Fetch, Incorporated

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
Regards,
[redacted]
They never called me multiple times, I can send a call history from my phone service to confirm that. I've called them after they made excuses on how 'they never received the fax' or nothing was time sensitive when it was. They are making false stories just to save their hides. & [redacted]'s condition was not pre-existing when the fee was for testing to see what was going on. I wouldn't reccomend PetPlan on my worst enemy's pet & would have no problem letting the media know of their scam of a company.

This is in response to the Revdex.com (Revdex.com) complaint presented by [redacted]. We appreciate [redacted]’s concerns and would like to provide him and explanation regarding his claims assessment and reimbursement.
[redacted] has expressed frustration regarding his policy coverage. We...

would like to assure [redacted] that all of his claims have been reimbursed at his chosen coverage: 100% reimbursement and a $50 deductible. We would like to remind [redacted] that deductibles are applied per condition, per policy term. Additionally, any invoice items that are not covered via the policy have been excluded during claims processing (e.g. food, routine anal gland expressions, etc.).
We would like to take the opportunity to provide a detailed explanation of [redacted]’s claims outlined in the Revdex.com complaint:
• Claim [redacted]: Includes invoices from September 18, 2014 related to vomiting and diarrhea. These fees came to a total of $697.64; after $35.09 was removed for food and applicable tax and application of the chosen co-pay (0%) the total amount eligible for reimbursement is $662.55. Payment in the amount of $330.04 was authorized on December 1, 2014. Additionally, payment in the amount of $200.00 was authorized on March 26, 2015. We have determined that an additional $132.51 is owed to [redacted] and have authorized payment in the aforementioned amount.
• Claim [redacted]: Includes invoices from October 11, 2014 relating to vomiting and diarrhea. These fees came to a total of $220.40; after $34.55 was removed for food and applicable tax and application of the chosen co-pay (0%) the total amount eligible for reimbursement is $185.85. Payment in the amount of $185.85 was authorized on March 26, 2015.
We would like to apologize to [redacted] regarding his customer service experience and thank him for bringing his concerns to our attention. We appreciate his feedback, for it is for feedback like his that allows us to improve our customer service experience going forward.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

[To assist us in...

bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
While the business did reach out to me in an effort to resolve this complaint, the complaint has yet to be resolved.  I would therefore appreciate if the Revdex.com would leave this case OPEN until an actual resolution has been reached.
Regards,
[redacted]

The business response below does nothing to satisfy my complaint. Of course I was refunded the balance of my policy; I was entitled to that by contract.The fact still remains that Petplan raised the deductible from $100 to an totally unreasonable $400 per injury or sickness. That is besides the cost of the annual premium. Before I cancelled, Petplan admitted on the phone that they did not attempt to sell me similar coverage because it would be so much more than what they were currently offering. Their attempt to reach me me was a message on my answering machine. I called back and spoke to a person who put me on hold to speak with Carly.I was on hold for a long time when I was told it would be a little while before she could speak to me, that I should hand up and she would call back as soon as she was available. That was somewhere around 10:30 am. I said I would be at home until 1pm. To this day I have heard nothing from Petplan. So I would appreciate your updating my complaint.Thank you and you, too, have a wonderful day.

We would like to thank [redacted] for bringing his concerns regarding our new policy changes to our attention via the Revdex.com (Revdex.com) and appreciate the opportunity to address his concerns.Recently, Petplan had a change of underwriter and therefore, some changes to our policies...

occurred. Our previous underwriter decided to leave the pet insurance industry. As a result, we needed to find a new underwriter who allowed Petplan to keep the same coverage we previously offered and who ensured all of our existing policy holder’s claim’s continued to be coverable. With this change of underwriter, we took this opportunity to improve our product offering, by introducing a broader range of policy limits, deductible and copay options. We certainly appreciate [redacted]’s concern with the premium increase for his pet’s policy. With these changes, our premiums have increased to reflect the appropriate risks.We understand [redacted] elected to cancel his policy on 02/25/2017 and a refund has been issued back to his credit card in the amount of $755.43.On May 4th, 2017, we attempted to reach out to [redacted] via phone to discuss his concerns. We have not heard back from [redacted] at the time of our response. We encourage him to contact us if he has any additional questions as we would be happy to assist. We are available 24/7 at [redacted]

We would like to take this opportunity to thank Ms. [redacted] for bringing the concerns she has regarding her claims to our attention via the Revdex.com (Revdex.com).   As indicated in the Terms and Conditions of Ms. [redacted]’ chosen policy, we will not reimburse you for 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 your policy.  Ms. [redacted]’ policy inception date was September 29, 2017.   Furthermore, and as stated in the Terms and Conditions of your policy, if your pet has not been examined by a veterinarian within the twelve months prior to the effective date of your policy, you must arrange to have your pet examined within thirty days of the effective date of this policy.  Any medical conditions or clinical signs observed or recorded during this first examination of record, and any conditions related to, resulting from, and/or caused by these clinical signs and conditions, are considered pre-existing and are not eligible for coverage.    According to the medical records we have received, there was no physical examination performed by a veterinarian within the twelve months prior to the effective date of your policy on September 29, 2017.  As such, the examination performed on September 30, 2017 serves as this initial examination to determine any pre-existing conditions.  According the medical records we have received from [redacted] dated September 30, 2017 (within the first fifteen days beginning on the effective date of your policy, as well as the first examination of record), your pet was seen for coughing.  The medical records from [redacted] and [redacted], as well as the letter from your treating veterinarian, indicate that this cough recurred so x-rays were pursued.   As the clinical sign of recurrent coughing was noted within the first fifteen days beginning on the effective date of your policy, and this clinical sign is consistent with the claimed condition of recurrent coughing, your policy will not provide coverage for this claimed condition.   We understand Ms. [redacted]’ concern with her pets recently denied claim. We have reached out to her to further discuss and offer assistance with available options moving forward. At the time of this response, we have not heard back from Ms. [redacted]. We encourage her to contact us if she has any questions or additional concerns. We are available at [redacted] and are always happy to assist.

Thank you for the recent communication via the Revdex.com (Revdex.com).  We appreciate feedback regarding the recently submitted claims regarding [redacted]’s fractured right foreleg.  
The referenced claim was initially denied as the medical history indicated...

that clinical signs were present during the policy waiting period. However, an amended medical history has been submitted.
After additional review of the entire claim, we have further determined that we are unable to provide coverage for the provided claim ([redacted]) as we do not have medical records documenting a veterinary examination within the 12 months prior to policy inception (December 29, 2013).  At this time we have received medical records from the following facilities:
- [redacted] Veterinary Hospital
- Emergency Veterinary Clinic of [redacted]
- Breeder ([redacted]) vaccine history
According to our records, during the purchase of your policy, the date of December 27, 2013 was provided as the last available examination date. The earliest date of service provided is December 29, 2013 from Emergency Veterinary Clinic of [redacted], Inc., with no submitted medical records on or prior to December 27, 2013.  As December 29, 2013 is also the date of the claimed condition, we must consider all abnormalities found during this examination pre- existing as per the Terms and Conditions of your policy.  Should there be additional medical records for examinations in the 12 months prior to December 27, 2013 we would be happy to provide an additional review of claim [redacted].
Please refer to the pertinent part of the Terms and Conditions of the policy:
VII.
General Conditions
7. CARE FOR YOUR PET
b. If your
pet has not been examined by a vet
within the twelve (12) months prior to the effective date of
the policy you must
arrange to have your pet examined
at your own expense within the first
thirty (30) days after the effective date of the policy. The examination will
be used as the basis for determining any preexisting
conditions. This section applies to both new
policies and continuous policy years where your pet has
not received the care described in Section VII.7.a. For the avoidance of doubt;
if your pet does not receive its annual
health check during a period of continuous coverage, the next examination will
be used as the basis for determining any pre-existing conditions.
Many thanks.

We would like to thank [redacted] for bringing her recent customer service experience to our attention via the Revdex.com (Revdex.com).  Feedback, like [redacted]’s, allows Petplan to continue to improve our customer service experience for all policyholders, including [redacted]...

[redacted]. 
 
We have performed a thorough review of [redacted]’s claim for [redacted].  We hope that [redacted] is improving with the care he has recently received.  We are happy to report that [redacted]’s claim ([redacted]) is eligible for coverage for [redacted]’s lameness.  According to the medical records it appears that [redacted] is currently experiencing left hind limb lameness with secondary muscle wasting.  We sincerely hope that with further care his lameness resolves quickly!  
Regarding [redacted]’s customer service experience; we would like to assure her that this is not out standard of customer care and we are sincerely apologetic to the service [redacted] experienced.  We will continue to look into the feedback provided by [redacted] and will rectify it.  
At this time, [redacted]’s claim has been overturned and she will receive reimbursement in the amount of $872.18 (Total Bill $1,072.18 - $200(deductible)=  $872.18). (Please note, that [redacted]’s policy also provides 100% reimbursement, rather than 80% as indicated in [redacted]’s complaint. ) 
[redacted] requested we waived the $200 deductible for claim [redacted]. Unfortunately, we are unable to waive the deductible, as this is part of the policy, as written in the Terms and Conditions.  However, we would like to send [redacted] $50 in [redacted] gift cards as an apology for any inconvenience caused.

Thank you for your recent communication regarding this matter. It is our understanding that a member of our customer service team has reached out to [redacted], and a refund has been issued, per his request. Having said that, we apologize for any inconvenience caused, and appreciate his feedback....

The section of our website [redacted] found to be unclear is currently undergoing redesign, so we will certainly incorporate his experience into the new build.
Many thanks.

We would like to take this opportunity to thank [redacted] for bringing her concerns regarding her policy to our attention via the Revdex.com (Revdex.com). We are sorry to hear about the frustrations caused from her experience.   We certainly appreciate [redacted]...

concern of her pet’s previous lapsed policy, especially due to her pet’s health. On November 17, 2015, we were unable to process her renewal fee with the credit card on file. We then made the following attempts to notify her of this outstanding payment: 11/17/2015 via email 11/19/2015 via voicemail 12/01/2015 via voicemail 12/08/2015 via voicemail 12/16/2015 via voicemail 12/17/2015 via printed letter - This letter also indicated the policy would not be eligible for reinstatement after 12/31/2015.   Since we did not receive any communication from [redacted] the policy lapsed and was not eligible for reinstatement. On 02/24/2016, [redacted] purchased a new policy through our website [redacted] All [redacted] polices are subject to the terms and conditions and do not provide coverage for pre-existing conditions.   On May22, 2017 we have attempted to reach out to [redacted] via phone to discuss her concerns. We have not heard back from [redacted] at the time of our response. We encourage her to contact us if she has any additional questions and we would be happy to assist. We are available 24/7 at [redacted].

We have received [redacted]’s concerns surrounding her
recent claim.  We would like to thank [redacted] for presenting her concerns and allowing Petplan provide additional
insight into our policy coverage.[redacted] indicates concern surrounding Petplan’s
congenital...

coverage.  Petplan does
provide coverage for congenital conditions, except when clinical signs that are
related to, resulting from, and/or caused by the condition were first observed
prior to the policy inception. 
Specifically, in [redacted]’s case her dog [redacted] presented to the
vet for “strong urine odor” and was treated for a urinary tract infection on
March 16, 2015 prior to policy inception (policy inception April 7, 2015).  [redacted]’s condition continued and she was again
treated for a urinary tract infection on May 20, 2015.  On May 20, 2015 during [redacted]’s appointment
for another urinary tract infection additional diagnostics were performed to
determine the underlying cause of [redacted]’s persistent and recurrent urinary
tract infections.  According to the
medical records, at this appointment corrective surgery for a left ectopic
ureter with mal- development of bladder sphincters was discussed to treat
[redacted]’s persistent and recurrent urinary tract infections.The pertinent part of the Terms and Conditions are below:I. Definitions Used Throughout This Policy Some words or phrases in the policy have been defined below.
Defined words or phrases are printed in bold type and have the following
meanings, unless a different meaning is described in a particular coverage or
endorsement.Clinical Sign(s)
Changes in your pet’s normal healthy state, its bodily functions or behavior
(as observed by any individual, or recorded in your pet’s medical record).Congenital Defects or
Abnormalities  Any condition(s) or
disorder(s) present at and existing from the birth of your pet.V. General Exclusions The following general exclusions apply to your policy and coverage parts. We will NOT pay costs you incur for your pet in the following categories:f. Congenital defects or abnormalities where clinical sign(s) were apparent prior to the effective date of the
policy or that became apparent during the first fourteen (14) days beginning on
the effective date of your policy.Regarding [redacted]’s concerns surrounding the customer
experience she received.  We have
reviewed the calls referenced in the complaint and have determined that at no
time did we indicate that congenital conditions were coverable in cases where
clinical signs of the condition were present prior to policy inception.  We sincerely appreciate [redacted] providing her
feedback and apologize for any perceived miscommunication.  We would like to refund the remaining portion
of [redacted]’s premium.  [redacted] will be receiving an additional $45.13.

HI Alyssa,
Thank you so much for your email!  [redacted]’s policy does not provide coverage for pre- existing conditions as defined by his policy.  As the condition claimed by [redacted] is considered pre- existing per his Policy, we are unable to extend coverage.
Please let me know if you have any further questions and it is a pleasure to meet you as well!  Thank you in advance for your time an attention to this matter!
Warmest wags,
elyse d[redacted], CVTclaims managerpet parent to [redacted] (10 yr rescued beagle mix),
[redacted] (13 yr rescued longhaired mini dachshund), [redacted] (8 yr rescued DSH) and [redacted] (13 yr rescued DSH)

Review: I submitted a claim to Petplan on June 20, 2014 for giardia in my dog. First of all, they guarantee a 30 day time frame to review claims. Each time they asked for additional information, it was supplied the same day or the very next day. It is now over the 30 day period, I called to check the status of my claim and they said it is still under review. I told them it was past the 30 day mark and they blamed it on the fact that they needed additional information. I told them that it was supplied right away and that it wasn't my fault they waited 2-3 weeks to ask for that information. I was very insistent on having this claim reviewed immediately. They reviewed it within an hour and denied it. I called and asked why it was denied and they said it was a pre-existing condition.

They said my dog had signs and symptoms of giardia at his vet visit which was not during the covered period. I explained that was not true. I took him in for a work up because I had just adopted him, he was diagnosed with anaplasmosis and I did not submit a claim for that because I knew he wasn't covered yet. At that time we also did a fecal test as a routine test because some of the places I was looking at boarding and going to daycare required the test. That test came back negative.

Fast forward to June 19th and my dog is extremely sick. I take him to the vet, he had an extremely high fever, the vet did some testing and he tested positive for giardia. Several visits and numerous medications later, I submit a claim. This timeline clearly shows that he did not have giardia during the time he wasn't covered, the first giardia test. Was done as a routine test and I never put in a claim to have that covered. I fully believe they decided yo deny my claim because I was a nuisance and wanted to know when the claim would be reviewed since it was over 30 days.Desired Settlement: I want this claim covered and a check mailed to me for the coverage. If this cannot be done, I want to be reimbursed the money I have spent on this insurance coverage so that I can take my business elsewhere.

Business

Response:

We would like to thank [redacted] for her recent

communication to our attention via the Revdex.com (Revdex.com).

[redacted]'s experience with claims

processing was not of our normal high standard, and we would like to express our sincere apologies

regarding the customer service [redacted] received. We appreciate [redacted] providing us the

opportunity to make the situation right and provide an additional review of her

claim. After further review of the

submitted claim ([redacted]) we have determined that the claim is eligible for

coverage and a reimbursement check will be sent in the amount of $342.18. This

represents the invoices of $169.25 and $482.38 less the $200 deductible, charges

for food ($4.77 + $13.50), and charges for diagnostics associated with a condition

that first occurred during the waiting period (Anaplasma test for $91.18)).

Again, we would like to apologize for the customer service [redacted] received, and thank you her for allowing us the opportunity

to further investigate coverage of her claim for [redacted]. We hope that she and [redacted] are doing well!

Review: Petplan is refusing to cover my pets injury fees based on the fact that my pet didn't get a vet checkup within the first 30 days of my contract. However they proceeded to tell me that my pet would be covered from here moving forward even though this goes against their written guidelines within the contract. I also was never notified saying that this initial checkup was mandatory, nor that I was passed my first 30 days and that my vet fees were not going to be covered by them. Only when I was looking for them to uphold their end of the contract and reimburse me my vet bills that totaled up to $380, was their an issue.Desired Settlement: Refund me the money I paid to Petplan since zero of vet fees are getting covered.

Business

Response:

We sincerely apologize to [redacted] for any misunderstanding concerning how our policies work. A full refund of any monies paid will be processed today, and should show as refunds to the original credit/debit card within 3-5 days. The additional reimbursement amounts to a total of $33.87 for [redacted] (at the point of cancellation [redacted] had paid a total of $58.22, Petplan refunded $24.35 at the time of cancellation) and $66.25 for [redacted] (at the point of cancellation [redacted] had paid a total of $85.51, Petplan refunded $19.26 at the time of cancellation).

Review: Petplan is the sister company of Petplan UK, the world’s largest pet insurer and a unit of [redacted] Insurance, part of the [redacted] Group. I guess when Pet Plan was established on September 2003 by husband and wife entrepreneurs Chris and Natasha A[redacted] it may have been a well intended Insurance Company trying to benefit pet owners in the United States. In August 2011, Petplan became the first and only pet insurance company named to [redacted]. Magazine’s list of the 500 fastest-growing companies in America. Coming in at #123, Petplan was recognized for tripling its workforce and growing its gross written premiums by more than 2,200 percent over the past three years, despite the challenging economic climate. I made this introduction of the company so that the public would know that you are dealing with a company that's worthy of the profile on the TV program "[redacted]". If I had done some research before and found out that PetPlan had Fetch Incorporated a/k/a: PetPlan had 47 complaints filed against business with the Revdex.com, I probably would NOT have taken out a policy for my dog, because a Red Flag has been raised by the complaints listed with Revdex.com. Even though the company attempts to resolve the complaints, the fact that 34-of the complainants found problems with PetPlan's service, you should suspect that you may be dealing with a racketeering enterprise. When your vet tries to file a claim for 6-times and the transmission is not accepted by the Claims Department, you know that the company is a FRAUD. When you file a NOTICE OF APPEAL, and they don't acknowledge the filings, you know you dealing with a deceptive business.

PLEASE TAKE NOTICE THAT I am hereby appealing PetPlan Insurance Company’s decision rendered on 7/23/2014 in reference to the above listed claims filed for medical treatment of my dog “[redacted]”.

DISPUTED FACTS

It is my assertion that the claims were “wrongfully denied” due to Pre existing conditions pursuant to bad faith practices, PetPlan Insurance Disregarded the facts of the claim and my rights under the terms and conditions of the policy.

DEFINITION:

In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a pet’s health insurance went in to effect. Before 2014 some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions are no longer allowed after January 1, 2014.

1. Policy [redacted]-00 was issued and became effective on Thursday, March 20, 2014 3:48 AM.

2. From July 6, 2005 to Thursday, March 20, 2014 3:48 AM, the pet “[redacted]” was physically healthy and showed no signs of illness. Please refer to the pet’s medical records submitted to PetPlan.

3. On 5/29/2014 I took the pet to my veterinary physician, who after thorough examination made the following clinical Diagnoses:

5/29/2014, 5: 13 PM Spondylosis - L 7S 1 (Dr. [redacted], DVM, PC)

5/29/2014, 5:13 PM Hypothyroidism (Dr. [redacted], DVM, PC)

These clinical signs / medical conditions of the pet did not exist before the effective date of the Policy, or within 14-days of the effective date of the policy, therefore THE CLAIM WAS WRONGFULLY DENIED.

FURTHERMORE; From 6/6/2014 12:12 AM to 6/6/2014 17:19 PM the veterinary physician at ROEDERS ARK attempted on 6 occasions to Fax the Medical Records with the Claim forms from Fax No: ###-###-#### to PetPlan Claims at Fax No: ###-###-####. All of the 6 Fax transmissions failed in that PetPlan’s fax number refused to accept the incoming transmission. When a Claims Department of an Insurance Company has a defective Fax line, it is already as suspected act of bad faith practice.

Wrongful Denial — Insurers are required to act fairly and in good faith towards their customers. Insurance “bad faith” laws prohibit insurers from wrongfully denying or paying claims or acting unreasonably in their claims handling.

It is my intention to file a complaint with the New York State Department of Financial Services against PetPlan for improperly denying payment for the aforementioned claims and may take other legal action as deemed appropriate.

I strongly urge you to review the wrongful processing of this claim and in the future have a representative sign his or her name and indicate their position. The conclusion “ Warmest Regards The Petplan Claims Team” is inappropriate response because insurance regulations require that a claims representative sending the correspondence be properly identified.Desired Settlement: Pay my Claim of $579.50 minus deductible.

Pay my Claim of $43.00 minus deductible.

CANCEL MY POLICY EFFECTIVE IMMEDIATELY.

Issue me any Refund that I am entitled to from the past premium payment.

Business

Response:

Petplan has reached out to [redacted] regarding this matter. After further review of the dispute the matter has been resolved according to the terms of the policy, to the satisfaction of [redacted].

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. The claim has been processed and PAID.

Regards,

Review: Our (now 7 month old) puppy had emergency medical care provided on January 11, 2014. The vet immediately filed a claim for insurance reimbursement. 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 veterinarians. we currently have one date on file (1/11/2014) therefore the history is incomplete." We have sent all medical records for which we are aware. THE DOG IS A PUPPY AND DOES NOT HAVE A SIGNIFICANT MEDICAL HISTORY. I am a business school professor and it is my impression that the company may be arbitrarily denying claims to lower its overall costs.Desired Settlement: Full reimbursement for claims due with a formal apology for wasting my time to have to follow up repeatedly on the claims status.

Business

Response:

Thank you for your recent communication regarding claim [redacted]. 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 veterinarians. we 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 pet. This history MUST include notes from doctor's exams. If 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 [redacted], with no history prior to the claimed date. The communication sent to **. [redacted] was simply a request for the medical records prior to that date. At no time was [redacted]’s claim ([redacted]) denied.

We have sent all medical records for which we are aware. THE 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 [redacted]. After communication with **. [redacted], the complete medical history from [redacted] was received on Friday, February 7, 2013, and confirmation of receipt was communicated via email. On February 11, 2013 the claim

review was completed and the submitted claim was determined to be eligible for coverage. On February 12, 2013 a check in the amount of

$402.40 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 **. [redacted].

Review: Purchased pet insurance in November 2013. First claim for pneumonia was denied, correctly, because it was a preexisting condition. However, during the diagnostic procedures for the pneumonia (xray) showed a possible diaphragmatic hernia, which is congenital in a significant number of smaller dogs. When I filed my pre-authorization form, it was denied in 3 days, because they said it was related to the pneumonia. When I called, they said I could file an appeal, if I had the vet supply extra information. I had my vet fax a lengthy explanation. I waited a week, and called to inquire on the status of the appeal, and was told it could take 4 to 6 weeks to complete the appeal. I told them this was holding up my dogs treatment, but waited another two weeks for any response. Their response was that they needed more information about an appointment in March 2014, after the possible hernia was suspected, and after all of the diagnostics that supported that suspicion were done. In short, it would appear that they intentionally denied my claim and are now using every possible delay to avoid approving the procedure.Desired Settlement: I'd like the approval process completed in a reasonable amount of time, so I can continue with my dog's treatment.

Consumer

Response:

---------- Forwarded message ----------

From: Revdex.com of Metro Washington DC <[email protected]>

Date: Wed, May 7, 2014 at 12:34 PM

Subject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].

To: [redacted] <[redacted]>

---------- Forwarded message ----------

From: [redacted] <[redacted]>

Date: Wed, May 7, 2014 at 10:35 AM

Subject: RE: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].

To: "[email protected]" <[email protected]>

I received a response from the company on 04/29/14, in which they completed their review of my pre-auth request. I am satisfied with the completion of the request. The ticket can be closed on my end.

Review: Pet Plan is a pet insurance company. I insured my two siamese cats on 4/09/13. Both of the cats were in good health. One of my cats, [redacted], seemed to be having a hairball issue (at least that's what it looked like to us). On the Thursday 4/25/13 when I got home from work the cat was in distress and looked like he was having trouble breathing. I had to rush him to the pet emergency. He was kept overnight and we were able to pick him up on Friday 4/26/13. I filed a claim for [redacted] with Pet Plan - Policy #[redacted] claim #[redacted] on 4/29/13. I have been periodically tracking the claim on their website. Finally today, 06/03/13, the website stated that the claim was closed yet it provided no status or information whether the claim had been paid, how much, or if the claim had been denied so I called Pet Plan ###-###-####. They stated that the claim had been denied because of waiting period. I looked at my contract and it states 14 days as a waiting period. From 04/09/13 to 04/25/13 is clearly beyond 14 days. When I mention this they stated to me that he was sick a week prior. This is incorrect. He was not "in distress" the week prior. He seemed to be hacking up a hair ball every now and then. We had no idea that the cat had a respritory problem until I came home from work on Thursday 4/25/13 and he was in distress and having trouble breathing. That's why we rushed him to the ER. The admittance to the vet hospital on 4/25/13 was beyond their waiting period therefore Pet Plan should play the claim as to their contract.Desired Settlement: Pet Plan should pay claim #[redacted] for [redacted]'s insurance policy #[redacted]

Business

Response:

Thank you for your recent communication regarding [redacted]’s policy (# [redacted]).

Review: I called in to Pet Plan to setup insurance coverage for my dog [redacted]. When I spoke to the representative over the phone, it was explained to me that I would have to pay a deductible and after that was reached for a claim, they would cover the rest, The deductible was $200 and up to $10,000 worth of treatment. I was explained that the only thing that was not covered by this insurance are illness that were diagnosed before the policy had started. Just a few days before we started this policy, we took our dog for her yearly checkup and had additional tests done. At this time, nothing was diagnosed. We waited weeks to bring her back because the representative explained that there was a waiting period before we could fully use the policy. We brought her back to the vet and continued testing. At that time, we gathered all paperwork to submit for reimbursement. I faxed over the paperwork and heard nothing. We then decided to use the pre-authorization form to decided whether or not to see if Petplan would cover our treatment still. The vet faxed over the paperwork, and in reply Petplan stated they never received our original paperwork. So, I faxed it again, and still nothing. They finally received the paperwork from the original claim and then requested documentation from the past two years of vet visits. I sent in that paperwork. I scanned in all the paperwork and they responded saying they never received the original paperwork fir the original claim. I quickly sent back and email stating that I did send in that paperwork and forwarded the email they sent to me acknowledging that they revived it. I was told I would be notified in two business days of their decision. A week or more went by and heard nothing until I received an email denying the pre-authorization. I called into Petplan and the associate explained to me because she showed signs of a problem that they would not cover her. I explained to the individual that that was not what was explained to me when I signed up for this plan. I was told as long as my dog was not clinically diagnosed with a problem, that Petplan would cover the bills. When I asked how they can deny the pre-authorization but not the original claim, she told me that they haven't gotten to it yet. So, wouldn't it make sense to deny the original claim first before the pre-authorization? That makes no sense to me. I asked to speak to a supervisor which she denied, She stated she would have the supervisor review the recording of the conversation the insurance person and I had last year and would call me back. I received a voice-mail hours later and when I called back there was no answer. On top of all this that night I come home, I receive a letter dated 07/14 that they have closed my claim due to not receiving paperwork. I have emails documenting that they did receive my paperwork on the 9th and that it would be processed. This seems to me like one big scam and I am going to let everyone know about what is going on. We continued to spend money under the assumption that we would be covered under this policy. Just like all the reviews I am now reading online about this, this is not the first time something like this has happened.Desired Settlement: Either they honor the agreement as discussed when I signed up or I am seeking a full refund of the year I have paid so far, $543.13. In addition, I am seeking the money I spent after signing up for this service, expecting it back once filing a claim. The total on that was $495 ($695-$200 ded).

Business

Response:

We would like to thank [redacted] for his communication to Peptlan via the Revdex.com (Revdex.com). Feedback on our daily processes and procedures help us to continue to improve our service.