Do Pet Insurance Companies Offer Pre-Authorizations?

Pre-authorization in pet insurance, sometimes called prior authorization or a letter of guarantee, is not a universal feature. Some insurers offer it, some don’t, and the ones that do handle it differently enough that the term can mean something quite different depending on the carrier. At Lemonade Pet, the process is called a pre-approval: a formal confirmation of coverage eligibility for a specific procedure before treatment happens, rather than a reimbursement request after.

What is a pet insurance pre-authorization, and does every insurer offer one?

Pre-authorization in pet insurance is a formal confirmation from the insurer that a proposed treatment plan is eligible for coverage, before treatment begins. Think of it as a green light with a dollar figure attached. In some markets and with some carriers, this is called a letter of guarantee.

The short answer to whether every insurer offers it: no. Pre-authorization is not a standard feature across pet insurance carriers. Some process everything after the fact and reimburse the client directly, with no pre-treatment confirmation available. Others offer a version of it through separate workflows. Knowing which carriers offer it, and how, is increasingly useful clinical knowledge for practices with a high proportion of insured clients.

At Lemonade Pet, the process is called a pre-approval. The terminology is different, but the function is the same: a client can request a confirmation of coverage eligibility for a specific procedure before it happens, rather than submitting a claim and waiting for reimbursement after. The rest of this guide focuses on how that process works at Lemonade specifically, what your practice needs to provide, and how to build it into your front desk workflow.

It’s also worth clarifying what a pre-authorization is not: a guarantee of full payment. Pre-approval confirms eligibility for coverage based on the information submitted at the time of request. It doesn’t override deductibles, co-insurance, annual limits, or exclusions that may surface during final claim review. Make sure clients understand that distinction before they assume the bill is fully handled.

When is a pre-authorization worth pursuing?

Pre-authorization isn’t appropriate for emergency cases where immediate intervention is required. It’s a planning tool: best used for high-cost, schedulable procedures where the client has time to get a coverage answer before committing to a treatment plan.

As a general guideline, Lemonade Pet pre-approvals are most appropriate when the estimate exceeds $3,500. Cases where pre-authorization genuinely helps your team and the client:

• Orthopedic surgery (TPLO, FHO, fracture repair): estimates often run $4,000–$8,000+, and knowing coverage status before scheduling changes everything
• Oncology workups and treatment plans: chemotherapy protocols and staging diagnostics are high-dollar and multi-visit, making pre-authorization especially valuable
• Specialty referrals: when you’re sending to a cardiologist, neurologist, or internal medicine specialist, the client benefits from knowing what’s covered before the appointment
• Advanced imaging: MRI, CT, or scintigraphy

For routine wellness visits, minor illness cases, or straightforward diagnostics, a standard post-visit claim is all that’s needed. The same applies on the other end of the spectrum: when the clinical picture requires immediate intervention, pre-authorization isn’t the right tool. Proceed with care, then advise your client to submit the claim once the patient is stable. Where pre-authorization earns its place is in the middle: planned, high-cost procedures where you have a clinical window to get approval before moving forward, and the patient can safely wait for it.

How does the Lemonade Pet pre-approval process actually work?

Understanding the process from the insurer’s side helps your team set accurate expectations with clients and avoid common friction points.

Who initiates it

The pre-approval request must come from the policyholder, not the practice. Clients can initiate a request through Lemonade’s customer experience team. The practice’s role is to provide the documentation that supports the request, primarily a detailed, itemized estimate for the specific procedure or diagnostic being proposed, and any relevant medical records.

Who reviews it

Pre-approvals at Lemonade Pet are handled by an experienced, dedicated team of claims advocates, not a general queue. This matters for your team to know: if a client tells you their pre-authorization is under review, it’s being looked at by someone with specific experience in evaluating these cases.

How long it stays active

Once a Lemonade Pet pre-approval is approved, it remains active for 90 days. During that window, when the policyholder submits their final claim after treatment, they can link it directly to the pre-approval in the Lemonade app during the claim submission flow. This linkage is done by the client, not the practice.

If a pre-approval expires without a claim being submitted, the condition or treatment doesn’t become ineligible. It simply means future claims for that treatment won’t be linked to the pre-approval and will be reviewed as standard claims instead.

One claim per pre-approval

Only one claim can be linked to a given pre-approval. Follow-up claims related to the same case need to be linked to the initial claim, not the original pre-approval. The linked claim should also match the condition and treatment specified in the pre-authorization. For example, if a pre-approval was approved for a TPLO procedure for a CCL rupture, pre-operative bloodwork or a surgical consult should not be linked to that pre-approval. Only the TPLO claim itself should be linked.

What does the practice need to provide?

While the pre-authorization request is initiated by the client, the documentation that supports it comes largely from your practice. Submitting complete, accurate records the first time reduces back-and-forth and keeps the process moving.

What Lemonade Pet needs to process a pre-approval:

• A detailed, itemized estimate for the specific procedure or diagnostic from your hospital
• Complete medical records, including SOAP notes for the presenting visit
• Prior medical records sufficient to support a medical record review, which Lemonade Pet may conduct at the time of the pre-approval submission
• Specialist referral letter if the client is being referred

One thing that consistently slows pre-authorizations across all insurers: incomplete medical history. If you’re a specialty or emergency practice seeing the patient for the first time, request records from the primary vet before the client initiates their pre-approval request. Insurers, including Lemonade, will need them to complete their review, and waiting on records adds days to the process.

How does Lemonade compare to other insurers on pre-authorization?

Not all pet insurers offer pre-authorizations, and the ones that do handle them differently. A few distinctions worth knowing for your team:

Reimbursement vs. direct pay: Most pet insurance policies, including Lemonade Pet, reimburse the client after treatment. The client pays the practice at discharge, submits the claim, and receives reimbursement from the insurer. A smaller number of insurers pay the practice directly at the point of service. Each model has different implications for your AR and discharge workflow.

Pre-authorization availability: Some insurers don’t offer pre-authorizations at all. Knowing that Lemonade Pet does, and being able to communicate that to an insured client before a high-cost procedure, is a practical advantage in the exam room.

Turnaround time: Lemonade Pet’s AI-assisted claims review is designed to move faster than traditional manual review processes. For pre-approvals specifically, this means clients are more likely to get an answer in a timeframe that actually informs their decision, rather than after they’ve already proceeded with treatment.

Preventative care exclusion: Lemonade Pet pre-approvals are for accident and illness conditions only. Preventative treatments and medications, including spay/neuter procedures and heartworm prevention medications, are not eligible. This is consistent with how most insurers handle pre-authorization, but worth confirming with clients who may assume otherwise.

A front desk SOP for Lemonade Pet pre-authorizations

A simple workflow your CSRs and practice manager can implement without rebuilding anything from scratch.

Step 1: Insurance status at check-in

Train every CSR to ask at check-in: “Does [pet name] have pet insurance? If so, which carrier?” Flag Lemonade Pet policyholders in your practice management software. For high-cost cases, note it for the DVM before the appointment starts.

Step 2: Flag pre-authorization-eligible cases

When a treatment plan is developing that’s likely to exceed $3,500, flag it as a potential pre-authorization case. The DVM should note it in the visit summary, and the CSR should inform the client that their Lemonade Pet policy may offer a pre-approval option before they proceed.

Step 3: Prepare the documentation package

Before the client initiates their pre-approval request with Lemonade, have your itemized estimate ready. Make sure it’s broken down by line item, not a single lump sum. If you’re a specialty practice, request prior records from the primary vet proactively.

Step 4: Set client expectations clearly

Script for CSRs: “Lemonade Pet offers a pre-approval process for cases like this. You’ll need to initiate the request through Lemonade directly, and we’ll provide the estimate and any medical records they need from our side. Once approved, your pre-approval stays active for 90 days. We’ll help you with the documentation, but the request itself comes from you as the policyholder.” This keeps your team in the right lane and gives the client a clear next step.

One last thing

Pre-authorization isn’t a standard feature across pet insurance, and the practices that handle it best are the ones that know which carriers offer it and how the process works before a client is sitting in the exam room with a $6,000 estimate in front of them.

Lemonade Pet’s pre-approval process is designed with speed and clarity in mind: an experienced dedicated team, a 90-day active window, and AI-assisted review that reduces turnaround time all add up to a more functional answer for clients at the moments that matter most. Knowing that, and being able to communicate it clearly, is one more way your practice can turn a stressful financial conversation into a manageable one.

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 the policies issued, 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 may not be available in all states. Please note that statements about coverages, policy management, claims processes, Giveback, and customer support apply to policies underwritten by Lemonade Insurance Company or Metromile Insurance Company, a Lemonade company, sold by Lemonade Insurance Agency, LLC.  The statements do not apply to policies underwritten by other carriers.