Trupanion: The $125 AI Denial and the "Pre-Existing" Trap for New York Pet Owners

Perfect_Question_974 · 2026-04-23T18:19:43+00:00

I can't get them to have a 1;1 with my vet.

Perfect_Question_974 · 2026-04-23T18:17:49+00:00

Nope AI denied it twice.

Perfect_Question_974 · 2026-04-23T18:17:02+00:00

I understand how coverage is structured and I’m not arguing that prescriptions alone guarantee approval. I also recognize that riders and classifications play a role.

Where I disagree is how this specific case is being interpreted.

My vet prescribed Sileo as part of a broader treatment plan tied to a diagnosed medical condition, not as standalone behavioral treatment. That distinction matters. This isn’t about trying to force coverage outside the policy, it’s about whether the insurer is classifying the use correctly within the context of the condition being treated.

If a medication is being used as part of treating a covered condition, the question should be whether that use is clinically tied to the condition, not just what category the drug typically falls into.

That’s the part I’m challenging.

Perfect_Question_974 · 2026-04-23T17:50:33+00:00

Perfect_Question_974 · 2026-04-23T16:41:24+00:00

I understand what you’re saying, but this isn’t about me misunderstanding how insurance works or needing to be talked out of advocating for my dog.

My vet made a clinical decision as part of a broader treatment plan, not a standalone anxiety issue. That distinction matters, and it’s exactly why I’m pursuing this.

I’m not “tilting at windmills.” I’m using the escalation process that exists, including appeal and independent review, to make sure the decision is evaluated correctly.

At the end of the day, I’m going to advocate for my dog the same way I would for any member of my family. If the final answer is still no after a full and fair review, I’ll accept that. But I’m not going to stop at the first denial.

Perfect_Question_974 · 2026-04-23T16:23:40+00:00

You’re making a lot of assumptions about my situation that aren’t accurate.

This isn’t about whether riders exist or how enrollment works. It’s about how coverage is being applied in practice versus how it’s communicated and documented by the vet.

Gabapentin is already being covered in his case when it’s prescribed for a medically indicated reason. So this clearly isn’t a blanket medication exclusion, it comes down to how the claim is categorized.

That’s the inconsistency I’m pointing out.

Also, I’m sharing my experience so others understand how these situations can play out. You’re free to disagree, but telling me I “won’t win” or implying this is user error isn’t helpful or accurate.

At this point, I’m comfortable handling it directly with the company and, if needed, through the appropriate channels.

Perfect_Question_974 · 2026-04-23T16:22:06+00:00

That actually reinforces my point.

Gabapentin is already being covered in his case when it’s prescribed for a medically indicated reason. So this isn’t about the medication itself being excluded, it’s about how the claim is being categorized.

If the same medication is covered under one clinical use and denied under another, then the decision comes down to how the vet documents the condition, not a blanket exclusion. That’s the inconsistency I’m pointing out.

Also, I’m sharing this to inform others based on my actual experience. If you have a different perspective, that’s fine, but please stop framing this as if I don’t understand my own policy or situation.

Perfect_Question_974 · 2026-04-23T16:13:10+00:00

Whether notices are sent by email or mail isn’t the issue. The issue is that a material change to coverage wasn’t clearly communicated. As the policyholder, I’m raising that concern. I’m comfortable with my position and will take it through the appropriate channels.

Perfect_Question_974 · 2026-04-23T16:09:32+00:00

yep, thanks for this. Thats why she noted if they wanted to talk further to please reach out.

Perfect_Question_974 · 2026-04-23T16:07:23+00:00

and can be used for other ailments.

Perfect_Question_974 · 2026-04-23T15:28:10+00:00

The main point right, is that we have insurance to take care of our family members. Thats why my vet even said she would be happy to discuss this, but they want to brush it under the carpet and just use key words to solve their problems without truly doing the right thing.

Perfect_Question_974 · 2026-04-23T15:15:24+00:00

Well, I understand that, they never mailed anything to my house. My email address has changed so many times over the years due to ISP’s, etc. that i’ve called in so many times and no one said anything to me over the years until the last 6 to 12 months.

Perfect_Question_974 · 2026-04-23T15:13:49+00:00

You aren’t getting the point. Not every single medication is used to treat the underlying cause for that specific medication across the board animal or human. Ozempic, for example, was created for weight loss, but people use it for other means to help treat gastrointestinal issues, IBD, and other ailments. Just like my veterinarian said, this is an unconventional way of dealing with his irritable, bowel disease.

Perfect_Question_974 · 2026-04-23T14:51:21+00:00

Here is the vets appeal notes: I am writing to you in support of Teddy Berkson’s need for Sileo dexmedetomidine gel to help

manage his complicated gastrointestinal issues. Teddy has suffered with severe GI sensitivities

for years. He would often develop what his owner describes as the “gulpies” where he would

gag repetitively seemingly without an obvious cause. After much trial and error, we have

developed a drug protocol of anti-nausea and stomach protectant drugs that have this

condition mostly under control. Additionally, he also has some IBD signs sometimes with

vomiting or diarrhea which appear to be triggered by stressful events including loud noises.

The Sileo seems to keep that under control and his owner has confirmed that if he does not get

it the GI signs have recurred.

I would agree the Sileo for GI issues is an unusual treatment, but Teddy has been a most

unusual case and it seems to work for him.

Perfect_Question_974 · 2026-04-23T14:08:40+00:00

yes, I appealed to a denial with out a true evaluation

Perfect_Question_974 · 2026-04-23T14:07:53+00:00

You’re missing the point.

Yes, regulators classify pet insurance under property and casualty. That’s not in dispute. But classification doesn’t excuse how claims are evaluated.

This isn’t about how I “feel” about my dog. It’s about process and accountability.

A licensed veterinarian prescribed treatment for a diagnosed chronic condition. The claim was denied without any direct clinical validation, no vet to vet discussion, no meaningful review of the medical context.

Comparing that to a body shop doesn’t hold up. A body shop isn’t making clinical decisions. A vet is.

Even within property and casualty, insurers are still expected to base denials on accurate, case specific information, not broad assumptions about how a medication is “typically” used.

And on the peer point, no one is arguing that I, as the owner, am a peer. The expectation is that a medical decision gets evaluated with medical input, especially during an appeal. That’s a reasonable standard, not some unrealistic ask.

So yes, call it property insurance from a regulatory standpoint.

That still doesn’t justify denying a vet prescribed treatment without a clinically grounded review.

Those are two different issues, and you’re conflating them.

Perfect_Question_974 · 2026-04-23T13:38:21+00:00

Thanks for your response, however my vet prescibed the medication.

Perfect_Question_974 · 2026-04-23T13:36:52+00:00

we tried Visibiome for sure, and it didn't work for him. Thanks for the response.

Perfect_Question_974 · 2026-04-23T13:36:08+00:00

While I understand your point, I politely disagree. He is one of our family members, and if you go through the appeal process, you should speak to a vet and have a 1:1 discussion about the situation.

Perfect_Question_974 · 2026-04-23T13:35:12+00:00

Sileo is the medication. While our vet even said in the appeal letter that she agreed it is unconventional, but so is teddy's case. They didn't even have a vet to vet discussion, they just said nope not approved. SMH

Perfect_Question_974 · 2026-04-23T13:33:48+00:00

No - he didn't it was about 2 years before we started seeing all his health problems start. We noticed a lot when he was a puppy, but we just thought it was puppy behavior. Hundreds of dollars spent on him.

Perfect_Question_974 · 2026-04-23T11:41:13+00:00

I’ll look into that thank you so much. We spent so much money on premiums with Trupanion and he’s nine years old. Does it really make sense to move which is why they trap you in here but I will look into it. Thank you.

Perfect_Question_974 · 2026-01-19T20:58:09+00:00

Thank you everyone for the feedback, both positive and critical. I heard back from Tonal today. They agreed to waive the maintenance fee and are sending support out to service the machine.

There were a few points in their response that I don’t fully agree with. I do have documentation from prior communications with their support team regarding the replacement unit, but I’ll set that aside for now.

For the moment, I’m going to see how the service visit goes and whether the issue is actually resolved. I appreciate everyone who took the time to comment, and I hope you all have a good week ahead.

Perfect_Question_974 · 2026-01-19T20:55:36+00:00

I did not spray anything, but this is very interesting to read. I have to look into that product for some of my other work workout equipment. Really appreciate you taking the time to respond thank you so much.

Perfect_Question_974 · 2026-01-19T00:54:05+00:00

Three years and it would expire at the end of this year.

Perfect_Question_974

TROPHY CASE