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Emergency

The pet health insurance won't pay: what to do?

Pet health and surgery insurance covers vet costs, but not without limits. Disputes often arise over waiting periods, pre-existing conditions, the reimbursement amount under the German scale of fees for veterinarians (GOT), and exclusions. A close examination of the terms is worthwhile.

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Your chances of getting your money back

The benefit depends on the insurance terms: insured treatments, waiting periods, reimbursement rates, and maximum limits. Billing is done according to the scale of fees for veterinarians (GOT).
A refusal is not always justified. If it relies on a questionable pre-existing condition or an unclear clause, you can object and pursue the reimbursement further.

What you should do now

  1. 1

    1. Check the terms

    Look at which treatments, waiting periods, and limits are agreed.

  2. 2

    2. Check the invoice

    Compare the vet invoice with the GOT and the reimbursement rate.

  3. 3

    3. Question the refusal

    Check the reasoning, for instance regarding a pre-existing condition or waiting period.

  4. 4

    4. Object

    In case of justified doubts, object to the refusal in writing.

How to spot the scam

  • An alleged pre-existing condition is assumed without evidence.
  • The reimbursement stays below the GOT rates without explanation.
  • The treatment still falls within a waiting period.

Frequently asked questions

Why doesn't the pet health insurance pay?

Frequent reasons are waiting periods, excluded pre-existing conditions, uninsured treatments, or maximum limits. Billing according to the GOT also plays a role. Check the reasoning against your terms; not every refusal is justified.

What is the GOT?

The scale of fees for veterinarians sets the framework for billing veterinary services. Insurances often reimburse up to a certain rate of the GOT. If the invoice is within the usual range, the reimbursement should be made accordingly.

What can I do against the refusal?

Have the reasoning reviewed and object in writing if it does not hold, for instance in the case of an unproven pre-existing condition or an unclear clause. Collect evidence such as treatment reports and the invoice to support your reimbursement claim.

Take action now

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.