Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] They never contacted me nor the vet that I useAnd we sent everything they had asked forIt is irritating that they can not receive the actual medical records but seem to receive the invoicesWhich I and the vet sent exactly the same way they asked us toWe sent everything and have received nothing
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolvedAlthough I am glad they took the time to review the claim and accepted their mistake in denying it in the first place, I still find it deceptive that they tricked me into getting a supposedly better policy more expensive and with more coverage but omitting to explain that it will make all previously covered illnesses a pre-existenceI will accept the response but will take my business elsewhereRegards, [redacted] %
All Lifetime policies contain a "Waiting Period" applicable to new illnesses There is both a definition of "Waiting Period" in the policy form and the "Waiting Period" application rule is covered in the EFFECTIVE DATE section of the policy form."Waiting Period" shall refer to an initial period of days from the inception date of this policy shown on the declaration page for illness claims.EFFECTIVE DATE"Your" coverage begins as of the effective date and time shown on the "documents of insurance" (including the Declarations, which forms part of this policy as issued) provided to "you" upon enrollment int the Plan "We" will not reimburse "you" for illness expenses arising from any incident pertaining to "your pet" occurring within the initial "waiting period" commencing at policy inception shown on the declaration page This "waiting period" shown on the declaration page will not apply to accident expenses or any subsequent "policy period" representing a renewal of this policy, if continuous coverage is maintained The effective date of the policy in question ( [redacted] ) is 9/24/ The effective date for illness coverage is 10/8/ Treatment was received for the claim (Incident number [redacted] ) in question on 9/24/2016, the same day as the policy effective date Per policy terms and conditions (the insurance contract), the claim was denied We believe this claim was denied in good faith and in accordance to clear policy language filed and approved by the state of New York
Unfortunately, this seems to be a case of miscommunicationAt the time of purchase, MsFelected to forego the complimentary 30-day policy and instead opted to purchase a Premier $2k policy, scheduled to be active on 2/16/We apologize for any misunderstanding on our part as it is always our goal to sell clear, comprehensive and value-oriented policies to our customersBecause of the misunderstanding, we have reached out to MsF., letting her know that her policy has been cancelled and we will be sending her the full refund amount as requested
Our goal at PetFirst is to provide a positive experience for our policyholders even though, at times, claims may be denied due to policy exclusions or other provisions This insured initiated a pet insurance policy using our on-line system There are prompts in this process that direct the customer's attention to policy exclusions and provisions In this case, however, the insured has filed two claims One claim was denied because it was below the insured's deductible amount The other claim has been closed because we did not receive an itemized invoice for the treatment date of service PetFirsts Customer Service is going to reach out to this insured to see if we can obtain the information needed to re-open and process the claim We will also help the insured to understand the policy provisions and the claims process
Ms [redacted] has a PAWS plan with PetFirst This plan covers accidents and illnesses and does not cover routine examinations as listed in her policy exclusions EXCLUSIONS AND LIMITATIONS Beyond the limits and exclusions pertaining to specific coverages under this policy that have thus far been set forth above, this policy will not pay for costs “you” incur for: Routine examinations, routine tests or screens, vaccines, teeth cleaning or polishing The claim Ms [redacted] is referring to in this complaint was closed because PetFirst did not receive the required documents We include in the policy packet a check list that lists what is needed to process a claim Attach all medical treatment records for the claimed incident? If this is your pet’s first accident or illness claim, please provide months of medical records (i.edoctor’s notes; prior to and including the incident date) If your pet is less than months of ages, include all vet visits If this is not your first accident/illness claim, but is a new incident, please include the medical records related to the new claim If you recently adopted, please include adoption paperwork PetFirst has made multiple attempts to retrieve the required documents for Ms*** PetFirst sent an email to Ms [redacted] explaining what documents we were missing When PetFirst did not receive the information from Ms***, PetFirst called and faxed, on separate occasions, the Veterinarian’s office asking for the medical records The Veterinarian’s office sent us prior invoices but that is not what we had requested We re-requested, per the Veterinarian’s office, to send the fax request again asking for the medical records, but as of today PetFirst still does not have the medical records The medical records give PetFirst the assessment and plan of action for the pet and is needed to properly code the treatment Ms [redacted] called PetFirst customer service times and was told each time that medical records were needed to be able to process the claim Medical records were explained to Ms [redacted] as being the doctor notes that would be in the pets file Ms***’s claim can be re-opened if the medical records are received PetFirst apologizes for the confusion and has made every effort to obtain the medical records that are required to continue to process the claim
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Their own employee told me on the phone that they continue to add exclusions every year I called to review this policy every year before renewing and was told that my coverage was good and included accident coverage Again this is an accident not just a condition that developed the vet documented on the claim they are refusingI will be glad to provide a copy of his notes on the claim This company is an Internet scam they are really a company called something like American alternative insurance based in New Jersey representing themselves under a different name in your state and doing business exclusively over the Internet and phone misrepresenting the coverage and increasing the price every year I want the amount they said they would cover $1,per incident and I want the money they collected for my two dogs since while misrepresenting coverage I am very concerned about this company preying on senior citizens You should be also Regards, [redacted]
Based on a detailed review of this claim as well as the claims history of this pet, it is our determination that this claim should have been paid as a separate incident As such, we have approved and re-submitted the claim for payment A check will be mailed to the insured within the next two weeks
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below [redacted] Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] While I realize this resolution should be satisfactory to me, I would like their advertising to be addressed How can they possibly use a line on their website saying they pay 90% of all veterinary bills when they don't cover anything routine and deny everything else? This seems like a scam to anyone who makes the mistake of buying their insurance They are now also claiming a per incident limit, and are only going to send $1,of the entire amount I requested I believe they have agreed to resolve this claim for a bare minimum and with restrictions How can this be a legal way to do business? Regards, [redacted] %
We regret that claims were not settled as quickly as we would like Each policy that is issued by PetFirst's states that claims will be settled within days of receipt of the information required to process the claim The outstanding claims noted by the policyholder have now been settled If there are any questions about the claims themselves or the settlement time, please contact me directly at [redacted] Sincerely, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted]
It is always our goal to pay claims in a hassle-free manner and unfortunately, in this situation, we fell shortAfter further review of the documentation sent to us by [redacted] we were able to locate and interpret the package of services purchased and are processing the claim in questionWe have reached out to [redacted] *, letting her know that we will be refunding her for these services
RevDex.com: I have reviewed the response made by the... business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved. Regards, [redacted]
Our plans do cover urinary tract infections but all new polices are subject to a day wait period to ensure there are no pre-existing conditions. We apologize for any misunderstanding but according to the terms of the policy that are filed with the State's Department of Insurance we
would not be allowed to cover this item since it falls within that window prior to the illness effective date
Our mission at PetFirst is to provide peace of mind to our insured's by paying covered claims and doing so in a timely manner according to the contract provisions of the policies filed with and approved by the Department of Insurance Our underwriter requires that we have detailed records from
the treating veterinarian so that claims may be properly adjusted In review, we have determined that the required information was received and this claim is being processed today Reimbursement will be issued to the insured based on the policy terms and conditions
It is PetFirsts' goal to provide peace of mind to our pet parent policyholders. The policyholder was provided information regarding the number one exclusion for pet insurance policies, pre-existing conditions, in each of the calls with a PetFirst agent. The definition of pre-existing is
included in the Definitions section of the policy form that the insured received upon activating a policy with PetFirst. This definition reads, "Pre-Existing Condition: Any illness, condition requiring medical treatment or injury affecting Your Pet that manifests, whether diagnosed or treated, prior to the inception date of this policy." The policyholder adopted the pet on January 27, 2018. The pet was taken to the veterinarian on 2/6/having issues with eating. According to the veterinarian records the pet had "heavy tarter PMupper both side w/gingivitis". The tarter buicausing the issue with the pet could not have developed in days. Per the definition of Pre-Existing in the insurance contract, this illness would have manifested prior to the policy inception date. There was no discussion on the phone calls of a waiting period for this policy. There is no illness or accident waiting period on the 30-day policy and the waiting period on the 12-month policy is waived due to the insured already having coverage with PetFirst. It is PetFirsts belief that this claim was correctly denied based on the policy contract terms and conditions that were filed and approved in the policyholder's home state. As stated above, it is PetFirsts' goal to provide peace of mind to our pet parent policyholders however we must adjust claims according to the policy contract
Ms *** *** has had accounts with us for years. Our Customer Service department has been in touch with Ms *** and we do show we have accounts with her but they have been cancelled with us due to non-payment. Ms*** has signed up for policies using our on-line system but then
they were cancelled. The policies that she currently has for Creamy and Sweetie are in delinquent status because the credit card she is using has declined. Payments for May and June are currently due. Ms*** told our Customer Service Rep that she was disputing charges with her bank. We have left messages with Ms*** explaining that we needed a new credit card in order to continue coverage for her pets. We would love to keep coverage on Ms***'s pet but we need to work out payment for the polices. We will make an attempt again to talk to Ms*** and get this all ironed out
It is PetFirsts goal to create a positive experience for our policyholders The claim addressed in this complaint has been reviewed It has been determined that the appropriate veterinary records have been received and there is enough documentation to continue to process the claim
The claim is being paid and a check will be issued to the policyholder based on the terms and conditions of the policy contract. We appreciate all of our pet parents and apologize for any inconvenience the delay in processing this claim has caused
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] They never contacted me nor the vet that I useAnd we sent everything they had asked forIt is irritating that they can not receive the actual medical records but seem to receive the invoicesWhich I and the vet sent exactly the same way they asked us toWe sent everything and have received nothing
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolvedAlthough I am glad they took the time to review the claim and accepted their mistake in denying it in the first place, I still find it deceptive that they tricked me into getting a supposedly better policy more expensive and with more coverage but omitting to explain that it will make all previously covered illnesses a pre-existenceI will accept the response but will take my business elsewhereRegards, [redacted] %
All Lifetime policies contain a "Waiting Period" applicable to new illnesses There is both a definition of "Waiting Period" in the policy form and the "Waiting Period" application rule is covered in the EFFECTIVE DATE section of the policy form."Waiting Period" shall refer to an initial period of days from the inception date of this policy shown on the declaration page for illness claims.EFFECTIVE DATE"Your" coverage begins as of the effective date and time shown on the "documents of insurance" (including the Declarations, which forms part of this policy as issued) provided to "you" upon enrollment int the Plan "We" will not reimburse "you" for illness expenses arising from any incident pertaining to "your pet" occurring within the initial "waiting period" commencing at policy inception shown on the declaration page This "waiting period" shown on the declaration page will not apply to accident expenses or any subsequent "policy period" representing a renewal of this policy, if continuous coverage is maintained The effective date of the policy in question ( [redacted] ) is 9/24/ The effective date for illness coverage is 10/8/ Treatment was received for the claim (Incident number [redacted] ) in question on 9/24/2016, the same day as the policy effective date Per policy terms and conditions (the insurance contract), the claim was denied We believe this claim was denied in good faith and in accordance to clear policy language filed and approved by the state of New York
Unfortunately, this seems to be a case of miscommunicationAt the time of purchase, MsFelected to forego the complimentary 30-day policy and instead opted to purchase a Premier $2k policy, scheduled to be active on 2/16/We apologize for any misunderstanding on our part as it is always our goal to sell clear, comprehensive and value-oriented policies to our customersBecause of the misunderstanding, we have reached out to MsF., letting her know that her policy has been cancelled and we will be sending her the full refund amount as requested
Our goal at PetFirst is to provide a positive experience for our policyholders even though, at times, claims may be denied due to policy exclusions or other provisions This insured initiated a pet insurance policy using our on-line system There are prompts in this process that direct the customer's attention to policy exclusions and provisions In this case, however, the insured has filed two claims One claim was denied because it was below the insured's deductible amount The other claim has been closed because we did not receive an itemized invoice for the treatment date of service PetFirsts Customer Service is going to reach out to this insured to see if we can obtain the information needed to re-open and process the claim We will also help the insured to understand the policy provisions and the claims process
Ms [redacted] has a PAWS plan with PetFirst This plan covers accidents and illnesses and does not cover routine examinations as listed in her policy exclusions EXCLUSIONS AND LIMITATIONS Beyond the limits and exclusions pertaining to specific coverages under this policy that have thus far been set forth above, this policy will not pay for costs “you” incur for: Routine examinations, routine tests or screens, vaccines, teeth cleaning or polishing The claim Ms [redacted] is referring to in this complaint was closed because PetFirst did not receive the required documents We include in the policy packet a check list that lists what is needed to process a claim Attach all medical treatment records for the claimed incident? If this is your pet’s first accident or illness claim, please provide months of medical records (i.edoctor’s notes; prior to and including the incident date) If your pet is less than months of ages, include all vet visits If this is not your first accident/illness claim, but is a new incident, please include the medical records related to the new claim If you recently adopted, please include adoption paperwork PetFirst has made multiple attempts to retrieve the required documents for Ms*** PetFirst sent an email to Ms [redacted] explaining what documents we were missing When PetFirst did not receive the information from Ms***, PetFirst called and faxed, on separate occasions, the Veterinarian’s office asking for the medical records The Veterinarian’s office sent us prior invoices but that is not what we had requested We re-requested, per the Veterinarian’s office, to send the fax request again asking for the medical records, but as of today PetFirst still does not have the medical records The medical records give PetFirst the assessment and plan of action for the pet and is needed to properly code the treatment Ms [redacted] called PetFirst customer service times and was told each time that medical records were needed to be able to process the claim Medical records were explained to Ms [redacted] as being the doctor notes that would be in the pets file Ms***’s claim can be re-opened if the medical records are received PetFirst apologizes for the confusion and has made every effort to obtain the medical records that are required to continue to process the claim
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Their own employee told me on the phone that they continue to add exclusions every year I called to review this policy every year before renewing and was told that my coverage was good and included accident coverage Again this is an accident not just a condition that developed the vet documented on the claim they are refusingI will be glad to provide a copy of his notes on the claim This company is an Internet scam they are really a company called something like American alternative insurance based in New Jersey representing themselves under a different name in your state and doing business exclusively over the Internet and phone misrepresenting the coverage and increasing the price every year I want the amount they said they would cover $1,per incident and I want the money they collected for my two dogs since while misrepresenting coverage I am very concerned about this company preying on senior citizens You should be also Regards, [redacted]
Based on a detailed review of this claim as well as the claims history of this pet, it is our determination that this claim should have been paid as a separate incident As such, we have approved and re-submitted the claim for payment A check will be mailed to the insured within the next two weeks
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below [redacted] Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] While I realize this resolution should be satisfactory to me, I would like their advertising to be addressed How can they possibly use a line on their website saying they pay 90% of all veterinary bills when they don't cover anything routine and deny everything else? This seems like a scam to anyone who makes the mistake of buying their insurance They are now also claiming a per incident limit, and are only going to send $1,of the entire amount I requested I believe they have agreed to resolve this claim for a bare minimum and with restrictions How can this be a legal way to do business? Regards, [redacted] %
We regret that claims were not settled as quickly as we would like Each policy that is issued by PetFirst's states that claims will be settled within days of receipt of the information required to process the claim The outstanding claims noted by the policyholder have now been settled If there are any questions about the claims themselves or the settlement time, please contact me directly at [redacted] Sincerely, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted]
It is always our goal to pay claims in a hassle-free manner and unfortunately, in this situation, we fell shortAfter further review of the documentation sent to us by [redacted] we were able to locate and interpret the package of services purchased and are processing the claim in questionWe have reached out to [redacted] *, letting her know that we will be refunding her for these services
RevDex.com: I have reviewed the response made by the... business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved. Regards, [redacted]
Our plans do cover urinary tract infections but all new polices are subject to a day wait period to ensure there are no pre-existing conditions. We apologize for any misunderstanding but according to the terms of the policy that are filed with the State's Department of Insurance we
would not be allowed to cover this item since it falls within that window prior to the illness effective date
Our mission at PetFirst is to provide peace of mind to our insured's by paying covered claims and doing so in a timely manner according to the contract provisions of the policies filed with and approved by the Department of Insurance Our underwriter requires that we have detailed records from
the treating veterinarian so that claims may be properly adjusted In review, we have determined that the required information was received and this claim is being processed today Reimbursement will be issued to the insured based on the policy terms and conditions
It is PetFirsts' goal to provide peace of mind to our pet parent policyholders. The policyholder was provided information regarding the number one exclusion for pet insurance policies, pre-existing conditions, in each of the calls with a PetFirst agent. The definition of pre-existing is
included in the Definitions section of the policy form that the insured received upon activating a policy with PetFirst. This definition reads, "Pre-Existing Condition: Any illness, condition requiring medical treatment or injury affecting Your Pet that manifests, whether diagnosed or treated, prior to the inception date of this policy." The policyholder adopted the pet on January 27, 2018. The pet was taken to the veterinarian on 2/6/having issues with eating. According to the veterinarian records the pet had "heavy tarter PMupper both side w/gingivitis". The tarter buicausing the issue with the pet could not have developed in days. Per the definition of Pre-Existing in the insurance contract, this illness would have manifested prior to the policy inception date. There was no discussion on the phone calls of a waiting period for this policy. There is no illness or accident waiting period on the 30-day policy and the waiting period on the 12-month policy is waived due to the insured already having coverage with PetFirst. It is PetFirsts belief that this claim was correctly denied based on the policy contract terms and conditions that were filed and approved in the policyholder's home state. As stated above, it is PetFirsts' goal to provide peace of mind to our pet parent policyholders however we must adjust claims according to the policy contract
Ms *** *** has had accounts with us for years. Our Customer Service department has been in touch with Ms *** and we do show we have accounts with her but they have been cancelled with us due to non-payment. Ms*** has signed up for policies using our on-line system but then
they were cancelled. The policies that she currently has for Creamy and Sweetie are in delinquent status because the credit card she is using has declined. Payments for May and June are currently due. Ms*** told our Customer Service Rep that she was disputing charges with her bank. We have left messages with Ms*** explaining that we needed a new credit card in order to continue coverage for her pets. We would love to keep coverage on Ms***'s pet but we need to work out payment for the polices. We will make an attempt again to talk to Ms*** and get this all ironed out
It is PetFirsts goal to create a positive experience for our policyholders The claim addressed in this complaint has been reviewed It has been determined that the appropriate veterinary records have been received and there is enough documentation to continue to process the claim
The claim is being paid and a check will be issued to the policyholder based on the terms and conditions of the policy contract. We appreciate all of our pet parents and apologize for any inconvenience the delay in processing this claim has caused