Insurance, decoded · Blog

Pet insurance, for the day you need it.

Pet insurance is the financial backup plan you hope to never use — but if your dog tears a CCL or swallows a sock, you'll be incredibly grateful you set it up before it was needed. Here's how surgery coverage actually works.

The three plan types.

Accident-only. Cheapest premiums. Covers surgery from injuries — fractures, lacerations, swallowed objects. Doesn't cover illness. Good for budget-conscious owners who want emergency protection.

Accident and illness. The standard. Covers both injury-related and illness-related surgery — including the big ones like CCL repair, cancer removal, GI foreign-body extraction.

Wellness add-on. Routine care: annual exams, vaccines, dental cleanings. Usually a small add-on rider, not a standalone plan.

If you can only choose one, accident + illness is the one that covers the surgeries you're most likely to face.

The three financial levers.

Every policy combines three knobs that determine what you actually get reimbursed:

Deductible — what you pay out of pocket before insurance kicks in. Annual deductibles range from $100 to $1,000+. Higher deductible = lower premium.

Reimbursement percentage — typically 70%, 80%, or 90% of the eligible bill after the deductible. Higher percentage = higher premium.

Annual cap — the most insurance will pay in a policy year. Ranges from $5,000 caps to unlimited.

Combined: a $5,000 surgery with a $500 deductible and 90% reimbursement nets you $4,050 back from the insurer. Out of pocket: $950.

What's typically covered — and what isn't.

Covered under standard accident + illness plans: emergency surgery, cancer surgery, CCL repair (TPLO), foreign-body removal, mass removal, soft-tissue procedures, hernia repair.

Not typically covered: pre-existing conditions (the #1 exclusion across every carrier), spay and neuter (these usually require a wellness add-on), routine dental cleanings, breeding-related procedures, cosmetic procedures.

Waiting periods apply when you first enroll — usually 14 days for illnesses, sometimes longer for orthopedic. If your dog tears a CCL before the waiting period ends, it won't be covered. Sign up while they're healthy.

How to file a surgery claim.

Before surgery: notify your insurer if pre-authorization is required. Confirm the procedure is eligible.

During surgery: you pay the practice in full at the time of service. Almost no insurers pay providers directly — they reimburse owners.

After surgery: submit the itemized invoice, your discharge paperwork, and the full medical record. Most carriers have a portal or app. We provide all the documentation you need at discharge.

Expect reimbursement in 1–4 weeks once the claim is filed cleanly.