VETERINARY SERVICES FAQS
Your ASPCA® Pet Health Insurance Questions Answered – With a Click of Your Mouse!
Below you’ll find our most common questions from our veterinary community, along with access to our customer community FAQs and helpful contact information. If you can’t find what you’re looking for please find your designated representative here to answer any ASPCA® Pet Health Insurance questions you may have, set up an appointment, or request a visit to your practice. You can also review our Sample Pet Insurance Plans for more information on coverage and policy guidelines.
I work for a veterinary practice and I would like information about coverage for my own pet.
Get started with a quote! If you need a veterinary staff discount code, you can send us a request and we’ll provide your code via email. Please note that our policies exclude treatment when the veterinarian conducting or supervising the treatment is you, a co-owner on your account, or an immediate family member.
As a policyholder, where can I get answers about my own coverage?
Visit the ASPCA® Pet Health Insurance policyholder Member Center, or call 866-204-6764 for further assistance.
How are claims submitted?
Typically the pet owner pays the veterinarian at the time of service, and then the pet owner submits a claim for reimbursement. Pet owners submit claims through the Member Center or on the My Pet Insurance mobile app. A veterinary practice can submit a claim on the pet owner’s behalf by email or fax. Click here to download a claim form with instructions for submission. If the claim is for veterinary direct reimbursement, it may be sent to email@example.com.
Obtaining an estimate: How can we find out if a procedure is covered?
Estimates for diagnostics and treatment can be submitted for review to determine eligibility prior to services. Estimates can be emailed to firstname.lastname@example.org or faxed to 855-324-9881. Please include 12 months of medical records with your submission. Please allow 7-10 business days for processing. After the estimate has been reviewed, the pet owner will receive an explanation of benefits, which outlines the services covered by the plan and how much they may be reimbursed. Click here to download our estimates guide for more information.
Allowed amounts are subject to change based on actual services rendered on submitted claim form upon final review. The benefit indicated is not necessarily the benefit that will be issued as all benefits payable are subject to any Deductibles and Incident limits at the time of claim consideration. This Pre-authorization and Estimate is void after 30 days from the date of completion or termination of the current policy period or the effective date of any midterm policy changes.
Can reimbursements be sent to the veterinary practice for payment?
Yes, we offer claim reimbursement directly to veterinary practices, in the form of a mailed paper check after the services have been completed and the claim has been processed.
Claim reimbursements are based on eligibility and the individual plan structure. We strongly recommend submitting an estimate in advance to verify eligibility, before agreeing to accept insurance reimbursement as payment. Please review the questions related to estimates and emergency coverage approval for more information.
Please note that we cannot guarantee coverage or the issuance of reimbursement, so it is important that alternative payment arrangements be made with the pet owner, in case the claim is not eligible for coverage.
When utilizing the claim form for submissions, please ensure the “Pay to Veterinarian” box is checked and that the client has signed the form for authorization. We are unable to send reimbursement to your practice without the pet owner’s authorization.
Where should I send medical records for my client?
Medical records may be sent by email to email@example.com. In your correspondence, please include the claim number in the subject line of your email, and attach the original medical records request along with the QR code on the request. If you would prefer to send the records by fax, you may do so using fax number 866-204-6764. Please note that faxes do not always transmit successfully, and we may need to send an additional request for records if they are not received.
How can I get more information about a client’s claim?
Our friendly Veterinary Services Team is here to help with any questions you may have about a claim that has been processed. Please email us at firstname.lastname@example.org, or give us a call at 877-738-2677. We are available between 9am and 5pm EDT.
How can a disputed claim be reviewed?
If the pet owner feels that a claim was processed in error, they should first read their policy, then contact Customer Satisfaction to discuss their question or dispute. If the pet owner wishes to further dispute the outcome of a claim, they may submit a request for appeal review. This can be emailed to email@example.com or faxed to 800-884-6350. The owner must provide their name, policy number, claim number(s), reason for dispute, and any supporting information that can assist us in reviewing the claim(s). All requests for appeal review must be initiated by the pet owner that is listed on the policy.
During the appeal review, we will re-evaluate the claim(s) using the pet’s medical records to determine eligibility, based on the coverage in place. Claims are processed according to plan terms and conditions, and a claim adjustment is not guaranteed with an appeal review.
If a treating veterinarian would like to provide us with additional medical perspective to clarify medical records or help us better understand the nature of the pet’s condition, this information may be provided to the owner for submission with their appeal request. It may also be sent directly to us at firstname.lastname@example.org. This information should be based on medically relevant knowledge of the pet’s condition, and supported by the medical records. Please note that we are not able to accept modified or amended medical records without a written explanation as to why the records have been amended.