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Well, the insurance has again denied our pre-authorization claim for Java's surgeries. They told me that because it is stated in the Terms & Conditions that cruciate injuries are excluded unless you get a health certificate within 30 days of the instatement of the policy they cannot approve the claim. I told them that when I called to sign up for the policy I asked what I needed to do and was told I didn't need to do anything, that the girls were covered as of 2/12/2010. I told them that I called a second time when Java was injured asking for clarification on the cruciate exclusion and I was given incorrect information about what I needed to do for the claim. They found the first phone call, but conveniently they cannot find the other phone call. They said it still didn't matter, that yes, I was misdirected and given misinformation and the first agent neglected to tell me about the exclusion or that I needed to get a health certificate, but that that was simply an internal training issue and had no bearing on my claim because of the Terms & Conditions. I did argue that I called to ask for clarification about that but was given incorrect info. He said it didn't matter. My claim has been denied. I am awaiting a phone call from the Chief of Business Operations, but I'm not holding out hope that I am going to get anywhere.
I have no idea what we are going to do now. We got a second opinion from another ortho vet, the one that treated Moka for her broken leg, and he confirmed the diagnosis of bilateral ACL tears. The surgery estimate is between $6000-$7400, not including aftercare. So, basically we are looking at spending $13,000 on 2 dogs in less than 6 months. We just can't afford that. We are going to have to take out a loan to pay for Java's surgeries, and we still owe on Moka's surgery. What a nightmare.

Here is the exact exclusion clause from the Terms & Conditions:

Any treatment associated with the damage or rupture of cruciate ligaments or defects of the patella during the first 6 months that the policy is in effect. Except coverage is given if a certificate of health stating that your pet has been examined and does not have any pre-existing conditions relating to the cruciates or the patellas is provided by a licensed veterinarian within 30 days of the effective date of the policy.

When I called and asked about this, I was told by an agent to have my vet give us a health certificate stating that Java had never been treated for a cruciate injury prior to this injury and I also sent all her medical records, which showed that she had no pre-existing injuries or illnesses.

The supervisor said that to them it seemed too convenient that my dog injures her cruciate within a week of signing up for the insurance.
But honestly, that is exactly what happened. I signed up for insurance on 2/12/2010 and Java got hurt on 2/16/2010. I signed up because Moka had broken her leg and we learned an expensive lesson, we wanted pet insurance in case anything like that happened again. He asked when she broke her leg, I told him December. He said well then why did you wait so long to sign up for insurance? I told him it was because we didn't have the $500 to pay for the first year up front because of Moka's vet bills, so we had to wait until our tax return came in, which is when I did sign up. He said the timing was just hard to believe. That Java probably got hurt first and we decided then to hurry up and sign up for insurance, thinking it would be covered. Basically, accusing us of fraud, it sounded like.

Any thoughts? Was this really an error on my part? I thought I had covered all my bases when I called to sign up on the phone instead of the internet, because that way I could speak to a live person, get my questions answered and be told exactly what I needed to do to be covered. I guess not.

Thoughts, ideas and advice VERY welcome and appreciated!!
 

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I do not have any advice than contact the Better Business Bureau, and if the Chief of Operations does call back , make sure you tell him that you are a loud mouthed ***** and will take every opportunity to let every one in the dog world know that they are a bad business to deal with. Do they have a web site? Face book? Any thing where public comment can be made?
 

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When I called and asked about this, I was told by an agent to have my vet give us a health certificate stating that Java had never been treated for a cruciate injury prior to this injury and I also sent all her medical records, which showed that she had no pre-existing injuries or illnesses.

The supervisor said that to them it seemed too convenient that my dog injures her cruciate within a week of signing up for the insurance.
Gina, have your vet issue the health certificate immediately! According the T&C it should be covered then. You only have 2 days to do it, so do it by tomorrow!!!!!

Tell the supervisor to kiss your ass, that is none of her concern! Like you could really predict this would happen?!?!
 

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Send written account of everything that has transpired, as thoroughly and accurately as you can document, to BBB, your state attorney general, any organization referenced by the company involved literatue or website. List eveyone one of them as CC'd on the letter itself, and send them. Not email.

Do you have any friends that are lawyers? Any chance one of them would put your letter on their letterhead? It helps.
 

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Additionally - perhaps post the info on the insurance company - and let us help to protest via email/letter and state that we will not use this pet insurance - and that we will notify our freinds of the same! Sometimes, pressure is a good thing.
 

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Coincidentally, I just sat through a 2.5 hour presentation by VPI on Monday! I think they have you on this one, unfortunately :(

Even if your vet writes a letter now chances are it won't make any difference for a number of reasons. Did your vet ever check for cranial drawer movement before this injury? I'd bet money the answer is no. Why? Because the only time we actually do that test is if we suspect CCL damage. We might manipulate the joints on a physical exam to check for arthritis (unlikely since she's young) or hip dysplasia (unlikely since it's unreliable) but neither of those give any information on the cruciates. So, Insurance company will ask, what exactly was done by vet to certify no problems with stifles? Nothing really. Speaking as one who would be writing that letter, personally, I would be extremely hesitant to certify a dog that currently has bilateral CCL tears as having healthy ligaments prior to the tears. Pet insurance companies have a lot of money, and lots of lawyers, and I definitely do not want to go to court for real or imagined insurance fraud.

Again, reading your post about taking out loans to have a surgery done - it just makes me cringe. Can you get CareCredit so you're not paying interest (if you make payments on time)?

One more plug for lateral suture:
http://avmajournals.avma.org/doi/abs...a.2005.226.232 (no difference in outcome between the two)
http://avmajournals.avma.org/doi/abs...a.2003.222.184 (TPLO has more complications - I think this is mainly because dogs walk sooner after TPLOs, so owners let them do too much, not necessarily a fault of the surgery itself)
http://avmajournals.avma.org/doi/abs...avma.234.2.229 (lateral suture had fewer complications)
 

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Discussion Starter #7
Coincidentally, I just sat through a 2.5 hour presentation by VPI on Monday! I think they have you on this one, unfortunately :(

Even if your vet writes a letter now chances are it won't make any difference for a number of reasons. Did your vet ever check for cranial drawer movement before this injury? I'd bet money the answer is no. Why? Because the only time we actually do that test is if we suspect CCL damage. We might manipulate the joints on a physical exam to check for arthritis (unlikely since she's young) or hip dysplasia (unlikely since it's unreliable) but neither of those give any information on the cruciates. So, Insurance company will ask, what exactly was done by vet to certify no problems with stifles? Nothing really. Speaking as one who would be writing that letter, personally, I would be extremely hesitant to certify a dog that currently has bilateral CCL tears as having healthy ligaments prior to the tears. Pet insurance companies have a lot of money, and lots of lawyers, and I definitely do not want to go to court for real or imagined insurance fraud.

Again, reading your post about taking out loans to have a surgery done - it just makes me cringe. Can you get CareCredit so you're not paying interest (if you make payments on time)?

One more plug for lateral suture:
http://avmajournals.avma.org/doi/abs...a.2005.226.232 (no difference in outcome between the two)
http://avmajournals.avma.org/doi/abs...a.2003.222.184 (TPLO has more complications - I think this is mainly because dogs walk sooner after TPLOs, so owners let them do too much, not necessarily a fault of the surgery itself)
http://avmajournals.avma.org/doi/abs...avma.234.2.229 (lateral suture had fewer complications)
We Have Care Credit for Moka's injury, which we are still paying on. That only has a 0% interest rate for 6 months, after that it goes up to 22% interest rate. So, that is a dead end because our line of credit with Care Credit is not high enough to cover both of these surgeries for Java, not to mention it is going to take alot longer than 6 months to pay $7000 in vet bills, which means the interest rate would go up to 22% on the balance.
 

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Did you actually see that clause in your terms and conditions? (are these the ones they email to you?)Reason I am asking is I have that insurance, got it last week actually and after reading your post I checked my terms and conditons and that clause wasn't in mine. I wonder if it has to do with the age of the pet or location or what. Though I have to say that after reading my terms I found some things that I don't like.
 

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That really does suck! This is exactly what I am afraid of with pet insurance, and why we have a pet savings account instead. So sorry this happened.
 

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I don't know what to say except that I'm sorry. I hope you get some resolution. If it was me I'd be cancelling that insurance.
 

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That really does suck! This is exactly what I am afraid of with pet insurance, and why we have a pet savings account instead. So sorry this happened.
Us too.

I looked into it once. They won't cover Angus because he's had cancer, so it's moot for him anyway.

They always give us a printout at our vet's, and at the bottom it has how much I would have saved if I had pet insurance. It's usually like $5, maybe $10. Not a very big percentage of the bill.

I'm sorry this is happening. :( It's one of the worst runs of luck! What would be the penalty for cancelling your policy, I wonder? Can you even do that?

I kind of can't believe that the guy admitted that an employee misrepresented the policy to you, calling it an "internal training problem," but still won't cover it. There's something wrong about that.
 

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I'm so sorry this isn't working. I have to ask...is anyone having any luck with the insurance plans for pets? I kind of always thought they were a sham business and your claims would be denied like yours are.
 

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There is absolutely no reason to pay $3500 per surgery. You can shop around and find a good reputable vet in your area fully capable of doing a traditional repair for $1400 - $1600. I know it's not cheap but it's a heck of a lot better than $3500! Also get the leg fixed that is bothering her and go through rehab and see how she does. Sometimes the months of rest can heal a partial tear that she has in the other knee that she is currently not showing any symptoms.
 

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I agree with meandclint. You do NOT have to pay this much for these surgeries. Check out the vet colleges in your area, also don't go the TPLO route.

I also agree that many times a partial tear will heal.

Don't rush into this. Find alternative ways to help your dog that won't bankrupt you.
 

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There is absolutely no reason to pay $3500 per surgery.
I agree, I would definitely check around before settling on the vet. $3500 is crazy!
 

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There is absolutely no reason to pay $3500 per surgery. You can shop around and find a good reputable vet in your area fully capable of doing a traditional repair for $1400 - $1600. I know it's not cheap but it's a heck of a lot better than $3500! Also get the leg fixed that is bothering her and go through rehab and see how she does. Sometimes the months of rest can heal a partial tear that she has in the other knee that she is currently not showing any symptoms.
Yes, really there is zero reason to do this surgery. You can't afford it, and traditional repair is just as good if not better in some cases. There is no reason to go into debt over this, and pooh on your vets for not telling you otherwise if they know the financial hardship you're facing with your other pup's bills.
 

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I think you've gotten some good advice and suggestions. While you are the one that knows your dog the best and will make the right decision for your family, keep in mind vets don't know everything. Vets will usually recommend the most common correction/fix for a problem and forget to mention other things that may work. Their best recommendation may not be the best for your situation.

For instance when I was a kid we had a cat that got an abcess on his foot. We took him to the vet and the vet recommended some kind of surgery(I don't remember what because I was so young) but I remember my mom saying no to the surgery and that he was just a barn cat and she'd take him home for my dad to take care of. (Gasp, yes I know it is awful, that is just how things were done on the farm) Anyways the vet backpedaled and said we could try soaking the leg in a special solution 4x a day. It might work, it might not. Well what do you know it worked and the outside barn cat lived to 18. So surgery wasn't 100% necessary to correct the problem, yet that is what the vet wanted us to try first.

Reflect and go with your gut on what to do. I wish the best for your dog.
 

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I have to agree with meandclint I would proceed with the surgery on the knee that she is showing symptoms in then go from there on the other knee. I just roughly figured in my head how much we have spent so far on Huck's pre-surgery, surgery and post-surgery and so far I have totaled $2650. He has been on crate/bedroom confinement for the last 6 weeks and I want to go the full 8 weeks before we give full run again. Like was said before while Java is recuperating for those 6 to 8 weeks, the other knee may heal or at least give time to pay off/down one surgery before having to do the next.

Also another thought...you may want to ask the vet if there is any rush to do the surgery. Huck was not in pain and with the anti inflammatory he did even better. When we had the consultation with the ortho vet he said he needed surgery (he graded his knee a 4) but there was no rush to do it. Even though he hopped on it mostly and when standing or eating had gotten to the point of no weight bearing on that leg at all. So if you restrict activity and she is not in pain maybe it can wait until finances are better.

I wish you peace of mind with what ever you decide. I know how hard it is to make decisions like these.
 

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Send a copy of any complaints to your states department that regulates insurance, the BBB and if you bought it as part of your benefits at work the head of your benefits department. The more people you CC when you write the CEO the more likely you are to get the response you want.
 

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make sure you tell him that you are a loud mouthed ***** and will take every opportunity to let every one in the dog world know that they are a bad business to deal with.
You'd be amazed what this can do! The more noise you make the more they are likely to help you out. The whole situation sucks and I'm sorry you have to go through it, but hang in there.
 
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