So Your Pet Needs ACL Surgery: Will Your Insurance Cover It?

Most pet insurance companies cover ACL surgery if your furry friend injures their knee ligament, but policies have limits and exclusions. Whether pet insurance will cover your pet's ACL surgery will depend on when the injury occurred, whether your insurance covers pre-existing conditions, and other factors. Learn more about how coverage works for this common surgery.

Pet Insurance and ACL Surgery

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 Pet Coverage

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 Pet Coverage

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.

How Pet Insurance Coverage For ACL Surgery Works

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

1. You notice your pet is limping.
2. You schedule an appointment with the vet of your choice.
3. The veterinarian examines your pet and orders an X-ray.
4. Your pet is diagnosed with an ACL tear.
5. After discussing treatment options with the vet, ACL surgery is recommended.
6. You schedule the surgery and pay the veterinarian's office directly.
7. You submit a claim to your pet insurance company with an itemized invoice.
8. The company reviews your claim and supporting documentation. 
9. If approved, your insurance plan helps cover some or all of the procedure’s expenses with a reimbursement check or deposit.

Common ACL Surgery Limits and Exclusions

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.

Average Cost of ACL Surgery

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

Your pet’s ACL surgery is likely covered by your comprehensive pet insurance policy, as long as it wasn’t a pre-existing condition. With accident-only coverage, the surgery should be covered if the torn ligament was caused by a sudden, unexpected accident. However, insurance policies vary on what they cover. Check your policy for exclusions and limitations to know if and how much you’ll be reimbursed for ACL surgery expenses.