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Spin Off- Major Medical Insurance-Need Advice

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  • Spin Off- Major Medical Insurance-Need Advice

    I've had major medical coverage for my horse since September. How and when do you submit a claim for medical bills? Do you call the insurance company and let them know you are going to submit a bill from the vet?

    Also when my horse was on a month worth of doxycyline for Lyme, would the insurance company (I have Great American) have paid the treatment and vet bills?

    Please advise because I paid for the coverage but have no clue how to submit a claim and for what I would submit a claim.

    What have you submitted for? I need all the help and advis I can get because this is new to me

    Thanks.

  • #2
    I have Great American ... they are processing a claim I just filed regarding my mare's ehrlichiosis. The adjuster did say they would cover the initial exam, bloodwork and antibiotics. I now have to submit all the bills for their review.

    I have really mixed feelings about major medical. It would be great to have if my horse had some difficult-to-diagnose lameness, as it should cover things like bone scans and such. But my mare is not really a colic surgery candidate, so even though I have "coverage" for that, I may not use it. Plus it seems like every time you file a claim, when you go to renew, whatever you claimed in the prior year will be excluded. (Actually, if you fill out the form prior to renewal about whether you had diagnostic x-rays, ultrasounds, etc., and indicate you did do one of those things, then they'll most likely exclude that body part whether or not you filed a claim.)

    You paid for the coverage, so you may as well use it. Just be prepared for renewal time ... you'll almost certainly have some exclusions based on whatever claims you had the year before. Sometimes they will be nice and remove exclusions if you go a year and the issue doesn't crop up again.

    When I filed this past claim, I called my agent first because I had a few questions. She answered those, then I called Great American. You'll leave your info with someone who will then pass it along to an adjuster, who will call you a day or so later and double check everything. The adjuster will then mail a form to your vet for them to fill out, and then they'll mail you a letter w/ envelope for all your bills so they can review them and determine how much they will pay.
    Full-time bargain hunter.

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    • #3
      Great American is a great company to deal with. They pay on time and have very nice customer service people. Having said this, since my gelding had a DDFT issue 4 years ago, that ENTIRE LEG has been uninsurable.

      Also, they review all your vet records. I never submitted that I had my horse's nose scoped when he had a nose bleed 2 years ago and wouldn't you know...now his sinusis and nasal cavity are uninsurable too.

      Comment


      • #4
        Just call your agent and ask how you go about submitting a claim. That's what you pay them for.

        Comment


        • #5
          I have Great American too.
          You have to call them immediately, like the same time you call the vet, at the very beginning. Otherwise they can refuse to pay.
          Then they send you a form for the vet to fill out and for you to fill out,
          both get sent back and then they send you the forms to make a claim.
          what i did was I went ahead and paid my vet and had Great American send the check to me.
          "Perhaps the final test of anybody's love of dogs is their willingness to permit them to make a camping ground of the bed" -Henry T. Merwin

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          • #6
            What's the point of the insurance if your horse slowly becomes uninsurable if you have anything done?

            I never really heard of insurance for horses until after I bought my mare and I never got her insured. Since then, I have been thinking about getting insurance for the next horse and am really on the fence about it.

            Comment


            • #7
              I also use Great American. I had never insured a horse, but when I brought a Clydesdale and started taking him to shows all over California. I used them because my trainer did. And I really got my money's worth for the first year of coverage--about $7000 in bills they paid for three separate major issues. The customer service was great. But each of the three incidents I submitted claims for, we called the emergency number and alerted them, told them where the horse was going and they contacted the vet hospital. Yes, they did exclude several things due to the injuries/issues, but I expected this. It would be hard for a company to stay in business if they did not do that. When I purchased the second show horse, I called to insure him right away.

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              • #8
                Insurance can be a confusing and somewhat overwhelming process .... until you do it.

                I was very confused about which company, exclusions, deductables, how to claim etc.... but once I made the decision and actually purchased coverage it has been simple and I'm so glad I did. This past year insurance paid for bone scans, xrays, shock wave, arthroscopic surgery and stem cell therapy for a medial meniscal tear and honestly, I don't care if the whole leg is excluded next year. Without insurance, I may not have been able to afford the extensive care my gelding needed this year and next year he would still be lame!

                When he became lame, I simply called the adjuster and he talked me through the entire process. It was simple, I was reimbursed quickly and so far nothing has been denied, I havent' quite reached my major medical limit...

                Comment


                • #9
                  I have Great American as well and had never filed a claim until last month for my boy's gastric ulcers. I called my agent to find out what to do, and she told me to call GA directly. I have had absolutely no problems with the claim and received payment within three weeks of filing. It was pretty straight-forward, but I was still very appreciative of the level of service that I received. That said, for what I pay in premiums, I should get that kind of service!

                  Comment


                  • #10
                    And even if you DON'T call in a claim, they can still exclude conditions at renewal as the policies are annual and anything occurring prior to the renewal date is pre-existing, claimed or not. So if you have the coverage, call it in! Why pay for the coverage if you're not going to use it? Call your agent, they'll talk you through the process. That's their job!
                    It's not about the color of the ribbon but the quality of the ride. Having said that, I'd like the blue one please!

                    Comment

                    • Original Poster

                      #11
                      Thanks for your advice everyone. I will definitely call my agent if something should happen and I need to submit a claim.

                      Comment


                      • #12
                        Originally posted by idtogo View Post
                        Insurance can be a confusing and somewhat overwhelming process .... until you do it.

                        I was very confused about which company, exclusions, deductables, how to claim etc.... but once I made the decision and actually purchased coverage it has been simple and I'm so glad I did. This past year insurance paid for bone scans, xrays, shock wave, arthroscopic surgery and stem cell therapy for a medial meniscal tear and honestly, I don't care if the whole leg is excluded next year. Without insurance, I may not have been able to afford the extensive care my gelding needed this year and next year he would still be lame!

                        When he became lame, I simply called the adjuster and he talked me through the entire process. It was simple, I was reimbursed quickly and so far nothing has been denied, I havent' quite reached my major medical limit...
                        Who do you use?
                        But George Morris still wears rust-colored breeches- so can I!

                        Comment


                        • #13
                          Sorry, I use Broadstone

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