The claim summary came through the insurance app on Thursday night, and I read it twice at the kitchen table to make sure I had it right. "Amount applied to deductible: $286.00. Amount reimbursed: $0.00."
Add that to May's claim, and our deductible for this policy year stands at $498 met out of $500. We are, officially, two dollars short.
The two visits
Hank's policy is an accident and illness plan with a $500 annual deductible and 90 percent reimbursement after that. The policy year runs December 1 to November 30. Here's what we've claimed since last December:
- Around May 20: itchy paws, his seasonal spring flare. Exam, a skin sample under the microscope and medication. $212.00.
- Around August 7: a hot spot on his neck and an ear infection on the same side, both blooming during a hot, swimmy week. Exam, clipping and cleaning the hot spot, an ear sample and medication. $286.00.
Both visits were at my clinic, so both bills are after my 30 percent staff discount. Our insurer reimburses based on what we actually paid, so the discount shrinks the claims too. That matters more than people think, and I'll come back to it.
$212 plus $286 is $498. If Hank needs anything else covered before November 30, the first two dollars are ours and 90 percent of the rest comes back. If he stays healthy, the deductible resets on December 1 and we start over at zero.
The honest ledger
We've had this policy since December 1, 2022. Here's the whole picture, premiums against reimbursements:
- Year one (Dec 2022 to Nov 2023): $41.80 a month. A torn dewclaw and an ear infection added up to $640 in eligible bills. After the $500 deductible, 90 percent of the remaining $140 came back: $126.
- Year two (Dec 2023 to Nov 2024): $46.20 a month. $310 in claims, for an ear and an upset stomach. Reimbursed: $0.
- Year three so far (Dec 2024 through August): $52.65 a month, nine payments, $473.85. Claims: $498. Reimbursed: $0.
Total premiums paid since we enrolled: $1,529.85. Total reimbursed: $126. On paper that's a bad deal, and I'm not going to pretend otherwise.
Why I'm still glad we have it
We didn't buy this policy for ear infections. We bought it the week after Thanksgiving 2022, when Hank ate the roast twine and we put a $3,912 emergency surgery on a credit card with no insurance at all. That bill took us until the following August to pay off. (Anything connected to that surgery is excluded from the policy, which is fair.) The policy exists for the next bill like that one.
The $1,529.85 we've paid in premiums is less than half of that single surgery, and his plan has no annual limit. If Hank ever needs something big, at an emergency hospital or a specialist where my discount doesn't apply, the math flips fast. That's the bet we made, and nothing this year has changed it.
It also explains why our small claims rarely pay. My discount knocks 30 percent off his routine sick visits, so it takes a lot of ear infections to clear a $500 deductible. The policy earns its keep in exactly the places my discount can't reach.
From the front desk: a lot of people assume pet insurance pays at checkout, like a copay at their own doctor. Most of it doesn't work that way. You pay the clinic, send the claim and wait for reimbursement, and in a year of only small visits that reimbursement is often zero. I've watched that land as a nasty surprise at the counter more than once. It's much easier to hear before you need it.
Your own math depends on your plan, your clinic's prices and your pet's history, so this is our ledger and not a recommendation. If you're weighing a policy, ask the company to walk you through a sample claim with real numbers.
In the meantime, Hank has three and a half months to find a two-dollar problem. Please, buddy, don't.
