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Is gradual weight loss a pre-existing condition?

Published on: March 03, 2023 • By: DarkLight49 · In Forum: Cats
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DarkLight49
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March 03, 2023 at 10:31pm
My cat has been diagnosed with either IBD or lymphoma based on thickening of the intestines as seen on ultrasound. I have pet insurance that should pay for a biopsy so I'll know what she has, but I'm concerned that the insurance company will reject my claim based on what's in her medical records. I initially took her to the vet because I noticed a marked loss of weight and loss of appetite within the last few weeks, but looking back at her health records, she's been gradually losing weight since we first got her 7 years ago. She was 11.25 pounds at age 1, probably too heavy for her size, and 10.69 pounds 5 years later. During her enrollment exam (which was just a few months after she weighed 10.69 lbs), she weighed 10.24 lbs. Two years after that, she dropped to 9.56 lbs, but that was during the coverage period, so I don't think they can use anything that happened after enrollment to claim she had a pre-existing condition. What concerns me is that she dropped a little weight prior to being enrolled, and showed a gradual loss of a total of 1 lb over a period of around 5 years prior to and just after the enrollment period. The vet never told me she seemed unhealthy or that he had any concerns about the weight loss. I just assumed it was normal based on change in diet and activity after she was adopted, and being a little overweight to begin with. BUT, could the insurance company look at that weight loss over the pre-enrollment period and use that to claim she had a pre-existing condition? I can't imagine IBS or lymphoma could cause weight loss that slowly, it seems to me like she was pretty normal and healthy until very recently when I started to notice a loss of appetite. Just wondering if gradual weight loss over a period of years could in fact be an early indication of IBD and if the insurance company could use this to deny my claim even though there are millions of other reasons why she might have lost weight during that time, including change in diet, activity level, etc.
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Liz Buchanan BVSc MRCVS
Keymaster
March 03, 2023 at 11:25pm
Hello - thankyou for that thought-provoking question and I'm sure you won't be surprised to see me write:  it's difficult.  I cannot say in advance what your vet will say to the insurance company, or what the insurance company will try to argue.  I think that your vets' opinion carries more weight than mine.
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Liz Buchanan BVSc MRCVS
Keymaster
March 03, 2023 at 11:34pm
That said, if your vets have previously noted weight-loss that is purely explainable by dietary changes etc. and particularly if there has been a gap between that and further weight-loss, it may be arguable that the weight loss in the second case was independent of the first.  Particularly if the claim is put in for lymphoma or IBS, not weight-loss.  I think that, in this position, I would ask your vet directly whether they would be prepared to support your claim and whether they would expect the company to pay out under the rules as you are both aware of them.  It is not in vets' interests to charge you large sums of money that they know are never going to get refunded;  they might even agree to make enquiries of your insurance company in advance, but of course you would have to give your permission for this.  Different insurance companies are different.  Wiwhing you the best of luck in taking this case forward.  
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DarkLight49
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March 04, 2023 at 04:25pm
Thank you, I appreciate your quick reply. It's probably a little early to worry ... maybe they won't even say anything about the weight loss. But it's good to know that there are options if they do reject the claim. I'll make sure to ask my vet what she might be able to do the next time we see her. Thank you again.
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