WP - Waiting Period or Wellness/Preventative?
These two states do not have any sort of waiting period
New Hampshire
Maryland
Name the 3 parameters that make a claim blue banner eligible
The pet was less than 2 years of age at the time of enrollment
The pet has been enrolled a minimum of 180 days
The invoice amount is less than $1,000
Pet was 3 years old when it enrolled on 7/1/2020. The following exams took place: 5/4/2020, 6/13/2020, 7/20/2020. Which would serve as the EE?
6/30/2020. It is the closest exam that is still prior to the policy effective date.
Give 2 examples of something you would NEVER mark as pre-existing
Erin to listen to options....
The term "spaded" is frequently used by Pet Parents to describe what?
Spay
In which section of the medical records will you likely find notation of when the signs or symptoms of a condition began in the 15-day waiting period?
The subjective section
What four CONDITIONS would make a claim ineligible for blue banner if you did receive the blue banner?
Orthopedic
Cancer
Growths
Urinary in cats
Pet was 6 years old at the time of enrollment on 2/2/2021. They have the following previous visits: 6/6/2019, 7/1/2020, 11/11/2020, 12/2/2020, 3/6/2021. What would serve as the EE?
3/6/2021.
DOUBLE THE POINTS FOR WHY
You are placing a claim to WFI. After you've sent the email to the Pet Parent, what additional 2 steps do you need to take?
Fax/email clinic
Leave a case comment
Princess Fluffy McTwinkle Legs recently had abdominal surgery. She presented 5 days post op for staple placements since her sutures magically disappeared. How did these sutures magically disappear and why wasn't Princess Fluffy McTwinkle Legs wearing her cone?
..................
A dog presents to the clinic after getting into a scuffle with a stray dog. The invoice shows wound repair, blood work, sedation, rabies booster, antibiotics and NSAIDs to go home. Is the rabies booster eligible for coverage or is it wellness/preventative care?
Yes!
DOUBLE THE POINTS FOR THE WHY
You are processing a first time claim and you see that it is blue banner eligible. We have full MR on file. Do you perform the MRR? Why or why not?
Yes. MR always supersedes the blue banner so that we can ensure proper coverage and a good Pet Parent experience.
There are 2 aspects of the enrollment exam being a red rule. Both are done at the time of the medical record review. What are they?
Verify that the EE took place and record it in the claim wizard.
When placing a claim to WFI, what option requires you to enter veterinary hospital information?
Incomplete MR - 1st Claim
When reviewing medical records in this format, the term "chicken scratch" often comes to mind. These may also invoke a slew of curse words muttered under your breath.
Handwritten
A cat presents to the ER for lethargy. It has a fever of 105. The invoice has IVF, IV antibiotics, chest rads, abdominal ultrasound, fecal, 4Dx, CBC/Chem/UA, and a convenia injection. Is there anything not eligible for coverage? If so, what?
No, everything is eligible for coverage.
You are processing a first time claim and see NO blue banner. On the invoice are the following items: nail avulsion repair, bandage, antibiotics and an NSAID. Do you need full MR or can you process as is?
A pet parent submits a rabies certificate from a veterinary hospital they took their pet to 2 weeks prior to the policy effective date. She had been adopted 2 months prior and there are no additional prior veterinary visits. The pet parent says this is all the medical records there are. Do we use this as an EE? Why or why not?
No. If the pet parent took in the pet, then there should be actual SOAP notes since they would have had to do an exam for a new pet. The only time we can use a rabies certificate as an EE is if it was from a shelter/adoption group and that's all that can be provided.
What sort of time frame would we ideally want in terms of MR for a 5 year old pet?
2 to 3 years if possible
How many trees per year are killed to print Banfield medical records?
.....................
A 2 month old puppy has the EE during the 15-day waiting period. At that time, a grade 2 heart murmur is noted. The murmur is not noted again. Will we exclude heart disease from coverage moving forward?
No, heart disease WOULD be eligible for coverage moving forward.
DOUBLE THE POINTS FOR WHY
You are processing a first time claim. The pet has been enrolled for 46 days. We have no medical records, but the invoice looks like an acute corneal ulcer (fluorescein stain, ofloxacin, eye serum). Can you process this claim without medical records?
No, even though it appears acute, we still require MR since it's not blue banner eligible.
A 9 year old dog is enrolled on 12/1/2020 and the Pet Parent forgets to do an enrollment exam. They take the dog in on 4/4/2021 for acute vomiting. On exam, he has a painful abdomen and they suspect he has pancreatitis. They also find a growth on his right eyelid, crepitus of bilateral elbows, a fractured right canine. The dog is noted as totally healthy at the recheck visit 4/20/2021. Can we cover all of the above issues in the future? Why or why not?
We can cover the vomiting since it was acute, but everything else is a chronic issue that will require long term medical management.
Name 4 dental related conditions that HPPI could extend coverage towards if not pre-existing or excluded from coverage.
Stomatitis, enamel dysplasia, FORL, fractured teeth, malocclusion, etc.
What is the worst dog breed out there and why is it a French Bulldog?
Best answers win!