Fetch, Incorporated

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
Pet Plan continues to ignore my charge that they employ deceptive business practices, that though their deceptive marketing they have become the largest pet insurer in the nationThey need to be up-front and honest on their website and over the phone about how they define pre-existing conditionsPet plan should agree to pay the claims I've submitted
Regards,
*** ***

We want to thank *** ***s for bringing her concerns to our attentionOur customer service agent has personally reached out via phone and email to advise the refunded amounts, and to confirm that the correct amounts were successfully transferred back to the proper accountWe have not been able to speak to *** ***s directly; we encourage her to contact us to further discuss and to verify that she has received the refundsIf *** ***s would like to speak with us, we can be reached 24/at ***

This is in reference to the Revdex.com (Revdex.com)
complaint submitted by *** ***. We
would like to take the opportunity to thank *** *** for bringing her
concerns to our attention. *** ***’s Concern #1:“In purchasing
*** supplement for my pet advertised on box
was free trial for pet
insurance. In signing up for this it
states by upgrading would be given *** for $in day of signed up which I
signed up 12/10. Never received this
gift card.”Response:After receipt of the Revdex.com complaint we researched *** ***’s policy for ***. We found
that *** *** set up a free policy using the *** promotion; and also,
purchased a full policy using the *** promotion. These policies were incepted on the same day
and each have a separate and distinct promotion. Our third party vendor regarding the ***
promotion previously sent *** *** an email to verify her address. According to our records, her address has not
been confirmed. We have requested the
company provide the promised promotion to *** *** at the address provided at
the time of policy purchaseRegarding the *** promotion, our systems did not
recognize an upgraded policy as the full policy was purchased with the ***
promotional code. We have sent *** *** a $*** gift card as promised in the *** offer.*** ***’s Concern #2:“…also in submitting
claims was told no reimbursement since there is a day wait yet upon
purchasing you are required to pay 1st month and last month ahead of
time. My feelings on this matter then
the insurance should be in affect immediately.”Response:Petplan policies have a day illness waiting period and a
hour accident waiting period.
Conditions where clinical signs are first observed during the aforementioned
and respective waiting periods are not eligible for coverage. Additionally, Petplan policies do not provide
coverage for pre- existing conditions, or conditions where clinical signs were
first observed prior to policy inception or during the aforementioned waiting
periods. Specifically, in the case of
***, we received two claims (periodontal disease and hepatopathy). After review of claim *** for periodontal disease the
medical records provided indicate that *** was found to be afflicted with
dental disease in July of 2014. As
clinical signs consistent with periodontal disease were present prior to policy
(policy inception November 30, 2014), and *** ***’s policy does not provide
coverage for pre- existing conditions coverage could not be extended for claim
*** for periodontal disease.After review of claim*** for hepatopathy the medical
records provided indicate that *** was found to be afflicted with elevated
liver enzymes on December 11, (Day of the day illness waiting
period). As clinical signs were first
observed during the day waiting period for illnesses, and conditions consistent
with clinical signs found during the waiting period are not eligible for
coverage, reimbursement cannot be extended for hepatopathy.*** ***’s Concern #3:“Upon recently
cancelling was told reimbursement would be pro rated and received adj of
roughly $recently.”Reponse:*** *** requested cancellation of her policy on March 5,
2015. Per the Terms and Conditions of her
policy any cancellation request days after policy inception is subject to a
pro- rata refund. Specifically, in *** ***’s case this entitled her to $90.09, which was refunded on March 10,
to the credit card on file

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: ***I am rejecting this response because: The insurance is trying to separate the lab work and other claims and medications from being directly related to the foot injuryOn the very first claim, the veterinarian recommended lab work should be done due to the dogs age, in anticipation of having to put the dog under anesthesia to do numerous biopsies,( which was done within 2-weeks due to the foot not responding to medication)Also, the antibiotics caused diarrhea and all three veterinarians who treated the dog said he should be on probiotics while on antibiotics, to help with the diarrhea, which it did. The insurance did not pay for either box which was purchased at the vet officeLastly, they have left out much of the claims information and have very selective in what was sent to you.
After all this time, or more requests, I still have not been provided with a complete itemized list of each visit and what they paid
Per our agreement the insurance company has revived a payment every month, on time because they deduct it form my credit cardI provided every receipt from the vet, current records, Dr notes, and two years of vet records as they requested However when it came time to pay a claim, they have cheated me out of hundreds of dollars of reimbursement money that was directly related to the foot injury and infection
Regards,*** ***

[To assist
us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: Nothing has been resolvedI have submitted the claim & all bills as they requestedSaying that they "hope" to resolve it satisfactorily for me means absolutely nothing*** *** assured me that he would try to get the claim paid & if he couldn't, he would see to it that all of my premiums were refundedI prefer for the company to pay the claim & any ongoing claims for this incidentThat's why I took the insurance & according to what they tell me now, it was completely misrepresented to me when I purchased it over the phoneI bought this insurance & paid the premiums in good faithThey should pay the claimBarring that, a full refund for any premiums paid is expectedThis is working a financial hardship on meI need to have this company step up to the plate & take responsibility for the error made by their representative at the time I purchased the policies---and pay the claim
Regards,
*** ***

We hope this finds *** *** and her pet, *** wellWe would like to take this opportunity to thank *** *** for bringing the concerns she has regarding her claims to our attention via the Revdex.com (Revdex.com)We are sorry to hear about *** ***’s experience. As indicated in the
Terms and Conditions of *** ***’s chosen policy, we will not cover the costs that are incurred for any illness that is caused by, relates to or results from any injury, illness or clinical sign(s) her pet had prior to the effective date of this policy (06/13/2017)As the claimed condition of ear hematoma is related to, resulting from, caused by, and/or the same as these clinical signs (scratching at ears, yeast) and these clinical signs were noted prior to inception of *** ***’s chosen policy, the claimed condition is considered pre-existing and is excluded from coverage as per the Terms and Conditions of her chosen policy. We understand *** ***’s concern with her pets recently denied claimWe have reached out to her to further discuss and offer assistance with available options moving forwardAt the time of this response, we have not heard back from *** ***We encourage her to contact us if she has any questions or additional concernsWere are available 24/at ###-###-#### and are always happy to assist

We sincerely apologize for any delay in processing the submitted pre-authorizationWe have refunded not just back to February 17th 2014, but back to the policy inception date of April 9th, A total of $has been refunded back to the original credit cards from which funds were drawn -
$** *** *** ** *** and amounts $98.13, $98.13, and $to *** *** ** ***These credits should appear within the next 3-business days

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Tell us why here
We would like to thank *** *** for bringing her concerns regarding her billing schedule to our attention via the Revdex.com (Revdex.com.)
*** ***’s concerns have been researched and reviewed. It has been validated that on August 11, *** *** received a
refund in the amount of $25.19. We can certainly understand *** ***’s frustration and apologize for any inconvenience; we are pleased we were able to sort this out.
We thank *** *** for her patience and encourage her to reach out (***) with any future questions or concerns, as we are always happy to assist

Our Customer Service Supervisor (*** ***) is working with **. *** to have the claims in question submitted so that our claims team can analyze the existing medical records and properly assess the claimWe hope to be able to resolve this satisfactorily for **. ***

Petplan has reached out to *** *** regarding this matterAfter further review of the dispute the matter has been resolved according to the terms of the policy, to the satisfaction of *** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:The second response from Petplan associates clearly states that medical records were received from primary veterinary regarding a diarrhea issue, but no actions were performed (i.e., neither accepting nor rejecting claims) This is an insufficient answer if all required documents to assess claim were received Please process this outstanding requestAs far as premiums are concerned, a representative my contact me to discuss alternative options AFTER processing the February claim
Regards,
*** ***

Thank you for your recent communication regarding claim ***. We would like to take the opportunity to address
the concerns presented in the Revdex.com
complaint:
That claim has been denied now twice by PetPlan insurance
(gopetplan.com) due to "missing record(s) from all medical records from
1st visit to the present, from all treating veterinarianswe currently have
one date on file (1/11/2014) therefore the history is incomplete."
Petplan provides an in-depth, thorough review of claims
submitted for reimbursement of veterinary fees.
In order for the review to occur, a complete medical history is
required, as indicated on the claim form (attached) - "Please note that when assessing claims we require at least two years medical history for your petThis history MUST include notes from doctor's examsIf you have not already done so, please download a Medical Record Release Form from gopetplan.com/account and give a copy to all veterinary offices that have treated your pet.".
Upon initial receipt of the claim, the only records we had received were from *** *** *** ***, with no history prior to the claimed dateThe communication sent to *** was simply a request for the medical records prior to that date. At no time was ***’s claim (***) denied
We have sent all medical records for which we are awareTHE DOG
IS A PUPPY AND DOES NOT HAVE A SIGNIFICANT MEDICAL HISTORY
As above, the only records we had received were for the claimed dates at *** *** *** ***After communication with ***, the complete medical history from *** *** *** was received on Friday, February 7, 2013, and confirmation of receipt was communicated via email. On February 11, the claim
review was completed and the submitted claim was determined to be eligible for coverage. On February 12, a check in the amount of
$was mailed
I am a business school professor and it is my impression that the
company may be arbitrarily denying claims to lower its overall costs
In order to verify that submitted claims are eligible for reimbursement per the policy Terms and Conditions, they undergo thorough analysis and assessment. It is our intention to make this process as simple as possible, and we sincerely apologize that this was not the case for ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
RevDex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find it a little disheartening that they managed to include several phonetically similar spellings of my surname, but not once did the actually spell it correctlyIt is precisely this level of attention to detail that concerns me about the manner in which they conduct their businessNevertheless, I have done my due-diligence with respect to their performance when it comes to the actual business they are engaged and will accept their offer/apologyIt should be noted, that the pet insurance policy I purchased when this whole fiasco began also included a $gift card, which has yet to be delivered to my homeTo date, the only correspondence I have received from the business has been through the Revdex.com
Regards,
*** ***

This communication is in response to *** ***’s rejection
to our previously submitted Revdex.com (Revdex.com) response. We hope that this finds *** *** and her furry companion
*** well. *** is lucky to have
been rescued by *** *** and we wish them a lifetime of health and happiness. We are happy to hear that *** *** is in
receipt of both the $*** gift card and also the $*** gift cards for the
upgraded policy and *** policy respectively.
We hope that they are helpful in providing *** routine care.We sincerely appreciate *** ***’s feedback and would like
to provide clarification regarding her policy concerns presented in her Revdex.com
response.*** *** has indicated that she does not understand why
coverage did not go into effect immediately upon purchase of a policy. All Petplan policies have a day illness
waiting period and a hour accident waiting period. Per the Terms and Conditions of our policies,
conditions where clinical signs are first observed within the aforementioned
applicable waiting periods, are not eligible for coverage. Similarly, conditions where clinical signs
are first observed prior to policy are not eligible for coverage. Per the Terms and Conditions Petplan policies
do not provide coverage for pre- existing conditions. *** ***’s policy defines pre- existing
conditions as, “any medical condition which first occurred or showed clinical
sign(s) before the effective date of this policy or which occurred or showed
clinical sign(s) during the policy waiting period.” Specifically, in regards to the claims submitted to
Petplan. The following was determined:Claim *** was submitted for periodontal disease treatment received on February 5, After review of the medical records provided, prior to policy inception (policy inception December 1, 2014) in July the medical records note dental disease. As dental disease is noted in the medical records prior to policy inception the condition is considered pre- existing, pre- existing conditions are not eligible for coverage.Claim *** was submitted for elevated liver enzymes found during examination on December 11, 2014. After review of the medical records provided, on December 11, (day of the day illness waiting period), the medical records document elevated liver enzymes. As the clinical sign of elevated liver enzymes was noted during the day illness waiting period, and conditions that show clinical signs during the waiting period on not eligible for coverage, the claimed condition (elevated liver enzymes) is not eligible for coverage. Regarding *** ***’s concern surrounding her pro- rated
refund for her policy; we have authorized a full refund of *** ***’s premium
and she we receive an additional $credited back to her credit card.Additionally, we have reached out to *** *** in an
attempt to resolve her concerns. We hope
that *** *** reaches out to our Quality Assurance Team Lead to further
clarify and resolve her concerns

Our Customer Service Supervisor, *** ***, spoke to **. *** this morning, and she appears to have received the full refunds for her policiesPlease let us know if there are any further outstanding questionsMany thanks

We hope that this finds *** ***, ***, *** and ***
well. We would like to thank *** ***
for providing Petplan with the opportunity to provide review her concerns and
provide clarificationConcern #1: “I
asked several questions when I was looking into coverage for
my year old
catI asked if all conditions would be considered pre-excising because of her
age? They said no, that wouldn't be the caseI asked if the fact that she had
no vet records for the last years would be an issue? Because she hasn't had
any major health issues and until I got the dogs I didn't worry about her being
exposed to anything do to the fact that she is a strictly indoor catThey said
no, it wouldn'tI asked if her rate would get jacked up yearly due to her age?
They again said noSo I signed her upOn her first claim they tried to not
cover it because of lack of medical historyI called and argued that because I
was told this wouldn't happen and oh lookit didI had to speak with a
supervisor and got that one put throughfinally.”Petplan Response:Petplan requires an examination within the past months
prior to policy inception. If this exam
does not exist, our policy outlines that the first available examination is
used as a baseline of health; any diseases or clinical signs found during the
first exam after policy would not be eligible for coverage (Care for your Pet, b.).
We have reviewed the call between *** *** and our Pet Advisor (sales
agent) and this information was appropriately explained to *** ***.
*** *** references her cat, ***, in her Revdex.com
complaint. After review of the claims
submitted by *** *** for her cat ***’s health care, we have received two
claims for dates of service on 10/21/and 12/09/2015. We were unable to provide coverage for the
treatment provided on 10/21/as the invoice items (after application of the
co-pay [20%] and removal of any routine or preventative care invoice items) the
claimed amount did not meet *** ***’s chosen policy deductible of
$200.00. Regarding *** ***’s claim
for treatment provided on 12/09/2015, coverage for this claim was extended and
reimbursed after application of her chosen co-pay (20%) and chosen deductible
$200.
Concern #2:“All
three of my pets policies came up for renewal and they all went up slightly
Then we movedThe dogs policies went up about $100, My cats more then
doubledIt was a more then $increaseI feel I was mislead and lied to
when I called originally asking about getting coverage for my catI feel I
deserve a full refund minus what they paid out for the one claim that was
covered since I've had coverage on herThey would only refund up to that
claim.”
Petplan Response:Petplan policy preimums are
determined by three standard factors: breed, age and area and three
factors the policyholder influences:
deductible, copay and annual limit. The
combination of breed, age, area, and policyholder selected dedutible, copay and
annual limit determine the annual premium.
Petplan policies are customizable with regards to copay, deductible and
annual limit. Policyholders have the
ability to influence their preimum by adjusting the copay, deductible and
annual limit, effectively increasing or decreasing the overall preimum. Specifically, in *** ***’s case, when she
moved from her policy was re-rated because the area (one of three factors
listed above) changed. The area she moved
to increased her preimums.
*** *** purchased pet
insurance to ensure that if new accidents or illness arose coverage for her pet’s health care costs could be
riembursed per the policy. Petplan has
provided reimbursement for these unexpected costs as previoulsy explained. Per the Terms and Conditions of her policy in
the event of cancellation we will provide a pro rata refund based on the date of termination of the
policy (Cancellation and nonrenewal,
a.). According to our records, Ms
Brandt requested cancellation on February 29, 2016. To ensure a positive customer experience, we
authorized a backdated refund for Nika’s policy starting for the day following
the last treatment date claimed, and reimbursed by the policy. The cancellation was processed on March 1,
and *** ***’s card would be refunded within 2-days after
processing. We thank *** *** for
providing her feedback regarding her customer experience as it is for feedback,
like *** ***’s, that allows Petplan to continue to improve our level of
customer service. We do sincerely hope
that *** ***, ***, *** and *** are all doing well!

We would like to thank *** *** for her concerns presented via the Revdex.com (Revdex.com). We have researched and reviewed *** ***’s concerns addressed in the Revdex.com complaint #*** regarding Petplan claim numbers: ***, ***, ***, and *** for ***’s heartworm
disease. The inception date of *** ***’s policy was December 14, with cancellation of her policy (per her request) on March 29, As indicated in the Terms and Conditions of *** ***’s chosen policy, we will not cover the costs that are incurred for treatments for parasites (such as heartworms) or conditions related to parasites unless there is no preventive medication available for the parasite (V.cc.)Furthermore, we will not cover the costs incurred for conditions related to, resulting from, caused by, and/or the same as clinical signs and conditions noted within the first fifteen days beginning on the effective date of the policy (V.e.i.-iii.)(Policy attached for reference of above stated Terms and Conditions.) According to the medical records from *** Veterinary Hospital dated December 15, (within the first fifteen days after the effective date of the policy) *** was determined to have heartworm disease (parasite). The medical records from *** Animal Hospital dated February 11, indicate that ***’s heartworm disease had progressed to include caval syndrome (the presence of heartworms in the pulmonary artery, right atrium, and right ventricle with concurrent anemia). As such, ***’s heartworm disease and subsequent caval syndrome is excluded from coverage as per the Terms and Conditions of the chosen policyIn reference to *** ***’s refund request: As indicated in the Terms and Conditions of *** ***’s policy, “You may cancel this policy at any time by returning it to us or by notifying us in writing of the effective date of the future cancellationIf you notify us within the first thirty (30) days from the effective date shown on the declarations page, and you have not submitted any claim against this policy, we will refund the entire premiumAfter thirty (30) days, we will return the pro rata premium based upon the date of termination of this policy.” As the request for cancellation occurred after thirty days from the effective date of the policy, and a claim was submitted against this policy, a pro-rated premium refund of $was provided to *** ***. On April 10, we have attempted to reach out to *** *** via phone to discuss her concernsWe have not heard back from *** *** at the time of our responseWe encourage her to contact us if she has any additional questions and we would be happy to assistWe are available 24/at ***

We have reviewed *** ***’s feedback and we have independently reached out to him and resolved the matter