The Smart Vet's Guide to Pet Insurance Conversations

You’re explaining a $1,800 mass removal when the owner asks, “Will my insurance cover this?” Your stomach drops. You want to help, but you’re not an insurance adjuster. Here’s the thing: you have something more valuable than coverage predictions, you have the medical expertise to help clients file strong claims and get fair reimbursements.

What you absolutely cannot say

Let’s get the boundaries clear first. You cannot and should not:

• Make coverage promises: “Your insurance will definitely pay for this”
• Predict claim amounts: “You should get back about $1,200”
• Interpret policy language: “Hereditary conditions aren’t covered by your plan”
• Give claim filing advice: “Don’t mention the lump was there last month”

These statements expose you to liability and may turn out wrong, damaging your credibility when clients get different answers from their insurers.

What you can say and do to help

Medical history context

This is your superpower. You have documented medical history that supports legitimate claims:

“Looking at Buddy’s file, this ear infection is his first one ever, and it started three days ago, well after your policy waiting period. This timeline and medical history support that this is a new condition.”

Always recommend filing claims

The key message: File everything and let the insurance company make coverage decisions.

“I always recommend filing a claim for any significant treatment. Even if you’re not sure about coverage, it’s better to submit and get a definitive answer. The worst that happens is they say no.”

“Even if you’re not sure about coverage, I recommend filing the claim. Insurance companies make coverage decisions based on medical records and policy terms, not guesswork. The worst they can say is no.”

Offer comprehensive documentation support

Make insurance claims stronger by documenting and offering direct support:

• Timeline details: “Vomiting started 10/15/24 at 3 PM, no prior GI issues”
• Onset descriptions: “Acute onset during normal play, witnessed by owner”
• Previous related issues: “No prior urinary symptoms noted in 3-year medical history”
• Treatment necessity: “Medication required due to bacterial infection confirmed by cytology”

“To make this easier for you, we can submit your medical records directly to your insurance company along with your claim. This ensures they get complete, professional documentation and speeds up the process.”

Real-life conversation examples

Scenario 1: The skin mass removal

Client: “Will insurance cover removing this lump?”

Your response: “Max has a 2-cm skin mass on his shoulder that needs surgical removal and biopsy. The procedure costs $850 including anesthesia and pathology. This lump first appeared two weeks ago according to your notes, and Max has no history of skin masses.

I recommend filing a claim for this. Most policies cover mass removals, especially when they’re new growths like this one. I’ll make sure your claim includes detailed surgical notes, the pathology report, and Max’s medical history showing this is a new issue. We can submit all the records directly to your insurance company to make the process easier for you.”

Scenario 2: The ear infection

Client: “Should I bother filing a claim for an ear infection?”

Your response: “Bella has a bacterial ear infection that requires prescription medication and a recheck in two weeks. Total cost is about $180. Even though this seems minor, I’d recommend filing a claim.

This is Bella’s first ear infection according to her records, and it’s clearly a medical condition requiring treatment. I’ll provide detailed notes about the examination findings, the bacteria we identified, and the treatment plan.”

Scenario 3: The limping dog

Client: “Charlie’s been limping since yesterday. Will this be covered?”

Your response: “Charlie has a sprained shoulder from yesterday’s accident at the park. Treatment includes pain medication, rest, and a follow-up exam next week. Total cost is around $220.

Since this is an acute injury with a clear timeline, he was fine before yesterday’s incident and you’ve had coverage for over a year, this should be straightforward to claim. I’ll document exactly how the injury occurred, my examination findings, and that Charlie had no prior lameness issues. We’ll send everything to your insurer.”

Your role in the claims process

You’re not an insurance adjuster, but you are your client’s best advocate for strong claims. Your job is to:

• Provide detailed medical documentation that supports legitimate claims
• Encourage clients to file claims rather than guess about coverage
• Offer to submit records directly to streamline the process
• Document medical facts that justify treatment necessity and timeline

Remember: “I can’t decide what your insurance will cover, but I can make sure they have all the medical information they need to make a fair decision about your claim.”

This approach builds trust, speeds up reimbursements, and positions you as a valuable partner in your clients’ pet healthcare financing. You’re not doing the insurance company’s job, you’re doing yours better by helping clients navigate claims with professional medical support.

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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.