Cat IBD, chronic vomiting and pet insurance: when a biopsy changes the diagnosis, and which clause decides

Three labels for one run of vomiting

Veterinary sources use three names where an insurance form tends to see one. The Merck Veterinary Manual (professional version, full review August 2025, last updated June 2026) calls vomiting, diarrhea or loss of appetite that lasts more than three weeks a chronic enteropathy, and defines the term narrowly: "Chronic enteropathies refer to instances in which intestinal inflammation is suspected but not confirmed histologically." It keeps the name idiopathic IBD for the confirmed case, saying "the term idiopathic IBD should be reserved to describe chronic enteropathy characterized by persistent clinical signs and histological evidence of inflammatory cell infiltrate of unknown etiology." By that usage, a cat labelled IBD after a response to a diet or a drug, with no tissue taken, is a chronic enteropathy case. The invoice may still say IBD, and a policy pays or declines on the word the record carries.

Cornell's Feline Health Center (page updated April 2018) names the step that settles it: "A definitive diagnosis of feline IBD requires an intestinal or gastric biopsy and evaluation of the tissue under a microscope." Samples can be taken with an endoscope passed through the mouth or the rectum, or by abdominal surgery, and "Both endoscopy and surgical biopsy require general anesthesia, and the associated risks must be considered when deciding whether to perform these tests." The same page, describing the workup, says "Intestinal lymphoma, a form of cancer, can be particularly difficult to distinguish from IBD in cats." The test that confirms IBD is therefore also the test that can replace it, and that moment is where each policy clause below has to do its work.

The 2023 ACVIM consensus statement on diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies in cats (Marsilio and colleagues, Journal of Veterinary Internal Medicine 37:794 to 816, open access) says that "no single diagnostic criterion or known biomarker reliably differentiates inflammatory lesions from neoplastic lymphoproliferations in the intestinal tract of cats," so the diagnosis is made by "integrating all available clinical and diagnostic data." It adopts lymphoplasmacytic enteritis (LPE) for the inflammatory lesion and low-grade intestinal T-cell lymphoma (LGITL) for the neoplastic one, and it lists small cell lymphoma among the common names for the second. It states that "several arguments support the hypothesis that LPE and LGITL represent a continuum rather than 2 separate disease entities," and that "even after applying all currently available diagnostic tests, ambiguous cases will remain."

The statement also reports a timing difference that bears on every pre-existing clause. In the study it cites, signs had been present for a median of 365 days in cats with LGITL (range 62 to 1,460 days) and 107 days in cats with LPE (range 7 to 1,095 days), a ratio of about 3.4 to 1. It adds that "No study found significantly different clinical signs in cats with LPE or LGITL," that vomiting and weight loss are among the common signs, and that "Although weight loss is the most common clinical sign, it often is overlooked by clients or even veterinarians." Half the LGITL cats in that study had shown signs for a year or longer before they were presented. Twelve months is about 365 days, the reach of Figo's look-back, and that median is about two thirds of an eighteen-month window (roughly 548 days).

The label set can also widen. Merck notes an association between inflammatory liver disease, pancreatitis and chronic enteropathy in cats, and the ACVIM statement uses the term triaditis for the three together. A cat with a long record can therefore carry two or three diagnoses at once, which makes the rule for choosing the predominant one important on schedule-based forms. Both conditions are diseases of older cats (Cornell says IBD occurs most often in middle-aged and older cats, and the ACVIM abstract calls LPE and LGITL common diseases in older cats), which is the age at which enrollment gets harder; the age limits guide records the cut-offs. A weight trend in an older cat can also belong to the thyroid, as the hyperthyroid cat guide shows, or to the kidneys, which the cat kidney disease guide follows. Cornell's workup list names hyperthyroidism, feline leukemia, parasites and certain cancers among the other causes to exclude.

What the biopsy step does to a claim

Two of the ten documents print the biopsy requirement on the IBD line itself. The Nationwide VS-G-3-CA (02-15) schedule lists code 1249 as "IBD or Acquired Lymphangiectasia (Biopsy Required)", and the VS-21 (02-17) Superior Plan schedule, whose pages are printed "Effective 4-07", lists "1249 iBD (Biopsy required)" and, separately, "4010 Lymphangiectasia, Acquired" with the note "(Biopsy required)". Both come from an older Nationwide (Veterinary Pet Insurance) program and are dated samples; current terms may differ. Lymphangiectasia is easy to confuse with lymphoma on a schedule but names something else: Merck's chapter gives "dilation of the lacteals in lymphangiectasia" as an example of a change seen in tissue, and lists lymphangiectasia and lymphosarcoma as separate causes of similar findings.

Before a biopsy exists, the same VS-G-3-CA schedule offers lines that do not ask for tissue: 1241 Enteropathy, 1222 Gastropathy and 2020 Open or Undefined Diagnosis. The form does not say which of them a chronic vomiting claim is filed under. Section 4.A requires that a condition or procedure "must be listed in the Major Medical Plan Benefit Schedule", and section 4.C applies, in each incident, the Column A allowance of "the predominant condition for which your pet received veterinary services", so the line is chosen from the invoice and the chart. The table gives the amounts as printed, per policy term.

The biopsy itself is paid on its result. Section 4.D of VS-G-3-CA says: "We will only pay veterinary expenses for diagnostic testing resulting in the diagnosis of a condition that is covered by this policy." Section 4.E puts the same test on Specialized Diagnostic Tests, which must result in a diagnosis of a condition that is "covered by this policy" and "not an ineligible condition listed on page 10", and caps them at $1,650 per policy term. Endoscopy appears as line 7109 under Specialized Procedures, not under Specialized Diagnostic Tests, so the form does not say whether 4.E and its cap reach it, although 4.D's general wording on diagnostic testing may. Exploratory surgery is its own line (1217), and section 2.T defines Surgical as healing or therapy that requires cutting or entering a part of the body, then adds: "This does not include any diagnostic procedure or biopsy." The form does not say which line a biopsy taken during an exploratory laparotomy is filed under, or whether the $495 and $685 lines can be combined.

VS-21 prices the step differently. Its Specialized Diagnostic Tests list prints "endoscopy 150" and "ultrasound/echocardiogram 150", with the notes "This allowance is in addition to the maximum Diagnostic Allowances as listed for each diagnosis" and "Maximum benefit for Specialized Diagnostic Tests is $1000 per incident." The IBD line carries its own Column B diagnostic testing allowance of $236 and a Column C anesthesia allowance of $95, which matters because Cornell says both biopsy routes need general anesthesia. Proof is asked at both ends: a biopsy for the IBD line, and for cancer section 13.A warns "In all cancer treatment claims, you may be required to submit documentation of a test or tests showing that your pet was treated for a malignant condition," while the chemotherapy footnote says "Proof of malignancy required."

Two other documents attach a condition to the workup period itself. AKC section 9.j says "Any claim for an Illness or Injury where a final diagnosis has not been made will be pended as ineligible until We receive written documentation from Your Veterinarian with the definitive diagnosis." PetPartners section 9.k has a near-identical sentence. Neither says how long a claim can be pended or whether a presumptive IBD label counts as final. For a cat whose definitive diagnosis needs a biopsy, the invoices for weeks of diet trials and imaging can sit behind that sentence.

Where the other eight put the step

The other eight documents never name endoscopy or biopsy, and the step falls under their general words for diagnostic tests, laboratory tests, anesthesia and surgery. Four of them, AKC (5.e), Trupanion (5.e(13)), the Pets Best 12/2015 booklet (9.C.7) and PetPartners (5.e), join VS-21 (8.T) in refusing diagnostics for excluded conditions, so an endoscopy shares the fate of the diagnosis it produces, as VS-G-3-CA states outright.

Nothing in the eight says an endoscopy is covered or excluded as such. A claim for it rides on whether the illness it investigates is covered, and whether the invoice describes the procedure as diagnosis or treatment. That is why the order of events in the example below matters more to these eight than any procedure line.

Ten wordings for the first vomiting note

Every one of the ten documents reaches back past the start date. What differs is the event that counts, the look-back, and the way out. Seven of the ten state no look-back at all (Spot, AKC, MetLife, VS-21, VS-G-3-CA, the Pets Best Arizona sample and PetPartners). Figo's twelve months applies to an illness that first occurred or showed clinical signs, while its chronic-condition limb has no window; Trupanion and the Pets Best 12/2015 booklet look at eighteen months.

Four wordings count a veterinarian's advice as well as signs: MetLife, VS-G-3-CA and both Pets Best editions list "medical advice". A chart line reading "recheck if vomiting continues" is advice before any condition has been named. Trupanion reaches further in another direction: its 5.c(4) counts abnormalities "noted from diagnostic testing, screening or radiographs", which includes a blood value or an image flagged at a routine visit, and its definition of clinical symptoms includes any anomaly "readily detectible by a thorough and complete physical".

The sign limb is worded two ways among the documents that have one. MetLife, VS-G-3-CA and the Pets Best 12/2015 booklet ask whether the pet displayed signs or symptoms "consistent with the stated" condition. The Pets Best Arizona sample asks whether, "based on information from verifiable sources, the Pet had signs or symptoms directly related to the Condition for which a claim is being made", which is the wording of Section 3.F(3) of the NAIC Pet Insurance Model Act (#633, Summer 2022). A vomiting entry is more easily "consistent with" a later lymphoma than "directly related" to it, though the form does not say how the insurer decides, and the Model Act binds an insurer only where a state has enacted it.

Spot dates a condition from the moment signs were observed by anyone, were recorded in the pet's medical record, or "would have been detectable by a routine physical veterinary exam," and its definition of a Symptom reaches any change in "normal function, behavior or appearance," including changes that "did not require treatment at the time of observation." AKC's definition is compact and just as wide: "Symptoms means the first departure from normal function or feeling which is noticed by You or Your Veterinarian, reflecting the presence of an Illness or Injury." Weight is the sign the ACVIM statement says gets overlooked, and a weight recorded at a wellness visit is a dated observation under any of these definitions.

Figo is the only document that writes a rule for exactly this sign. Exclusion 1 lists situations treated as pre-existing and then says: "However, for the purposes of this exclusion, temporary conditions that started prior to the end of the Waiting Period, or the condition manifests after the Original Start Date, and the condition has not shown any Clinical Signs for a period of twelve (12) months, and is considered Cured, the condition shall no longer be considered a Pre-existing Condition." It follows with "Specific situations include, but are not limited to:" and, as item (b), "If Your Pet has been treated for Undiagnosed vomiting and/or diarrhea prior to the end of Your Pet's Waiting Period, Your Pet must be free of conditions with the same Clinical Signs for twelve (12) consecutive months before any conditions with the same Clinical Signs may be covered again;". On its words the clause follows the sign, not the label, so a cat that was treated for undiagnosed vomiting and later gets an IBD or a lymphoma diagnosis meets the same twelve-month test either way. The clause does not say whether the clean twelve months must run before or after the waiting period ends, whether one visit counts as being "treated", or how a condition diagnosed later is matched to earlier "Clinical Signs". Figo's own definitions are the only help: Undiagnosed means "not having been identified by a Veterinarian", and Clinical Signs means "changes in the normal healthy state, bodily function, or behavior of Your Pet observed by You, a Veterinarian, or other observer." The sample is a dog form; its Professional Services definition and its senior-cat rule show the text is written for both species.

The earlier visit's name matters too. Spot's definition of a Behavioral Problem lists "dietary indiscretion" among examples, while AKC defines Dietary Indiscretion as "gastrointestinal upset that occurs when a Pet ingests something its body cannot tolerate, including but not limited to, consumption of table scraps, garbage, or spoiled food" and adds "We consider this an Illness." A vomiting visit charted that way before enrollment is a behavioral problem under one wording and an illness under the other. Neither form says whether such a visit is "related to" a later chronic enteropathy, so the connection is argued from the chart.

The older chart comes with the first claim. Figo's Part II.1 says "Upon submission of Your first Claim, You must include twenty-four (24) months of medical or adoption records unless the Claim is for routine care only." MetLife's claim steps ask for the pet's medical and adoption records for the twelve months before the date of service on a first claim. Spot says it may ask for "the name and contact information of any veterinarian that has ever seen or treated your pet". Trupanion's 2011 form says "The complete medical history/records associated with your pet will be required to process any claim that you may submit," and the Pets Best 12/2015 booklet says it "may require complete medical history/records". An IBD workup is not routine care, so its first invoice pulls the older chart with it.

Which wordings reach the note and the episode

The same chart meets the ten wordings differently depending on two things: how old the wellness note is, and where the day-20 episode falls against each printed waiting period. The note is tried at 8 months, as in the example, and at 20 months (Jun 2, 2024, 610 days before the start).

Three results follow from the table. First, the 8-month-old note is reached by all ten, inside the stated window where there is one and by the bare words "prior to" where there is none. Second, the day-20 episode falls inside only one waiting period, Trupanion's 30 days, where 5.c(1) says "Illnesses that occur during the 30 day waiting period and accidents that occur during the 5 day waiting period will be considered pre-existing conditions." Third, at 20 months the note passes outside the stated windows of three documents (Figo's limb (b), Trupanion and Pets Best 12/2015), yet seven state no window, and Figo's chronic limb and vomiting rule and the Pets Best chronic-condition rule also state none.

Nothing in the table turns on which label the pathologist applies. Each wording attaches to the note and the signs, and none attaches to the report date. The label enters only through the money lines of the next two sections, through the chronic and cured wording, and through the clauses that single out cancer or inherited disease.

Same condition or a new one?

Ten documents use four kinds of claim unit, and the unit decides whether a relabel moves any money: an incident that merges related diagnoses (AKC, PetPartners), a condition defined by its manifestations across diagnoses (Trupanion), a group of signs with code-by-code allowances (the two Nationwide forms), and money measured by the policy period (the other five). The first three kinds, five documents in all, define a unit wide enough to hold a second diagnosis for the same signs.

AKC says an Incident "may include multiple diagnoses when they are secondary or related" and that "If an Incident is recurring or chronic, it will be considered one (1) Incident." PetPartners writes "Recurring, related and/or chronic conditions shall be deemed one incident." Both attach limits to the incident: AKC's Per Incident Limits, and PetPartners' per incident limit, described as the maximum "over the life of your pet(s) for each incident", with "Per incident limits do not reset at policy renewal for such prior period incidents." Whether lymphoma is "related" to IBD is the open word in each. The ACVIM view that the two may form a continuum supports reading them as related, but neither form defines the word. If the diagnoses merge, the second one draws on the first one's limit; if they do not, it opens a new one.

Trupanion's 2011 form defines a condition as "Any manifestations of clinical symptoms consistent with a diagnosis or diagnoses, regardless of the number of incidents or areas of the body affected," and ties the deductible to it: "Once the deductible amount has been met for a specific condition, the policy will pay out all future losses for that condition at the selected co-insurance rate." The words "a diagnosis or diagnoses" are the nearest thing in the ten to a sentence about more than one label for the same manifestations, and they lean toward a single condition and a single deductible. The form does not say who decides that the manifestations are the same.

Nationwide's two forms group signs, not diagnoses. VS-21 defines a Condition as "an illness, injury, or disease" and adds: "All manifestations of clinical signs or symptoms of an illness, injury, or disease, regardless of the number of affected areas of your pet's body, constitute one condition." Its Incident definition makes "Chronic or ongoing conditions, e.g. allergic dermatitis" one incident "no matter how many times you consult a veterinarian", and section 4.A says "Each condition is eligible for payment under only one primary diagnostic code and any applicable secondary diagnostic code, per incident," with section 4.C capping payments at "$4,500 per incident and a maximum of $14,000 for each policy term." If IBD and lymphoma are one condition, one primary code applies, and the form does not say which code takes over when the diagnosis on a running incident changes from 1249 to a neoplasia code. On the 4-07 schedule the dollar gap between IBD (A $478) and Lymphosarcoma (3103, A $528) is $50, and Neoplasia, Small intestine-Surgical (1246) is $870. The larger difference sits in Column D: "300/1200*" for 1246 and 3103 means chemotherapy or radiation up to $300 per treatment and $1200 in total with proof of malignancy, against "--" on the IBD line.

The five that do not group diagnoses are Spot, MetLife, Figo and both Pets Best editions. Spot's "annual deductible amount ... applies during each policy period"; MetLife's sample states "The Deductible will apply once per Policy Period"; the Pets Best 12/2015 booklet defines the Deductible as "The Annual amount you pay out-of-pocket"; and Figo pairs a Policy Annual Deductible with an Annual Maximum Benefit or a Covered Incident Limit, whichever the declarations show, plus an optional Per Incident Copay charged "per Accident, Illness or Injury per Veterinary Provider treating, diagnosing or performing tests for such Accident, Illness or Injury". A relabel moves nothing in the deductible on these five, and only the "related" language (Spot's pre-existing definition, both Pets Best waiting-period clauses "Illnesses and any related Conditions") links one label to another.

One sentence in the ten protects a condition that has already been paid. The Pets Best Arizona sample says: "A Condition for which coverage is afforded on a policy cannot be considered a Pre-existing Condition on any renewal of the policy." The sentence is the closing sentence of Section 3.F of the NAIC Pet Insurance Model Act (#633, Summer 2022), and the cat kidney disease guide follows it through a chronic claim. If the lymphoma is the same Condition the IBD claims were afforded for, the sentence helps at renewal. If it is a new Condition, it does not. The identity question is left unanswered here too. Chemotherapy lines, cancer exclusions and the same sample's clause on prior instances of lymphoma belong to the cat lymphoma guide, which follows the claim once lymphoma is the diagnosis.

Pricing the relabel on one schedule

VS-G-3-CA is the one document where the relabel has a printed price, because it pays by diagnosis code. Its illness definition says "All clinical signs or symptoms of an illness constitute one illness, regardless of the number of affected areas of your pet's body", yet section 4.B sets the Diagnosis Allowances as "the most that we will pay during the policy term for any condition covered by this policy, regardless of the number of incidents or treatments during the policy term", and 4.D adds: "Covered veterinary expenses that are paid under one Diagnosis Allowance are not payable under any other Diagnosis Allowance." Section 4.C bars paying both columns under one code for the same condition: "We will not pay both a Column A Primary Diagnosis Allowance and a Column B Secondary Diagnosis Allowance under any Diagnosis Code that applies to the same condition." Column B is the allowance for the condition "treated along with the primary condition". Two codes in one term therefore pair one condition's Column A with the other's Column B, and the predominant condition decides which way round.

The spread between the two pairings is $200 ($1,565 minus $1,365). IBD alone against neoplasia alone differs by $360, and the unbiopsied Enteropathy line is $465 below the IBD line. These ceilings leave out the Specialized Procedure and Diagnostic Test lines (endoscopy $495, abdominal ultrasound $440), the chemotherapy line ($2,400) and the deductible. The same schedule prices the companions in the triaditis set: Pancreatitis (1270) at $1,220 primary and $485 secondary, and Hepatopathy (1290) at $790 and $305, so a cat with three labels meets the predominant-condition rule three ways.

Set beside the pre-existing clause, the scale is plain. On this schedule a relabel moves a ceiling by a few hundred dollars. A finding that the first sign came before the start date moves it to zero for the condition and, under 4.D, for the diagnostic testing that found it.

Chronic, curable and cured against IBD

Five of the ten define a chronic condition. Spot, VS-G-3-CA and both Pets Best editions use the same words, "a condition that can be treated or managed, but not cured", and Figo defines it as a detectible condition that, "once developed, is deemed incurable or likely to continue for the remainder of Your Pet's life." Only one of the five names IBD. The Pets Best 12/2015 definition continues: "This includes, but is not limited to, Cruciate Ligament Event, atopy, renal disease, osteoarthritis, diabetes, inflammatory bowel disease, Cushing's, heart disease, hyperthyroidism, and hip dysplasia." Its section 9.A then deems chronic conditions pre-existing "if they are Present at any time preceding the Policy Effective Date", and Present includes conditions "in remission or controlled by medication, whether or not the Condition is noted in your Pet's medical records." The Arizona sample from the same administrator keeps the chronic definition, drops the list, drops the any-time rule and adds the renewal sentence, so the two editions answer the IBD question differently.

Cornell's description of the course is close to the forms' wording: "IBD can often be controlled so that affected cats are healthy and comfortable. However, even with proper management, symptoms may come and go." Merck adds that "Relapses occur with chronic enteropathy and are most often precipitated by dietary indiscretion." Those sentences fit "treated or managed, but not cured". Apart from that Pets Best list, none of the forms says whether a given cat's IBD is chronic; the status is left to be argued from the record.

VS-21 is the only document that defines Curable as well as Cured. "Curable" means "capable of being cured", and "Cured" means "resolution of a condition so that ongoing or intermittent treatment is not required and recurrences or complications are not expected." A cat on a maintained diet or a tapering drug has ongoing treatment, and Cornell's own sentence that symptoms "may come and go" cuts against "recurrences ... are not expected". The form does not say whose expectation counts, the veterinarian's or the insurer's.

Spot and Figo test for freedom from "treatment" and symptoms over 180 days and twelve months. Spot's own definition of Prescription Pet Food describes a diet a veterinarian must prescribe "for treatment of a specific covered medical condition for your pet", which makes it hard to call a cat still eating that diet free from treatment. Figo defines Treatment as care "provided and administered by a Veterinary Provider", a definition that does not obviously take in a diet fed at home. Neither clock is stated to include or exclude a prescribed diet.

Every route back tests the cat's state on the day of the claim, not the name of the diagnosis. A cat that was treated for IBD and is now called lymphoma has the same record of signs and treatment under either name, and no document says a new diagnosis starts a new clock. The pre-existing conditions guide sets out how these clocks work in general, and the guide to cover after a diagnosis follows the cat that has no policy yet.

Inherited IBD and the 6546 line

VS-G-3-CA splits IBD in two. Code 1249 is "IBD or Acquired Lymphangiectasia (Biopsy Required)". Code 6546, "Inherited Inflammatory Bowel Disease (IBD)", sits on the list headed "Diagnosis or Medical Treatment for Ineligible Conditions", beside 6547 Inherited Lymphangiectasia, 6022 Gluten-Sensitive Enteropathy, 6021 Histiocytic Ulcerative Colitis and 6020 Hypertrophic Gastritis or Immunoproliferative Enteropathy. Section 6.H excludes "Diagnosis or treatment of any hereditary disorder or any condition caused by or resulting from a hereditary disorder, except as provided in section 7 of this policy." Section 7.A pays "up to $275 during the policy term" for diagnosis or medical treatment of a listed condition and nothing for "any diagnosis or medical treatment provided in the first twelve months that this policy is in effect." On the printed numbers the same signs are worth $1,220 under 1249 and at most $275 under 6546, a gap of $945 and a ratio of about 4.4 to 1, with nothing at all in the first year.

The form defines a hereditary disorder as "an abnormality that is genetically transmitted from parent to offspring and may cause illness or disease", and says the list of conditions it regards as hereditary is kept on the insurer's website or available by phone. The saved text does not say how a given cat's IBD is placed in one column or the other, or on what evidence. The veterinary sources give little to go on. Cornell says "While the cause of IBD is unknown", adds that genetic abnormalities of the immune system are "thought to play a role", and says the cell types a biopsy finds "will indicate what type of IBD is present and help guide treatment", which is a classification of cells, not of origin. Merck says "The etiology of chronic enteropathies is poorly understood in small animals."

The other documents handle inheritance differently. AKC excludes "Congenital and Inherited conditions including Elbow Dysplasia, Hip Dysplasia, OCD (Osteochondritis Dissecans) Osteoarthritis, Spondylosis, Luxating Patella, and Diabetes unless you purchase Optional HereditaryPlus Coverage", and defines Inherited as "an Illness, disease or condition whose presence is determined by genetic factors." PetPartners 5.b excludes "Inherited and Congenital conditions, unless you purchase coverage through our InheritedPlus endorsement" and defines Inherited as "an illness whose presence is determined by genetic factors." IBD is not named in either, and a disease in which genes are "thought to play a role" is not obviously one whose presence is "determined by genetic factors". Spot's definition of Condition includes "hereditary or congenital conditions" as conditions, and MetLife's coverage list includes "a congenital or hereditary disorder" among illnesses. Figo defines a Genetic Condition as "an Illness whose presence is determined by hereditary factors" but, apart from an exclusion for genetic and chromosome testing, uses the term only in its vaccine clause. Trupanion's 2011 form and both Pets Best editions contain none of the words hereditary, inherited or genetic. The hereditary and bilateral exclusions guide sets out how these clauses are usually built.

Diet trial months against the waiting periods

Merck's chapter recommends, unless the animal is debilitated, anorectic or showing severe weight loss, sequential trials before tissue is taken: deworming (fenbendazole for 3 to 5 days), then a hypoallergenic diet fed exclusively "for a period of at least 2 weeks to judge efficacy", a second dietary trial for a stable patient that does not respond, and for a nonresponsive patient a 3 to 4 week antimicrobial trial whose usefulness it calls uncertain. It reports that "A marked response to diet change alone occurs in over 50% of patients with chronic enteropathy" and that "Most patients respond within 2 weeks." Added up, the stated minimums are 17 to 19 days if the first diet works (3 + 14 or 5 + 14) and 52 to 61 days if all four steps are used (3 + 14 + 14 + 21 to 5 + 14 + 14 + 28), before any biopsy. Cornell adds that it "may take several weeks, or even longer, for cats to improve after a diet change." If the patient is debilitated, Merck says the diet and antimicrobial trials are skipped and "further investigations are performed", which can put a biopsy in the first weeks.

Eight of the ten documents print an illness waiting period, from 5 days (AKC) to 30 days (Trupanion), and six of the eight print 14. A first visit on day 10 falls inside seven of the ten waiting periods (the six 14-day ones and Trupanion's 30 days) and outside AKC's 5 days. VS-21 prints no waiting period but an effective date at least 14 days after acceptance, and VS-G-3-CA's form states none. The two Pets Best editions word the wait as "Illnesses and any related Conditions", so signs inside it take related conditions with them. Because the trials run 17 to 61 days, a cat whose first documented visit is in week one or two can reach the end of the sequence after every wait has expired and still have the whole condition dated to a visit inside one.

Which documents pay for the diet itself, and for how long, is settled in the prescription food guide. Here the diet is only a dated chart entry. One clause sets a month count against it: Trupanion's 2011 form covers "the incremental cost of therapeutic pet food when recommended and dispensed by your veterinarian in the treatment of injuries or symptomatic illnesses covered by this policy for up to two months of feeding". The form adds that a pet fed the diet as a long-term replacement is eligible for a discount to its monthly premium. Merck allows a second diet trial for a stable patient that fails the first, and Cornell says improvement may take "several weeks, or even longer", so a cat can still be on a trial diet when the two months are used. The dog side of the same stomach-claim questions, including pancreatitis and repeat flares, is in the dog vomiting, diarrhea and pancreatitis guide.

Matching the record to the clause

Which clause matters depends on where the chart stands, because the forms measure from the first sign and not from the report. Each case names the clause and the written question; choices about tests, diet and treatment stay with the veterinarian.

Asking about the biopsy step before it happens

• Does the insurer treat a later lymphoma diagnosis for the same signs as the same incident or condition as the IBD claims, for the deductible, the per-incident limit and the pre-existing clause?
• Which schedule line or code will a chronic vomiting claim be filed under before the biopsy, and which after it?
• Is the endoscopy, anesthesia and pathology bill paid on the diagnosis the pathology returns, or on the signs that led to the test?
• Is an inherited-IBD code or hereditary list in use, who decides that a cat's IBD is inherited, and on what evidence?
• Does the form count a veterinarian's advice before the start date as well as signs, and does any look-back apply to a vomiting note or a weight entry?
• Are claims pended while there is no final diagnosis, and for how long?
• Does a condition that was covered in one policy year stay outside the pre-existing clause at renewal, and does that protection reach a revised diagnosis?