A Vet's Guide to Pet-Insurance Optimized Medical Records

When Mr. Rodriguez brings his Golden Retriever for a torn cruciate ligament repair, the last thing anyone wants is for his insurance claim to sit in limbo for weeks. Yet that’s exactly what can happen when medical records aren’t optimized for insurance review. 

Here’s your guide on how to structure your documentation so your clients’ claims flow smoothly.

When do pet insurance companies need medical records? 

Pet insurance companies request medical records in two key scenarios:

At policy enrollment: Most insurers, including Lemonade, require records from the 12 months prior to enrollment, including any records during the first 14-days the policy is active. This establishes the pet’s health baseline and identifies any pre-existing conditions.

During claims processing: When a claim is filed, insurers may request additional records related to the specific condition being claimed, especially if there’s any question about when symptoms first appeared.

Without enrollment records on file, claims processing time increases significantly, as the claims advocate reviewing the claim has to obtain historical records before they can even begin reviewing the current incident.

What do claims advocates look for in medical records? 

Think of claims advocates as clinical detectives piecing together a pet’s health story. Here’s what they need from your documentation:

Essential identifying information

Every record should clearly show:

• Pet parent’s full name and contact information
• Pet’s complete identification (name, species, breed, age, sex, coat color)
• Your clinic’s name and contact information
• Date the record was printed/generated

Why this matters: Insurance companies handle thousands of pets named “Bella” and “Max.” Clear identification prevents mix-ups that can delay or derail claims.

Complete SOAP notes

The insurance team needs your full clinical reasoning documented:

Subjective: Owner’s description of the problem 

“Owner reports limping on right rear leg for 3 days, worse after exercise”

Objective: Your physical exam findings 

“Grade 2/4 lameness RRL, pain on manipulation of stifle, positive drawer sign, mild joint effusion noted”

Assessment: Your clinical diagnosis 

“Suspected cranial cruciate ligament rupture, right stifle”

Plan: Treatment recommendations and follow-up

“Radiographs scheduled, discussed surgical options, prescribed carprofen 75mg BID”

Diagnostic results (the full picture)

Include complete lab values, not just “CBC normal.” Insurance reviewers need actual numbers to identify trends and rule out pre-existing conditions.

“CBC: WBC 8.2 (6.0-17.0), RBC 6.8 (5.5-8.5), HCT 45% (37-55%) Chemistry: BUN 18 (7-27), Creat 1.1 (0.5-1.8), ALT 62 (10-125)”

Common record types that slow down claims processing

Well-meaning pet parents often submit documents that seem relevant but lack the clinical detail claims advocates need, inadvertently delaying their own claims. Pet owners typically grab whatever paperwork they have without understanding what insurance companies actually require.

The most frequent issue occurs when pet parents submit brief after-visit summaries instead of complete SOAP notes. Discharge instructions like “Bella seen today for limping. Prescribed pain medication. Return if not improved in 5-7 days” seem comprehensive to owners but don’t establish symptom timelines, severity, or rule out pre-existing conditions. 

Similarly, pet owners often submit simple vaccination records or health certificates for travel that don’t provide detailed physical exam findings that establish baseline health status. Raw laboratory results without clinical context also leave advocates without crucial information about why tests were performed or whether conditions are acute versus chronic.

How to educate your clients: When pet parents mention insurance during visits, briefly explain that insurance companies need complete medical records from your practice management system, not simplified discharge sheets, to process claims efficiently. Consider offering to submit records directly to their insurance company to ensure the right documentation reaches the right place.

How can my practice submit records to Lemonade efficiently? 

When your clients need you to send their medical records directly to Lemonade, streamlining the submission process saves time for everyone involved.

Email submission

Send medical records to: [email protected]

Critical detail: Include the pet’s policy number in your email subject line for fastest processing.

Subject line format: “Medical Records – Policy #[Policy Number]- [Pet Name]”

Email body template: To whom it may concern:

Please find attached medical records for [Pet Name], owned by [Client Name], Policy #[Policy Number].

Records include:

• Complete medical history from [Date] to [Date]
• SOAP notes from all relevant visits
• Diagnostic test results and imaging reports

If you need any additional information or clarification regarding these records, please contact our clinic at [phone number].

Thank you, [Your name and title] [Clinic name]

Fax submission

Fax medical records to: 929-990-4039

Critical detail: Include a cover page with the policy number prominently displayed.

Cover page format: 

MEDICAL RECORDS SUBMISSION 

Pet Insurance Policy #[Policy Number] Pet Name: [Pet Name] Owner Name: [Client Name] Date of Birth: [Pet’s DOB] From: [Your clinic name and contact info] Pages: [Total number of pages including cover]

Best practices for submission

• Double-check policy numbers: A single digit error can delay processing 
• Include complete records: Send all relevant visits, not just the most recent appointment
• Use clear file names: “Bella_Rodriguez_Medical_Records_2024.pdf” is better than “Records.pdf”

Optimization strategies for smoother claims

Document the timeline clearly

When addressing ongoing conditions, establish clear dates for:

• First observation of symptoms
• Initial presentation to your clinic
• Diagnosis confirmation
• Treatment initiation

“First noted mild coughing 2 weeks ago per owner. Presented today with increased frequency and exercise intolerance. Radiographs confirm early bronchial pattern consistent with chronic bronchitis.”

Address pre-existing questions head-on

If you’re seeing a pet for the first time, note what’s truly new versus historical:

“New patient exam. Owner reports no previous history of skin issues. Current generalized pruritus and erythema appear acute, began 5 days ago coinciding with diet change.”

Include relevant negative findings

What you didn’t find can be as important as what you did:

“No evidence of heart murmur, respiratory abnormalities, or abdominal masses on examination. Lameness isolated to left forelimb.”

Next steps: Optimize your practice

For your team: Review your current SOAP note templates. Are they insurance-friendly, or focused purely on clinical care?

For new clients: When clients mention pet insurance during appointments, remind them to submit recent records promptly after enrollment.

For claims: When clients face claim delays, offer to provide additional clinical context that might help clarify the timeline or condition severity.

For record submissions: Train your staff on proper submission protocols, including policy number formatting and contact information for Lemonade and other popular insurers at your practice.

Your role in the claims process

Remember: You’re not just treating the pet, you’re creating the foundation for your client’s financial recovery. The fifteen minutes you spend creating comprehensive SOAP notes can save your clients weeks of frustration and thousands of dollars in delayed reimbursements. In an industry where clear communication saves lives, let it save claims too.

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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.