@Meloncollie - this is very good to know and something I can definitely dig out. We have the pedigree certificate and both of her parents had good hip scores, but alas it seems our poor pup is just unfortunate.
And thanks everyone for your concern. Our little bear doesn’t seem to be in any significant pain and is wreaking havoc as usual, so fingers crossed she is ok. We only went for the checkup because we noticed she started to do the “lazy” sort of side lay during training (laying on one side), and was biting / licking at her hips occasionally. We were fairly surprised at the X-ray results, but they are conclusive.
It's ok, its a letter but painful. This was about 7 years ago - nowadays there is also plaintes.ch and legal insurance may help also.
The way I see it - focus now on the pup and getting the ops needed, then start the battle. Doing both at the same time is just too stressful (of course unless you are obliged to get pre approval or something to the like)
Epona are slow and they are picky. They will try to find a reason not to pay within the terms of the policy (show me an insurance company that doesn't).
Our dog has allergies and needs medication April through to September and they don't cover that. Other things, they may ask for vet reports, but generally end up paying (albeit at snail's pace as someone else mentioned). The real large expense that we had was a CT-scan, and that they paid without blinking....so go figure.
You could ask them up front, and if you did, I would certainly add a report from a veterinarian stating the necessity. That will prevent them having to come back and ask you for one.
I wanted to give an update on this. Since Epona have been taken over by a major insurance company, their turnaround time has improved massively. What used to take months (really!), now takes days. I submitted a claim the day before yesterday and got the settlement note today. It happened with the last claim also, but I waited to make sure it wasn't a fluke!
We unfortunately had to claim with Epona a few times over the past couple of years for our cats. They paid up each time, although the turn-around time was indeed months during Covid. The last time unfortunately involved a week in intensive care, blood transfusion and finally euthanasia - the claim was around 6000 CHF and paid without any query (just numerous follow-ups due to the delay). It's great to hear the turn-around time has improved, but I wanted to highlight that we had good experience overall with the company.