How Pet Insurance Companies Calculate Your Refund

One of the subtler, but important, differences between pet insurance companies is how claims for vet bills are paid.

We're not talking about check versus direct deposit into your bank account (although Embrace does both); we're talking about how your reimbursement is calculated from the amount you paid to your veterinarian at the time of service. It's not as straightforward as you might think.

Different Methods of Calculating Claims

There are three common ways pet insurers process claims reimbursement for vet bills:

  • Compare your vet bill by diagnosis to a benefit schedule
  • Direct percentage of the vet bill: deductible then copay
  • Direct percentage of the vet bill: copay then deductible

It's up to you to determine which method suits you best.

What is a benefit schedule?

Some pet insurance companies limit payouts based on a benefit schedule. A benefit schedule is a list of diagnoses with the maximum amount that the pet insurance plan will pay if your pet requires treatment for that diagnosis. In large metropolitan areas, the benefit schedule payout can be much less than the actual treatment costs. As a result, you may be left paying a large portion of the bill yourself even though you have pet insurance.

Deductible then Copay vs. Copay then Deductible

At Embrace, we reimburse you directly based on the vet bill you paid – not a benefit schedule. We also give you more back by first subtracting the deductible and then taking off the copay. Some companies do it the opposite way, subtracting the copay then the deductible, which can lead to a lower reimbursement.

For example: If you have a $700 incident and a $200 deductible, the "copay then deductible" method will cost you $40 more out of pocket.

We encourage you to check out our reviews on PetInsuranceReview.com to hear what Embraced pet parents think of our payouts.

Do pet insurance companies pay vets directly?

All pet insurance companies, including Embrace, pay claims by reimbursing you directly. You pay the vet at the time of service, submit your claim, and the pet insurance company pays you back. With this method, you can visit any vet because the vet doesn't have to "accept" the insurance or be part of a "network." However, if you are expecting a large veterinary bill, Embrace can work with you and your vet to pre-certify the claim and pay the vet directly.

What do I have to do for pet insurance reimbursement on vet bills?

Embrace's claim reimbursement process is simple:

  1. Take your pet to the vet.
    Print your personalized pet insurance claim form before your appointment. Visit any vet, specialist, or emergency clinic. There are no networks
  2. Complete the claim form & send it to Embrace.
    Have a vet staff member fill out your claim form and provide an itemized invoice. Submit the claim form and invoice by fax (800) 238-1042, e-mail, or direct upload to your MyEmbrace account.
  3. Get reimbursed.
    We'll process your claim and alert you when it's complete.

For more information on coverage for your pet, get a pet insurance quote here.

Copyright © 2005-2018 

Pet health insurance is administered by Embrace Pet Insurance Agency, LLC and underwritten by one of the licensed insurers of American Modern Insurance Group, Inc., including American Modern Home Insurance Company d/b/a in CA as American Modern Insurance Company (Lic. No 2222-8), and American Southern Home Insurance Company. Coverage is subject to policy terms, conditions, limitations, exclusions, underwriting review, and approval, and may not be available for all risks or in all states. Rates and discounts vary, are determined by many factors, and are subject to change. Wellness Rewards is offered as a supplementary, non-insurance benefit administered by Embrace Pet Insurance Agency in the United States. © 2016 American Modern Insurance Group, Inc.