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Breed & Health Resources

Claim Example: cataract surgery in a Greater Swiss Mountain Dog

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Zeus-MichelleFranklin Gunner is a 4 year old Greater Swiss Mountain Dog who was diagnosed with Juvenile Cataracts this year. Juvenile Cataracts is a hereditary condition that strikes a number of breeds at younger ages.

As you may know, Embrace Pet Insurance covers hereditary or breed specific conditions as long as there are no clinical signs of the condition before the end of the waiting period.

The costs for the cataract treatment can add up. Here are the totals for Gunner's treatment so far. Note that the prescription drug coverage was not selected for Gunner's policy so take home drugs such as Otomax were not covered by his policy.

Date Diagnosis Status Claim Amount Paid
1/17/2011 Juvenile Cataracts Deduct $121.28 $0.00
1/21/2011 Cataracts Paid $194.00 $16.65
4/13/2011 Unilateral Cataract Surgery Paid $1,637.00 $1,381.50
5/24/2011 Post Op Recheck Exam Deduct $77.00 $0.00
      $2,029.28 $1,398.15

Here are the specifics on Gunner's surgery costs (FYI, he lives in Oregon)

ITEM BILLED AMOUNT COVERAGE TYPE COVERED IN POLICY? COVERED CHARGES
Catheter $30.00 IL Y $30.00
Fluid Admin $35.00 IL Y $35.00
Anesthesia $225.00 IL Y $225.00
Antitbiotics $18.00 IL Y $18.00
Dexamethasone Inj $15.00 IL Y $15.00
Unilateral Cataract Surgery $1,200.00 IL Y $1,200.00
NeoPolyDex Opth $15.00 DD N $0.00
Diclofenac Sod Opth Sol $30.00 DD N $0.00
PolyB Trimethoprim Opth Sol $8.00 DD N $0.00
E-Collar $12.00 IL Y $12.00
Cipro $27.00 DD N $0.00
Tramadol $10.00 DD N $0.00
Acepromazine $12.00 DD N $0.00
  $1,637.00     $1,535.00

Gunner's claim payout was calculated as follows (the deductible having already been satisfied this year):

STEP 1: Calculate Potential Refund     
  Billed Amount:       $1,637.00
  Covered Charges:  (see attached detail)    $1,535.00
  Annual deductible remaining   $0.00
  subtotal   $1,535.00
  Copay 10%  (your copayment)    $153.50
Potential Refund        $1,381.50
         
         
STEP 2: Compare potential refund against your annual maximums
         
     Annual Maximum       $10,000.00
     Prior refunds for this policy year   $16.65
     Coverage remaining       $9,983.35
         
Your total refund is:        $1,381.50

Has your dog or cat had cataract surgery? How did it go?

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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. © 2020 American Modern Insurance Group, Inc.  Wellness Rewards not available in Rhode Island.