There are many "traps" of pet insurance, and complaints are concentrated in the claim settlement link [pet medical insurance designated hospitals can change to claims at any time, with many exemption clauses and a single compensation limit, and the insured amount is inflated]
According to the data of the "2021 China Pet Industry White Paper", the number of urban pet (cat and dog) owners in China reached 6844.8 million that year, an increase of 7.2021% year-on-year. At the same time, from 2022 to 13, the growth rate of the entire pet market is as high as 5.3960%, reaching <> billion yuan.
However, the related services supporting pets are far from keeping up, and pet medical care is one of the major "hard injuries", not to mention the high cost of hundreds of yuan and thousands of yuan, and the mutual doubts between hospitals and pet owners are more serious.
How to make "hairy children" save more money on medical treatment? Insurance companies smell a business opportunity. In recent years, many pet insurance companies have gone public, but as a "new thing", it faces many complaints.
On March 3, a reporter from the Beijing News entered the keyword "pet insurance" on the black cat complaint, showing a total of 15 complaints, many of which focused on the claim process, pointing out that the product design was unreasonable, "one sample when buying, one sample when compensating", and some customers also reported that pet insurance set deductibles, single compensation restrictions and other terms, so that the product could not meet the demand.
Can a cup of milk tea money a month really buy a guarantee for "hairy children"? On the occasion of 3.15 Consumer Rights Protection Day, in response to the chaos of pet medical insurance, a reporter from the Beijing News launched an investigation.
Designated hospitals change at any time, and it is difficult for consumers to apply for claims
"Small money to protect big illness", "Don't wait for pets to get sick and regret it", "Don't worry about pet serious illness, a cup of milk tea money every month can be done"... Insurance companies offer a variety of attractive slogans for pet medical insurance.
What kind of insurance product is this?
Taking pet medical insurance, which claims to be the top 1 in sales on the whole network, as an example, the protection content is pet disease and accident medical insurance (except for congenital and hereditary diseases): during the insurance period, if the insured pet suffers accidental injury or illness after the waiting period and receives treatment at a pet medical institution recognized by the insurer, the insurer will pay the insurance premium according to the agreed payment ratio and limit after deducting the single deductible stipulated in this contract.
In short, if you buy pet medical insurance, you can be reimbursed by taking a "fur child" to the doctor. According to the regulations, the age of the first insured pet is 60 days ~ 10 years old, and the insured pet must be a dog or cat pet that is healthy and kept for the purpose of fun and companionship.
So, how much is such a pet medical insurance? The promotional page shows that the basic version starts from 14.08 yuan/month, and the medical reimbursement amount is 5000,33 yuan/year; The upgraded version starts from 25.1 yuan / month, the medical reimbursement is 5,64 yuan / year, the premium version starts from 08.3 yuan / month, and the medical reimbursement is <>,<> yuan / year.
At first glance, pet medical insurance is good, but on the public platform, consumers have many complaints about pet medical insurance, and they directly point to the problem of claims.
Yaoyao (pseudonym) is a "regular customer" of pet medical insurance, as early as the beginning of 2021 to buy insurance for the family's cat and dog, last year, her cat went to a pet hospital in Fuzhou for gastroenteritis, and after the treatment, she was denied, but when she took the injured dog to the same hospital this year, she was denied compensation.
"In January this year, I renewed the pet medical insurance for the dog at home, underwritten by ZhongAn Insurance, and had to pay more than 1 yuan a month, in early February, because the dog was bitten and the wound was large, I sent it to the pet hospital. When I took my dog to see a doctor, I also specifically asked the hospital staff whether they cooperated with pet medical insurance, and got a positive reply, and the treatment cost a total of more than 30 yuan. Yaoyao told reporters.
Subsequently, Yaoyao initiated a claim, but did not find the pet hospital when submitting the materials, so she confirmed with the pet hospital whether it cooperated with pet medical insurance, and again received an affirmative reply from the hospital.
However, the claim initiated by Yaoyao was still denied because "your pet was treated at a medical institution not approved by our company, so it is difficult to pay the insurance money for this insurance trip." ”
What is the basis behind the same pet hospital, but there are two different claims results?
When the Beijing News reporter browsed the insurance instructions and important notices of the product, he found that one of them is: the insurer has the right to adjust the list of hospitals according to the actual cooperation, comprehensive service quality and overall risk control considerations, and the user must refer to the latest fixed/non-designated hospital list displayed on the page when taking risks, and the insurer is not liable for compensation for the relevant expenses incurred by hospitals not in the above list.
On March 3, the reporter saw on the insurance page of this pet medical insurance that there were 16,13337 designated hospitals in the country, and when the reporter searched for the pet hospital where Yaoyao's dog was treated in the designated hospital, he found that this hospital was not in the list, that is, the hospital was neither a designated hospital nor a non-designated hospital, according to the regulations, it was impossible to apply for a claim, which was also the reason for the insurance company's refusal to pay.
Yaoyao's experience is not unique.
In 2022, Ms. Dai insured ZhongAn Insurance's pet comprehensive protection insurance for her pet "Milk Candy", the insurance period is from September 2022 to the end of August this year, on October 9, 8, "Milk Candy" was treated in the original designated hospital "Mengbao Pet Hospital", and was found to be cystitis, and on October 2022, it was found to be pancreatitis, ZhongAn Protection Housekeeper recommended that Ms. Dai apply for a claim for pet cystitis separately, so, Ms. Dai first applied for a claim for pet cystitis, on December 10, 15, the claim payment of 10 yuan arrived, on the same day, Ms. Dai then applied for a claim for pet pancreatitis, but received a text message on December 16, 2022, saying that the claim had been rejected because "your pet is not treated at a medical institution approved by our company, so it is difficult to pay insurance money for this insurance". Later, Ms. Dai learned that the hospital that had successfully settled the claim more than 12 days ago was no longer on the hospital list.
The same pet suffers from two diseases one day apart, one disease is paid according to the standard of the designated hospital, and the other disease is rejected due to the late settlement of the claim by more than a month, and the insurance company's hospital list change is rejected.
Both consumers couldn't help but wonder, is it reasonable for insurance companies to adjust designated hospitals or non-designated hospitals at any time. A more extreme situation is that if you take cats and dogs to see a doctor, you specially choose a designated hospital, but after a period of treatment, and then go to settle the claim, but find that the hospital is no longer on the list, according to the provisions of "the user must refer to the latest fixed/non-designated hospital list displayed on the page when taking risks", combined with Ms. Dai's case, the pet owner may be denied compensation. However, the adjustment of the hospital list cannot be predicted by consumers, and naturally there is no guarantee that the hospital claim at the time of pet visit will still be on the list list.
Is this harming consumers? Yang Zeyun, a teacher at the Department of Finance of the School of Management of Beijing Union University, said that in fact, the designated institutions of basic medical insurance for people will also be adjusted, and the designated hospitals that dynamically adjust pet medical insurance belong to one of the ways and methods of risk control of insurance companies. However, unlike human medical institutions, pet hospitals do not have an authority similar to the rating of medical institutions, which is easy for consumers to feel that insurance companies arbitrarily adjust designated pet hospitals, but, from another perspective, insurance companies are not willing to exclude a hospital from designated institutions from the perspective of business, unless the hospital has some obvious insurance fraud.
"Of course, from the consumer's point of view, the most frequent is generally the pet hospital near the home, if it is excluded, the medical expenses incurred cannot be reimbursed, which will definitely affect the consumer experience, at this time, the excluded medical institution should inform consumers in time, so that consumers can change the medical institution in time to obtain insurance protection." Yang Zeyun said.
Wang Guojun, a professor at the School of Insurance of the University of International Business and Economics, told reporters that insurance companies adjust the list of designated hospitals and non-designated hospitals is not a big problem, because to prevent some moral hazard, but must inform consumers, explain, and even directly to consumers customized push, after all, insurance companies hold consumers' personal information and claim information, if not informed, insurance companies directly remove some hospitals from the list of designated hospitals or non-designated hospitals, which violates the legitimate rights and interests of consumers.
The two experts are more consistent with the fact that insurance companies have the power to adjust the list of hospitals, but they must inform consumers.
However, as mentioned above, consumers cannot predict the adjustment behavior of insurance companies, and Ms. Dai's situation may occur. In addition, on March 3, the reporter also randomly called the five hospitals shown on the above-mentioned ZhongAn Insurance pet medical insurance page, asking whether they were designated hospitals of the insurance, and the staff of only one hospital told the reporter affirmatively that it was a designated hospital, and the staff of the remaining four hospitals said that they were not clear and suggested consulting the insurance company.
Consumers wondered: "If hospitals don't know whether they are designated hospitals, wouldn't it be harder for us consumers to know?" ”
In order to fight for her rights, Yaoyao called the 12315 hotline to report, and after more than a month of "ripping off", she finally received a compensation payment of 3 yuan from ZhongAn Insurance on March 7 this year.
So, is there a similar situation with other pet medical insurance? The Beijing News reporter flipped through the pet medical insurance underwritten by Dadi Insurance on Tencent Microinsurance, the premium is 24 yuan / month, the total annual medical / accident reimbursement is 1,2 yuan, in the insurance instructions and statements did not see the relevant instructions of hospital adjustment, in the consultation, the customer service also said that there will be no situation that the hospital is still in the list when applying for insurance, but it is not in the list when the claim is settled.
Of course, some insiders believe: "In fact, the immediate adjustment of fixed-point and non-fixed-point hospitals is also beneficial to consumers, such as some who were not in the designated hospital when they were originally insured, and were later transferred, which is equivalent to expanding the scope of consumer services, but how to inform consumers of such changes more timely and accurately, testing the service capabilities of insurance companies." ”
Single compensation is set limit, inflated insured amount, etc. are "spit on"
Not only that, some consumers also believe that pet medical insurance has problems such as weak practicality and inflated insurance amounts.
Pet owner Yangyang (pseudonym) complained to reporters: "The original intention of buying pet medical insurance was to cope with the high medical costs of cats and dogs, but this type of insurance failed to solve the relevant problems." ”
The reporter noticed that pet medical insurance generally sets the maximum reimbursement amount and deductible for a single accident, for example, the pet medical insurance on Tencent Microinsurance sets a deductible of 200 yuan, and the maximum reimbursement amount of 1000,1000 yuan for a single accident, and explained that for the same disease or accidental injury, it is the same accident (that is, a single accident) that requires long-term and multiple visits for treatment, which indicates that as long as it is the same disease or accidental injury, even if it is a multiple medical treatment, the limit of reimbursement is only 1,2 yuan. The total annual medical/accident reimbursement of the insurance is $12,<>. In other words, even if the maximum reimbursement amount for a single accident is used up each time, it will take <> reimbursements to reach the level of the sum insured.
"A single insurance limit of 1000,1000 yuan or even more than <>,<> yuan does not meet my needs, and it is not uncommon for 'hairy children' to spend thousands of yuan on a medical treatment." Yangyang told reporters.
Short video blogger @青chunyao also "condemned" the relevant behavior on the public platform, saying that he spent 399 yuan to buy a pet medical insurance, pet accident and illness medical insurance premium of 1,5 yuan, a single accident compensation limit of 1500,3 yuan, but the final claim after dog disease only paid 50.<> yuan.
According to the claim results posted by the blogger of Qingchun Qiao, the total invoice amount of the dog for medical treatment is 460 yuan, minus the deductible of 200 yuan per time, minus the amount not covered by 255 yuan, and finally calculated according to the compensation ratio of the designated hospital, the actual compensation amount is only 3.50 yuan.
Yang Guang (pseudonym), president of a pet hospital in Guangxi, rejected the cooperation invitation issued by the insurance company after carefully studying pet medical insurance products, fearing that once the pet hospital is bound to the interests of the insurance company, it is likely to harm the rights and interests of consumers, and then damage the reputation of the pet hospital.
Under the influence of multiple factors, the penetration rate of pet insurance in China is less than 1%. In the view of the Kingdom Army, there are many problems in the pet insurance market, the biggest problem is that the supply and demand are not very smooth, pet owners who want to buy feel that the product compensation is inconvenient, the compensation amount does not meet the demand, and the products provided by the supply-side insurance company are relatively single, much the same. "Insurance companies should do a good job of market research, design products and terms according to the actual market situation, while preventing moral hazard, so that consumers can enjoy greater benefits, and consumers should also shop around when purchasing pet medical insurance to see the terms."
Over-diagnosis and treatment in pet hospitals hinders the development of pet insurance
In addition, some insiders believe that the chaos of the pet medical industry is also a major reason that hinders the development of pet insurance in China, for example, some pet hospitals have excessive medical treatment, which will undoubtedly increase the compensation cost of insurance companies and reduce the desire of insurance companies to cooperate with them.
An investigation by a reporter from the Beijing News found that there is no clear and unified standard on how to price pet medical projects on the market. Xiaozhong (pseudonym), president of a pet hospital in Beijing, said that the charging standards of each pet hospital on the market are different, and how each project is priced and what kind of treatment plan a specific sick pet adopts depends on the individual hospital, so cases of excessive diagnosis and treatment and sky-high charges are not uncommon.
He believes that the cost of examination is the most expensive part of the entire pet medical care, and the pet hospital it manages as an example, a biochemical examination charges 550 yuan, a chest ultrasound examination charges 500 yuan, and a cat triple test charges 220 yuan, and these tests are in the necessary items of pet physical examination, which means that only one pet physical examination, pet owners need to spend thousands of yuan.
Jiang Chuan (pseudonym) also has a deep feeling about the excessive diagnosis and treatment of the pet medical market. Last year, after his beloved pet suffered from keratitis, in the first pet hospital, Jiang Chuan spent more than 2,000 yuan to treat it, of which the examination fee accounted for more than half, the doctor also asked Jiang Chuan to take electrocardiograms, B-ultrasound, CT and other items for the pet, but after a period of treatment, there was no improvement, and the doctor told Jiang Chuan that the pet needed to remove the eyeball to avoid affecting the other perfectly functioning eye.
Subsequently, Jiang Chuan transferred the pet to the hospital, the second hospital required it to re-do various examinations for pets, the total cost of large and small examinations is also about 6,4 yuan, after seeing the disease for more than two months, re-examination once a week, registration fees, instrument fees cost hundreds of yuan each time, cats also need to use 800 different eye drops treatment, hundreds of yuan a bottle of eye drops, Jiang Chuan used more than 8000 bottles of each, in addition, under the doctor's advice, Jiang Chuan also spent <> yuan to buy a corneal protection lens for the pet, in order to treat the pet's keratitis, Jiang Chuan spent nearly <>,<> yuan in total.
Zhang Xianglin, who graduated from veterinary medicine and currently runs a cattery in Liuzhou, shared with reporters his experience of rescuing a stray cat with severe keratitis. He said that due to his limited budget, he bought several bottles of pet eye drops at an internal price of 3 yuan per pet in the pet store opened by his senior brother, and after a few months of "fierce drops", the stray cat regrew its lens and the eyeball was saved. In addition, Zhang Xianglin also revealed that the seemingly "sky-high" cat triple test on the market, in fact, the cost of test strips is only a dozen yuan, the purchase price of 17 yuan pet drugs, the guidance price is 60 yuan, and the low price will be considered "destroying the market".
Why is it so hard to buy genuine pet insurance?
Obviously, the current pet medical market order urgently needs to be rectified, how should insurance companies play a role in it?
Swiss Re pointed out in the "China Pet Insurance Development Report" released in 2021 that the benign interaction between pet insurance and the pet medical industry is crucial, the recognition of pet insurance by the pet medical industry will promote the promotion of pet insurance, and the professional opinions of pet doctors also constitute an important basis for pet insurance compensation, in turn, the rapid development of pet insurance will promote the standardization and standardization of the pet medical industry.
The Kingdom Army believes that in this regard, pet insurance is the same as human insurance, and human insurance has also been promoted in this regard for several years before gradually improving. For example, insurance companies rely on the government's social security resources to open up people's information channels, etc., so far, this aspect is still not perfect, there are still a lot of moral hazard, such as sick insurance, etc., which is an inevitable process. But how to shorten this process is something that insurance companies can consider, for example, whether insurance companies can build alliances with some pet hospitals, and hospitals within the alliance can enter the designated hospitals of insurance companies, which can reduce the cost of policy signing and help supervise the medical behavior of pet hospitals.
According to Swiss Re's analysis, if it grows at a growth rate of about 25%, by 2025, China's pet insurance premium scale is expected to reach about 14.1 billion yuan, and the pet insurance penetration rate is expected to reach more than 2.<>%.
Beijing News reporter Pan Yichun and Li Menghan