Major Medical claim question

[deltawave]

I have had Major Medical on my horses forever, and have made just one claim, ages ago when Kelly needed a CT scan of her sinuses. Mostly if they get a ding or a cut I don't bother, so it's been ages since I've dealt with this issue . . .

Bonnie needed her hocks done this week, and my trainer's (very pricey! FEI-level) vet was in town, and so he did the exam and the injections. I thought I'd do the usual--pay the bill, make a note of it on the insurance renewal when that came due, but no claim.

Uhhh, then the vet bill came. :D It's, umm, LARGE. :lol: He travels a long way and charges top-dollar. I think he's worth it, I was very impressed with him, but it's sort of shocking. :lol:

Now I think I want to make the claim for Major Medical to cover this--I am embarrassed to say that I never even thought about calling them first, because I'm so used to just absorbing the more modest stuff. I'm going to call Monday and just be honest with them--is this the type of thing they're going to balk at, because I didn't call first?

[BestHorses]

I don't think insurance covers hock injections since it's considered maintenance. They might cover the exam costs. Check your documents - mine list what's covered and what's not.

[deltawave]

Maintenance? As in the same category as teeth floating and vaccinations? Wow. What a strange thing to consider part of "routine health care"! :no:

ETA, thanks for the advice--looks like "routine" joint injections are not, in fact, covered and neither is "non surgical lameness six months after diagnosis" which is a bit fuzzy--she isn't, in fact, lame at all. But it sounds like they may cover this evaluation, at least. OK, got a game plan. Thanks again. :)

[titan]

It's true, injections are most often not covered. Even if you argue them as a treatment for lameness.

[TheOrangeOne]

If they are a treatment for "injury" though, you can usually get them covered. Worst that happens is you submit the claim, are denied, and pay the money anyways. Are her hocks an exclusion on the policy? I am not sure if they could put that on there because of a claim they denied, but it's worth asking about.

[deltawave]

She's never had anything in terms of injury or illness, so right now there are no exclusions on her policy. I'm pretty sure there will be now, though, when the policy is renewed in January. ;) Regardless of whether or not I make a claim, I have to tell them if she's had any treatment done in the past year.

[asterix]

well, for what it's worth, I have my arthritic horse's hocks done every so often and while it is not covered, it also doesn't mean any special exclusions.
And I am typically calling them after the fact when I have a claim to make, and that's not a problem, as long as you don't wait too long...
it never hurts to ask -- as you said, if you disclose on renewal they will know then anyway...

[Peggy]

Yup. They don't pay for it but do exclude if it's done. Star's GI tract is now back to being insured, but I think that only one leg is fully insured at this point. They didn't pay for the IRAP that was injected into his coffin joint b/c its use for a soft-tissue injury was experimental; however, they would have paid for the same injection if it was to treat a bone issue. But I definitely came out ahead, if you can call it that :sigh:, in 2008.

[WishIWereRiding]

Yes, Besthorses is right. Joint injections are considered "performance enhancing" and so are usually not covered. I have Great American. I had my horse's coffins and hocks injected as part of a lameness work up and they weren't covered (this I knew in advance). The lameness exam is covered. The thing is though that it's probably not worth submitting it unless you are going to meet the deductible (which in my case was $250). Those injections aren't cheap! My horse is now on stall rest for a battered suspensory. Whole lotta good those injections did! At least his hocks feel good standing around all day.

[deltawave]

Let me tell ya, the $250 deductible is MORE than used up with this exam and treatment! :lol:

[Donkey]

In my plan anything related to the treatment of osteoarthritis is automatically excluded. Diagnosis isn't excluded but IA injections would be considered osteoarthritis treatment and therefor excluded.

Good luck getting the exam covered. I hope you got what you paid for ;)

[Puddin Pie]

My major medical did not cover the coffin joint injection in our awful lameness case, but did cover all of the xrays and vet exams and would have covered irap but not tildren.

[ZiggyStardust]

My insurer doesn't cover joint injections, but did not make an exclusion for hocks when I disclosed that they'd been done.

[AKB]

We gave up on insurance after our last experience a few years ago. Our then 4 year old had a bump in his nostril that turned out to be a cyst. We had it aspirated and injected with formalin by a surgeon, at a cost of about $400.

The insurance rejected my claim, stating that it was a pre-existing condition. I agreed that the bump had been there over a year, although it was so tiny at first that I wasn't sure it was really there. I had the vet who did our coggins look at it the preceding year, and she wasn't sure it was there. I didn't report it on our annual renewal with the same insurance company because I wasn't sure if it was the shape of his (big) nose of if there was something there. Even though our insurance on all of the horses was consistently with the same company, they said that each year is a new policy, so this was a preexisting condition! I dropped the policies on all of our horses, after paying premiums for years and never making claims until this one futile attempt at a claim.

Good luck with the claim. Out of curiosity, how expensive were the injections and the exam? Our neighbor was quoted $600 for hock injections, and that did not include the price of the lameness exam. We paid $150 the time we trailered to the vet for the injections. Now, if we need hocks injected, my daughter can do them. Finally, some pay back after all of those years of paying her tuition!

[deltawave]

Well, let's just say my monthly credit card bill is usually smaller than this vet bill. And I charge *everything* :lol: To be fair, it was two horses getting stuff done, a vet that drove hundreds of miles to get here, and he spent a couple of HOURS working them up. I've got no complaints, but it was kind of a shock for my poor husband--must remember to NOT let him pick up the mail after a vet visit! ;)

[Androcles]

Maintenance? As in the same category as teeth floating and vaccinations? Wow. What a strange thing to consider part of "routine health care"! :no:

ETA, thanks for the advice--looks like "routine" joint injections are not, in fact, covered and neither is "non surgical lameness six months after diagnosis" which is a bit fuzzy--she isn't, in fact, lame at all. But it sounds like they may cover this evaluation, at least. OK, got a game plan. Thanks again. :)

Well, if you're giving a sound horse some kind of treatment, what else could it be considered other than routine maintenance, or performance enhacing? One might ask why you're giving a horse something they show no signs of needing - in the context of an insurance claim that is.

[AKB]

I understand about the vet bill. I recently spent $650 having our 21 year old retiree get navicular bursa injections. We then followed it up with a regional perfusion of Tildren a week later. Fortunately, my daughter did the Tildren. This is the same horse who gets pergolide, thyroid and Ventipulmin ($250 per bottle).

I have an understanding with the vet that he charges my credit card directly. For a while, I told him that I did not want a bill in the mail. Now, my husband has learned not to open any mail from vet's office and to never open a credit card bill. I now let the vet send me a statement, but it always is marked zero balance due.

We all have our own ways of maintaining marital harmony. My husband doesn't do well if he sees vet bills. We do as much as we can to keep the vet bills low, but sometimes it makes sense to spend some money on a thorough vet exam by a specialist.

[Grataan]

Out of curiosity, which joints did he inject? All of them or? And what did he put in there? I'm always curious to hear what other practitioners are using.

[goeslikestink]

She's never had anything in terms of injury or illness, so right now there are no exclusions on her policy. I'm pretty sure there will be now, though, when the policy is renewed in January. ;) Regardless of whether or not I make a claim, I have to tell them if she's had any treatment done in the past year.

once you claim for vet bills if an injury then it its excluded from your policy
ie cant claim on the same leg twice - or legs
if you havent made a claim then there shouldnt be any exclusions
if the horse has regular vets visits for rountine jabs etc then that rountine part and part of the parcel - so not you wouldnt claim
and that doesnt come under telling them if she had anything done - ie treatment as its routine and a matter of course

if however it was hock surgery of somesort then you can claim
but will be excluded once they have paid you out - as you cant claim for it twice

[WishIWereRiding]

DW--the joint injections wouldn't be applied toward the deductible. Only the lameness exam and any diagnostic tests done. When we were working up my horse, the $70 exam, $150 for bloodwork, $200 for x-rays and $200 for doxy for possible Lyme were all covered. After the $250, they cut me a check for the remainder. But the nearly $1000 hock and coffin injections did not get covered, which I knew (as well as the Coggins and fall shots). They also don't include any stable calls towards the amount covered. Now if you had more than $250 in lameness exams, x-rays, etc, I would consider filing a claim, but keep in mind they may exclude whatever was found.

[deltawave]

Thanks, I have to go do all the math and see if the likely-covered charges go way past the deductible--the farm call charge is huge because the vet drives 400 miles to get here. ;) It's not clear if the drugs used for doing the injections are covered--I'm guessing "not".

Grataan, he used Hyvisc and Depo-Medrol and injected the distal intertarsal and tarsal-metatarsal joints. On one side the two spaces were obviously in communication and we might have gotten away with one injection, but of course you don't know that until you go in. :)

Androcles, she was not clinically lame, but sort of "NQR" and moving more poorly than usual. So definitely not a 100% normal horse just getting done for the hell of it, but neither is she obviously lame to someone who doesn't ride her or know her. One of those "gray zone" things, and I do see your point. :)

[Grataan]

Hey! Same thing I use, although I don't do them nearly as often as some of my associates.

How is your pocketbook feeling today lol?

[deltawave]

How is your pocketbook feeling today lol?Grade 4+/5 lame ;)

But both my ponies are feeling lots better, so I'm happy. :)

[DMK]

Just to add another moment of "dayamn" to your day, *usually* call charges are also not covered (along with transportation expenses). I've been busy paying a lovely non-stop vet bill thanks to a 2 year old who managed to do a high tensile shear wound to his back cannon. When it first happened back in September, I still couldn't do a wrap thanks to my hand injury (yay, lacerations and surgery for everyone!) so I was paying for all these call charges+bandage change for something I could normally handle myself. Of course, being one of MY horses, as soon as I was able to manage wrapping, he added "complications" (infection, sequestrums, necrotic tissue) to the mix so I could keep on paying call charges.

Years ago I had a horse that legitimately needed a short series of legend due to me trying to kill him in the ring (he did file a police report). He uh, came up sore after that (big surprise) and we did x-rays, lameness eval just to see if I had caused more damage than we thought (we didn't), but since he was within 3 months of having his hocks injected, the vet opted for 3 weekly injections of Legend. Sigh, I was really hoping those bottles of legend would be covered since it was an acute injury instead of part of the normal long term chronic condition maintenance. Doomed for disappointment...

[pharmgirl]

Don't have much to add that hasn't been said already, but will add a friend's personal experience regarding claims and farm calls: My friend has Great American and had a claim for an eye issue. The insurance did not cover the farm call fees.

[Peggy]

Basically it appears that they will not pay to move the vet to the horse or the horse to the vet. Nor the fuel surcharge that I paid during the Summer and Fall of Many Vet Visits (2008). But they do pay hospitalization, including the overnight stay when he got the nuclear scintigraphy.

I did not bill myself when I led him to the clinic for the colic, so no $$$ out of pocket there.

[sdlbredfan]

AKB, would you mind sharing with us what company that is? Any company with such poor performance needs to be 'outed' as a PSA, so others can avoid them, IMO. (Referring to the 'Even though our insurance on all of the horses was consistently with the same company, they said that each year is a new policy, so this was a preexisting condition! I dropped the policies on all of our horses, after paying premiums for years and never making claims until this one futile attempt at a claim. ').

[ZiggyStardust]

To answer the original question, my insurer advises to seek treatment (if it is urgent) before worrying about calling them. If treatment is not urgent, I think it does not hurt to call first so they can get a claim started. I've had a couple of fairly large claims and though they were not urgent, I did not call first as I knew I was going to do the treatment regardless. Have to say I've been very pleased with my insurance company, given the aforementioned sizable claims. I believe the underwriter is Equine Insurance Group.

The standard of starting a new policy every year is a little frustrating (if you have a large claim started just before your policy is up, you are SOL after whatever grace period you have is up, mine is 30 days after policy end, because then your exclusion starts), but it seems to be the industry norm.

[deltawave]

After crunching the numbers, taking off for the farm call, the injections themselves and the drugs used, then subtracting the deductible, my insurance company would be coughing up a check for . . .

Forty six dollars. :lol:

I think I'll skip it. ;)

[BestHorses]

:lol: Yeah, that doesn't sound worth the trouble and you'd be raising a flag with the insurance co.