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Volume 50, Issue 11
A proactive pet owner who receives competent and successful veterinary care for a behavior issue has her claim denied. Whos correct?
Dr. Lisa Haywood had been caring for Fred, the Lanes' German shepherd, for four years. Fred received on-time preventive care, was microchipped, was covered by pet health insurance, and had loving owners.
Recently the Lanes had been visited by their daughter and grandchild. When Fred was eating his dinner and the youngster approached the dog, Fred reacted. He growled at the young boy, the youngster walked away, and Fred continued to finish his dinner. This alarmed Mrs. Lane and she immediately called Dr. Haywood.
The next day Fred came to see Dr. Lisa, his favorite veterinarian. In the exam room, the veterinary technician took Fred's vitals and discussed the reason for his visit. Mrs. Lane told the technician what had happened when her grandson approached Fred's food bowl while he was eating. She hoped to resolve this behavior if at all possible.
Dr. Haywood entered the exam room. She examined Fred and found him to be a healthy patient. She discussed the recent issue involving the young boy and Fred's reaction around his food. After the examination, Dr. Haywood told Mrs. Lane that the behavior Fred displayed was not a result of any pathology. His response to the young boy was a normal protective behavior displayed by many dogs when eating. In some dogs this protective behavior is more pronounced.
She went on to say that the simplest remedy was to feed the dog in an undisturbed setting. In this case, due to the unique circumstance of the continued presence of an inquisitive youngster, a consultation with a veterinary behaviorist would be appropriate.
Mrs. Lane was relieved. She was referred to a behavioral specialist with a diagnosis of exaggerated food-driven protective behavior. The behaviorist assisted Fred by teaching Mrs. Lane some behavioral modification techniques that would alter the dog's response to her grandchild's intrusions. Fred responded beautifully, the child was told not bother the dog when he was eating, and all was well.
That is-until Mrs. Lane summited her pet insurance claim.
The insurer declined both her primary and specialist care treatments based on the fact that the medical history revealed a possible pre-existing behavioral condition that excluded the dog from coverage. Mrs. Lane protested the exclusion to no avail. Finally, she went to her primary veterinarian for help. Dr. Haywood agreed with the owner and contacted the insurance carrier on her client's behalf.
Dr. Haywood made two points. First, her diagnosis and history clearly indicated that the dog's behavior was not pathological but simply a variation on the norm. Second, the judgment that a pre-existing condition may have existed was based on the owner's description of the events as noted by the technician in the record. The insurance company should make a determination of a pre-existing condition based only on the medical notes memorialized by a licensed veterinary professional. Client input in a medical history is a layperson's interpretation of clinical signs and is often misconstrued or inaccurate. She went on to say that, in this case, the veterinarian had never indicated any pathology or presence of an excludable condition in her medical notes.
The insurance company took the case under appeal but ultimately denied the claim. They maintained that the dog had displayed aggressive behavior multiple times over several months. In addition, as the veterinarian had stated, this was not a medical issue but in fact within the scope of normal behavior. They respected the owner's efforts to pursue treatment for the problem; nevertheless, just because the behavior had been recently exacerbated did not mean this dog's aggressive tendencies were not present before insurance had been acquired when the dogs was 14 months of age.
No one was happy with this outcome-no one except Fred, who now had a private dining room.
Who do you think was correct in the situation? We would like to know. Email us at email@example.com.
Dr. Rosenberg's response
First of all, this is an actual case (names have been changed to protect the innocent). Some canine behavioral issues are clearly rooted in eligible medical disorders. For example, acute separation anxiety, head trauma, seizure activity, brain lesions and the toxic ingestion of behavior-altering substances have all been associated with behavioral signs.
Pet insurance should not be considered a be-all and end-all. It's an adjunct support that a responsible pet owner uses to help defray unexpected professional care fees. This particular behavioral problem involving the health and well-being of a youngster was not necessarily a behavioral abnormality, but it was a behavioral problem. The spirit of pet health insurance and its coverage was never intended to pay for canine idiosyncrasies. I do not want to minimize the gravity of this particular situation. It mandates a satisfactory resolution. Nevertheless, I feel it goes beyond the scope of the pet healthcare mandate.
Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Dr. Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors and employees described are fictional.