How Do Salespeople Explain It?

In three conversations with sales agents for AKC Pet Insurance, we were told that the 365-day waiting period does not require the pet to be asymptomatic of the condition to be eligible for coverage. But, again, that’s not what the small print seems to say.

Of course, it could also be that we’ve misread the fine print, and that the salespeople have accurate information. But TCR has no way of knowing that because no executive or spokesperson at PPI will discuss the policy in a live conversation. Only the salespeople will talk about it if we call them undercover. And, again, what they say seems to contradict the small print.

To hear how the company’s salespeople explain the policy to consumers, The Canine Review made these calls  without identifying ourselves as media. (The press ethics rationale is that this constitutes consumer reporting; the scenario is analogous with a restaurant critic not identifying his or her affiliation. By default, once we identify ourselves as reporters, we are no longer in a position to experience the service or product as consumers.)

Here’s an excerpt from one conversation:

EB: That’s what I’m confused about because your website—I thought no pet insurance company covers preexisting conditions ever. So, I don’t understand—

Agent:  The majority don’t. We just recently updated all terms and conditions so that we could.

EB: When you say there’s a 365-day waiting period, what’s the purpose?

Agent: Right. Let’s say, um, I mean, in the example of allergies, if my, if, for example, my dog didn’t have any symptoms of allergies for 365 days, she could conceivably get coverage for her allergies.

Agent: So, for that particular condition for the first year, if you submitted any claims, it would not be considered reimbursable for you. You would have to have the policy for that full year, but once your policy renews with us, any future treatments or diagnostic measures, that’s recommended by your vet for the allergy condition could be considered reimbursable to you. And that would just be subject to the deductible and reimbursement rate that you choose.

EB: So, even though, even though it’s in her records that she’s been diagnosed with allergies, she could get coverage.

Agent:
Correct. It would just take that one year before we start reimbursing towards it.

Both David T. Kettig,  who joined Iguana Capital, Inc., which acquired a controlling interest in PPI as its Chief Executive Officer in 2021 and Lane B. Kent, PPI president, refused repeated requests to speak about the policy.

PPI would only provide an email from press officer Amanda Trcka, who did not attach telephone contact information:

Our product doesn’t have a “cured period” – meaning we do not require a condition to not show symptoms for a certain time period before its covered. This is different than other pet insurance offerings which may require a condition to show no symptoms for X amount of time before its covered.

For example, you start your policy on 1/1/21, and your dog had shown symptoms and was diagnosed and treated for allergies before their policy began. During their first policy term, claims for their allergy treatment would not be eligible. However, after you renew your policy for the following year, claims for your dog’s allergy treatments that have a date of service after 1/1/22 may be eligible (pending your specific policy, medical records, etc.).

Ms. Trcka mentioned “cured condition eligibility,” which is what some pet insurers have added in their fine print as part of what they offer. For example, U.S. Fire Insurance, which underwrites most of the pet insurance brands administered by Crum and Forster such as FIGO, Pumpkin, ASPCA Pet Insurance, and Spot, offers this precise language that is seemingly designed to avoid consumer confusion: “CURED CONDITION ELIGIBILITY.” Here is text from U.S. Fire Insurance’s boilerplate accident & illness policy:

There is a 14-day waiting period for: diagnosis, treatment or surgery related to accidents, [illnesses] and ligament and knee conditions. The waiting period begins on the first effective date of the applicable coverage. Any condition that occurs during an applicable waiting period is a pre-existing condition.

{“Illnesses” will only appear if the coverage selected includes these benefits and the applicable Waiting Period}

CURED CONDITION ELIGIBILITY

If your pet’s pre-existing condition is curable and has been cured and free from treatment and symptoms for a period of 180 days it is a new occurrence. This does not apply to ligament and knee conditions.

That clause about conditions occurring during the waiting period left me wondering:  What if my dog has a pre-existing condition before I sign up and then it occurs and gets treated during AKC’s 365 waiting period. Clearly it will not get reimbursed during the 365-day waiting period. Will it get reimbursed AFTER the 365 days if it recurs? Under the U.S. Fire policies, it clearly would not. The AKC fine print at first look seems not address this – and the sales people told me that my pet would be covered. But look more closely at that fine print: It does say that pre-existing conditions also include conditions that occur “during the Waiting Period.” So, the answer seems to be no coverage after the waiting period, either! In other words, it appears from the small print that any pre-existing condition that occurs – whether treated or not – during any 365-day period is never covered.