The Critical Coverage Conversation Every Vet Should Master

You’ve delivered the diagnosis, outlined the treatment plan, and now comes the moment every veterinarian dreads: watching a client’s face crumple when they realize their pet’s condition won’t be covered by insurance. “But we just enrolled last month,” they protest. 

Here’s where understanding the nuances of pre-existing condition coverage, including the growing category of “curable” conditions, can transform these difficult conversations into opportunities for better client education and stronger relationships. 

Let’s walk through your complete guide to mastering these crucial pre-existing condition conversations.

The pre-existing landscape: What actually counts as pre-existing?

Before diving into coverage nuances, it’s crucial to understand exactly how insurers define pre-existing conditions. The definition is broader than many clients, and even some veterinarians, realize.

In plain terms, a pre-existing condition is anything that happened before coverage started, including:

• Diagnosed conditions: Any condition you’ve already identified and documented
• Symptoms without diagnosis: Signs the pet showed, even if you hadn’t reached a definitive diagnosis yet, or if the owner noticed symptoms but hadn’t brought the pet in for evaluation 
• Treatment or advice given: Any medical guidance you provided, regardless of the underlying condition
• Related conditions: Future problems that stem from something documented before coverage began

The timeline matters: This applies to anything occurring before the policy start date OR during waiting periods (typically 14 days for illnesses, longer for specific conditions like orthopedic issues).

But, not all exclusions are permanent

The landscape has evolved significantly, and many insurers now distinguish between permanently excluded conditions and those that might qualify for future coverage under “curable condition” provisions.

Here’s how we handle curable conditions at Lemonade: Curable conditions are temporary illnesses or injuries that can become eligible for future coverage if they remain completely resolved without recurrent signs, symptoms, or continued treatment for at least 12 consecutive months.

This distinction matters enormously for your client conversations and treatment recommendations. Understanding when a condition might eventually qualify for coverage again can help you guide clients toward appropriate insurance decisions and set realistic expectations for their pet’s healthcare journey. 

Case study 1: The permanently excluded condition

The scenario: Max, a 4-year-old Golden Retriever, limps into your clinic. Your examination reveals early signs of hip dysplasia, confirmed by radiographs. The owner mentions they enrolled Max in Lemonade pet insurance three weeks ago.

The insurance reality: Max’s hip dysplasia would be considered a pre-existing condition and would be ineligible for coverage under his Lemonade policy as the waiting period for orthopedic conditions is 30 days, and hip dysplasia is a chronic condition that cannot be cured.

The client conversation

“I know this is frustrating timing with your recent insurance enrollment. Hip dysplasia is considered a pre-existing condition since the changes we’re seeing on X-rays developed before your coverage began. Unfortunately, joint conditions like this remain permanently excluded from coverage. However, your insurance will still cover other conditions Max might develop, including injuries or illnesses unrelated to his hips.”

This clarity helps clients understand why documentation matters and prevents false hope about future coverage for related conditions.

Case study 2: The curable condition path to coverage

The scenario: Luna, a 2-year-old domestic shorthair, presents with conjunctivitis one week after her owner enrolled in Lemonade pet insurance. You prescribe topical antibiotics, and the condition resolves completely within 10 days.

The insurance reality: Luna’s conjunctivitis would be considered pre-existing since it occurred during the 14-day illness waiting period. However, conjunctivitis qualifies as a curable condition under Lemonade’s policy. If Luna remains completely symptom-free and treatment-free for 12 consecutive months, future conjunctivitis infections could become eligible for coverage.

The client conversation: 

“Luna’s conjunctivitis won’t be covered this time since it appeared before her waiting period ended. However, Lemonade has curable condition provisions. If Luna goes a full 12 months with no symptoms, medications, or treatments, future cases of conjunctivitis could potentially be covered. I’ll note the resolution date in her records, which will be important for any future coverage determinations.”

Case study 3: The misunderstood infection

The scenario: Rosie, a 3-year-old Labrador, develops a severe ear infection one week after enrollment in Lemonade pet insurance. Your examination reveals chronic otitis externa with thickened ear canals, suggesting this is a longstanding issue despite the owner’s insistence that “her ears were fine before.”

The insurance reality: Despite occurring after the policy start date, the clinical evidence of chronic changes indicates this condition was present before enrollment, making it pre-existing. However, if completely resolved and managed properly, ear infections can qualify as curable conditions under Lemonade’s policy.

The client conversation: 

“I understand this seems sudden, but the changes I’m seeing in Rosie’s ears indicate this has been developing before your enrollment. This would likely be classified as pre-existing. However, if we can completely resolve this infection and Rosie stays ear-problem-free for 12 months, future ear infections might qualify for coverage under Lemonade’s curable condition provisions.”

Why documentation matters 

Your medical records play a crucial role in these determinations. For conditions that might qualify as “curable,” precise documentation becomes essential:

• Resolution dates: Note exactly when symptoms ceased and treatment ended
• Follow-up findings: Document normal findings at subsequent visits
• Treatment gaps: Record periods of no medication or intervention
• Recurrence patterns: Track any symptom returns, even minor ones

Practical implementations in your practice

Timing the insurance conversation

Bring up insurance implications early in the diagnostic process, not after delivering devastating news about excluded coverage. When clients mention recent enrollment, immediately flag the pre-existing condition implications and explain the difference between permanently excluded and potentially curable conditions.

Setting realistic expectations

“While this condition won’t be covered initially due to pre-existing condition rules, some insurers now offer coverage for certain conditions that completely resolve. I’ll track this carefully in your pet’s records, and we can reassess coverage eligibility in 12-15 months if everything stays completely clear.”

Managing chronic vs. curable classifications

Help clients understand that insurers distinguish between:

• Permanently excluded: Chronic conditions, joint/ligament issues, progressive diseases
• Potentially curable: Infections, injuries, temporary illnesses that completely resolve
• Gray areas: Conditions that might seem resolved but have underlying chronic components

The business impact

Understanding these distinctions helps your practice in several ways:

• Enhanced client trust: Accurate insurance guidance prevents disappointment and builds confidence in your expertise
• Treatment planning: Knowing coverage limitations helps you develop realistic payment plans
• Client retention: Pets with pre-existing conditions still need ongoing care, and clear communication about coverage helps clients budget appropriately

Moving forward

The pet insurance landscape continues evolving, and curable condition provisions represent a meaningful improvement for pet owners. By mastering these conversations, you transform insurance discussions from sources of client frustration into opportunities for education, trust-building, and better healthcare planning.

Remember: your expertise extends beyond diagnosis and treatment. Understanding how insurance intersects with your medical recommendations makes you an even more valuable advocate for your patients and their families.

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A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of policies issued by Lemonade, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage and discounts may not be available in all states.