Does Pet Insurance Cover ACL Surgery? What to Know

Pet insurance can help cover the cost of ACL surgery for dogs, as long as it isn't the result of a pre-existing condition. Comprehensive and accident-only policies may provide coverage, though the exact terms vary by plan. ACL surgery can be expensive, often ranging from $3,000 to $5,000, making it important for pet owners to review their insurance policy’s terms and conditions. Understanding what’s covered can help owners plan for veterinary expenses and avoid unexpected costs.

Understanding ACL Surgery Coverage in Pet Insurance 

If your pet needs ACL surgery, the procedure could be covered under both comprehensive and accident-only pet insurance plans. ACL surgery is a common surgery in dogs, though it’s quite rare in cats.

When your pet injures their knee or has chronic pain in the area, your vet might recommend ACL surgery to repair their ligament. Dogs and cats actually don’t have an anterior cruciate ligament (ACL) like humans. They have a cranial cruciate ligament (CCL) instead. However, since ACL is the more familiar term for this ligament, many veterinarians use the terms ACL and CCL interchangeably.

Comprehensive Coverage: What It Means for Your Pet 

Comprehensive pet coverage (accident and illness) is the most inclusive type of policy, and your pet’s ACL surgery is more likely to be covered under it. A torn ligament can have a number of causes that may be categorized as either accident-related or to due to degenerative condition. For example, they could have a traumatic rupture from a bad jump or developed a partial tear due to wear and tear on their ligament.

Accident-Only Coverage: How It Could Affect ACL Surgery Claims 

An accident-only plan may not cover ACL surgery, depending on whether ACL injuries are excluded from your plan as well as how the injury occurred. These plans cost less than comprehensive ones because they only cover accident-related medical costs.

An accident is a sudden, unexpected mishap. For example, if your pet falls and tears their cruciate ligament, that’s considered an accident.

But if your pet is a high-risk breed, such as a Labrador Retriever, and experiences gradual damage to its knees, the provider would likely may deny coverage for a ligament tear, considering it a pre-existing condition.

Navigating the Process of ACL Surgery Coverage

Each insurer has a slightly different process, but let's review how pet insurance coverage for a ligament surgery usually works.

1. Identify your pet's symptoms, such as limping.
2. Schedule and attend a vet appointment for an examination and X-ray.
3. Obtain a diagnosis of an ACL tear.
4. Discuss treatment options and schedule the surgery if recommended.
5. Pay for the surgery at the vet's office.
6. Submit a claim to your pet insurance company with the itemized invoice.
7. Wait for the company to review your claim and documentation.
8. Receive reimbursement if the claim is approved. 

Understanding Limits and Exclusions in ACL Surgery Coverage

Since ACL injuries are so common, some insurance companies have specific terms regarding their exact coverage. Here are some limits and exclusions you may find in the fine print.

Pre-Existing conditions

Pet insurance policies typically don’t cover injuries or illnesses that occurred before your plan went into effect or during the plan’s initial waiting period. ACL injuries may have a longer waiting period, such as of six months, much longer than the typical two weeks for other conditions.

So, if you’ve noticed your dog’s occasional limping before or in the months after creating a policy, and the vet diagnoses it as cruciate ligament degeneration, it’s considered a pre-existing condition. Many policies won't cover that ACL surgery.

Bilateral Condition

Bilateral conditions are issues that occur on both sides of your pet’s body. Once your pet has injured one cruciate ligament, the chances are high that they’ll also have trouble with the other one. Most insurers have specific exclusions related to these conditions.

So if your pet had a torn ACL on the right side before you signed up for insurance, and then needed surgery on their left side, it would likely be considered a pre-existing condition, and the claim may not be covered.

Estimating the Costs of ACL Surgery for Pets

ACL surgeries can cost between $1,500 and $10,000 or more per knee. Some providers may offer a discount if your pet needs both knees operated on at the same time. Surgery costs depend on factors like:

• The extent of the injury
• Your pet’s age, size, and overall health
• Medications used
• Your location 
• The type of surgery done

There may also be additional costs for follow-up appointments, pain meds, mobility devices, and rehabilitation if you’d rather have a professional help with physical therapy. Many vets include post-surgery check-up appointments and a set of X-rays in the surgery cost.

Remember that even when insurance companies cover surgery costs, you will likely need to pay your vet upfront first to later receive a reimbursement. And you won’t get back your deductible and co-insurance amounts. 

Moreover, your pet insurer may not cover follow-up visits or vet-recommended physical therapy. Some providers cover these expenses through an add-on to your plan.

Pet Insurance Companies That Cover ACL Surgery 

If you want to sign your pet up for an insurance policy, be sure the insurer covers ACL surgery. 

For example, Embrace Pet Insurance, Lemonade, and Fetch Pet Insurance are among the companies that say they will cover surgery for ACL tears.

The cost of pet insurance that covers ACL tears will vary based on several factors, including the insurance company's rates, your location, your dog's age and breed, and the amount of coverage your choose. Accident-only insurance is less expensive than comprehensive insurance, but it will likely only cover ACL tears as a result of a sudden incident, not from slow degeneration. For example, the average cost of an accident-only policy for dogs from Progressive Pet Insurance is about $9 per month versus $42 for a comprehensive policy.

When comparing pet insurance plans, you’ll want to get a customized quote for your specific animal. Note any exclusions.

Frequently Asked Questions (FAQs)

The Bottom Line

Comprehensive pet insurance typically covers ACL surgery unless the injury is pre-existing, while accident-only policies generally cover it if caused by an unexpected accident. Coverage details, exclusions, and reimbursement limits vary by policy, so it’s important to review your plan carefully to understand what expenses will be covered.