Next fron­tier of health re­form: pets?

cal­i­for­nia con­sid­ers whether in­sur­ers must post cov­er­age

Austin American-Statesman - - WORLD & NATION - By Cathy Busse­witz

SACRA­MENTO, Calif. — While states across the nation grap­ple with na­tional health care re­form, a new pop­u­la­tion of pa­tients is gain­ing at­ten­tion in Cal­i­for­nia: cats and dogs.

Many fe­line and ca­nine com­pan­ions face health care chal­lenges sim­i­lar to those that con­front hu­mans. Vet­eri­nary care costs are sky­rock­et­ing as pet own­ers are of­fered a so­phis­ti­cated menu of po­ten­tially life­sav­ing ser­vices, in­clud­ing kid­ney dial­y­sis, sono­grams and chemo­ther­apy.

U.S. con­sumers spent more than $12 bil­lion on vet­eri­nary care in 2009, ac­cord­ing to the Amer­i­can So­ci­ety for the Pre­ven­tion of Cru­elty to An­i­mals.

Yet only about 1 per­cent of own­ers have health in­surance for their pets. Those who do of­ten don’t un­der­stand what the pol­icy cov­ers and ex­cludes in an in­dus­try that has faced lit­tle reg­u­la­tion or even at­ten­tion — at least un­til now.

Demo­cratic state Assem­bly­man Dave Jones, who is run­ning for state in­surance com­mis­sioner in Novem­ber, said some of the same prac­tices be­ing cor­rected by the re­cently en­acted fed­eral health care over­haul are used by pet in­surance com­pa­nies, in­clud­ing deny­ing cov­er­age based on pre-ex­ist­ing con­di­tions.

Jones has in­tro­duced a bill that would make pet in­sur­ers post de­tailed in­for­ma­tion on Gary Lucks of Oak­land, Calif., had to fight to get the pet in­surance re­im­burse­ment he ex­pected af­ter his dog Bodie got can­cer. their web­sites so con­sumers can see ex­actly what is cov­ered and what is not. They could then com­pare op­tions, just as if they were buy­ing in­surance for them­selves in a post-health-re­form world.

“A num­ber of pet own­ers have com­plained to me that they bought a pol­icy, and they weren’t told about pre-ex­ist­ing con­di­tions,” said Jones, who has two cats, Dragon and Blanca. He said oth­ers have at­tempted to buy poli­cies but were told that be­cause of pre­ex­ist­ing con­di­tions in their pets, they couldn’t get pet in­surance.

The bill also would man­date that an in­surer dis­close whether it will re­duce cov­er­age or in­crease premi­ums based on claims filed in the pre­ced­ing pol­icy pe­riod.

Ac­cord­ing to pet in­surance com­pa­nies and an­i­mal ad­vo­cacy groups, Jones’ ef­fort is the first of its kind in the nation. The bill passed the state Assem­bly and a Se­nate in­surance com­mit­tee. It awaits hear­ing be­fore the Se­nate Ap­pro­pri­a­tions Com­mit­tee.

Pet in­surance varies widely depend­ing on the com­pany sell­ing the pol­icy. Just as with hu­man health in­surance, pol­i­cy­hold­ers pay monthly premi­ums. Most pet poli­cies re­quire own­ers to pay the bill in full and sub­mit a claim to the in­surance com­pany for par­tial re­im­burse­ment.

That’s where con­fu­sion can comes in. Many poli­cies state they will re­im­burse pol­i­cy­hold­ers a per­cent­age of rea­son­able and cus­tom­ary costs, but pet own­ers say vet­eri­nary charges can far ex­ceed what the in­surer con­sid­ers rea­son­able.

“The time when you fig­ure out how your in­surance works is when you are in the throes of an emer­gency,” said Jen­nifer Fear­ing, se­nior state di­rec­tor for the Hu­mane So­ci­ety of the United States.

That was the case for Gary Lucks, whose dog Bodie was di­ag­nosed with can­cer at age 10. Lucks spent about $5,000 on Bodie’s di­ag­no­sis and treat­ment. He ex­pected to be re­im­bursed about 85 per­cent of the cost but said he was paid back only about one-third.

Lucks, an en­vi­ron­men­tal lawyer who lives in Oak­land, wrote a com­plaint to the com­pany and even­tu­ally was paid the 85 per­cent re­im­burse­ment. He then took the money and paid his re­search staff to write a pol­icy paper and asked state law­mak­ers to take a closer look at the in­dus­try.

Ben Mar­got

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