Veterinarians treating own pets may face insurance denial

Some brands reject claims by practitioners who do the job themselves

July 5, 2023 (published)
Photo by Lake Koenig
Dr. Janet Riebe was dismayed to discover that a pet insurance claim for her dog, Sydney, was denied partly because she initially treated him herself.

When Dr. Janet L. Riebe filed a pet insurance claim this year for one of her three family dogs, a 4-year-old Labrador retriever named Sydney, she was surprised by the response from her insurer, Figo.

From the outset, the veterinarian in Wisconsin wasn't sure if any of the around $2,800 in treatment costs would be reimbursed. Near the end of a six-month exclusion period for orthopedic conditions, Sydney had been treated for intermittent lameness, first by Reibe, then by an orthopedic specialist. Riebe recalled reading on Figo's website that it sometimes makes an exception to the waiting period, so she figured she'd try requesting reimbursement.

As anticipated, the claim for the orthopedic specialist services was rejected because of the waiting period. But there was a different explanation for why the rest of the claim was rejected that took Riebe completely by surprise: She had made the mistake of treating her own pet.

Figo had quietly changed its definition of "veterinarian" to any licensed practitioner except her or a family member.

"While you might think you know what that definition is and be inclined to skip over it, don't!" Riebe wrote on a message board of the Veterinary Information Network, an online community for the profession and parent of the VIN News Service. "Little did I know that I needed to be reading the definition of ‘veterinarian' every year."

It's not unusual for some insurance companies — whether they're covering automobiles, humans or other animals — to shy away from allowing customers to fix their own cars or treat their own relatives or pets. That's because they fear the situation creates a greater propensity for "moral hazard," an industry term that denotes the likelihood that someone will take more risk if they know someone else is footing the bill.

Veterinarians treating their own pets, the theory goes, will have a strong emotional connection to their animal and an intimate knowledge of the claims process, putting them at a higher risk of overtreating the pet or committing insurance fraud.

In brief

At the same time, insurers that take such a hard stance are taking a chance of their own. Although they might reduce their risk exposure, they also could give the impression of being distrustful of veterinarians, who are key partners in insurers' ultimate success.

How companies choose to tread the line varies.

Figo was acquired in October 2021 by German investment firm JAB, which owns National Veterinary Associates, one of the world's biggest owners of veterinary practices, and other pet insurance brands, including ASPCA Pet Health Insurance and PetPartners.

At Figo, the change to its definition of "veterinarian" was made in May 2021, shortly before its acquisition by JAB, Amanda Trcka, a spokesperson for JAB's Independence Pet Group division confirmed in an email. PetPartners and ASPCA Pet Health Insurance have a similar exclusion, she added.

"The policy update is in line with other insurance practices (i.e., medical or auto) where it's common for claims to be denied if treated or seen by a family member or close friend," Trcka said. "In line with the larger insurance industry, this is to help mitigate risk and potential fraudulent activity."

Other pet insurers have taken the opposite approach. Trupanion, for instance, proudly states that its definition of veterinarian encompasses any properly licensed practitioner, regardless of their relationship to the patient.

"Trupanion does not, nor does it intend to have, any such restrictions — period," Trupanion's chief veterinary officer, Dr. Steve Weinrauch, said in an email. "The Trupanion policy was written by veterinarians, and the majority of our 1,500 team members come from a veterinary background. We are veterinary professionals; therefore we trust and understand the needs of our colleagues and classmates on the front lines of animal health."

Another large pet insurer, Embrace, said veterinarians are free to treat their own or family members' insured pets. It added, however, that "charges related to the veterinarian's time" are not reimbursed.

"For example, if a veterinarian does surgery on their own pet, and the claim is eligible for coverage, we cover everything other than the specific charges for the surgeon's time," Rachel Hinder, a claims manager at Embrace, said in an email. "As insurance is only allowed to make the insured whole again, the veterinarian cannot profit from being reimbursed for their own time on a claim."

Hinder added that for the purposes of establishing a new insurance policy, a pet must have been examined by a veterinarian unrelated to the insured pet in the 12 months prior to the start of the policy or in the policy waiting periods. Veterinarians also cannot perform an orthopedic examination to reduce an orthopedic waiting period for their own pets.

America's biggest pet insurer, Nationwide, did not respond to repeated requests for comment. Another large pet insurer, Fetch by the Dodo (formally known as PetPlan), recently considered prohibiting veterinarian customers who treat their own pets from making claims but opted not to after receiving feedback from veterinarians, according to a company representative.

From a global professional standards perspective, veterinary regulators and associations, too, approach the question inconsistently.

In the United Kingdom, the Royal College of Veterinary Surgeons, a regulatory body, explicitly discourages practitioners from treating their own animal or an animal belonging to a family member or close friend if that animal is insured.

"Generally, such conflicts of interest should be avoided," the RCVS states in section 9.36 of the supporting guidance for its professional code of conduct. "For that reason, it is advisable to get another veterinary surgeon to complete, sign and submit the claim form, wherever possible. Where this is not possible, the veterinary surgeon should state on the form the ownership of the animal."

In the U.S., there is no overarching professional regulatory agency; instead, veterinary practice is regulated state-by-state. The profession does have a national membership organization, the American Veterinary Medical Association. The AVMA principles of veterinary medical ethics make no mention of insured veterinarians treating their own pets.

For her part, Riebe was irked by Figo's suggestion that she presented a fraud risk. When making her claim, she submitted paid receipts from her clinic that included all of the discounts she'd received from her employer, including 10% off on medications and some free services from a reference laboratory.

"If I planned to commit fraud, I really don't think it would have been a mathematically wise plan to wait this many years to submit my first claim — which is a sarcastic way of saying I have not shown any inclination for fraud," Riebe wrote on VIN.

Most of all, she is disappointed that Figo failed to clearly communicate the change.

"I asked if they could make this clear to all applicants, but they never acknowledged my request for this," she said later in an interview. "I really just wanted to warn people, as I never even thought to ask. I am grateful I found out now with what would have been a relatively low claim, and not with something more costly."

The reference to Nationwide not responding to requests for comment was added after the story was published. It had been deleted inadvertently during editing.

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