PetPartners, Inc.

Since January 2016, PetPartners, Inc has refused to pay on my animal insurance claim despite repeated calls and claims to the contrary.In early January 2016, I was solicited to purchase a pet health insurance policy by PetPartners, Inc on behalf of [redacted] for a puppy that I had recently purchased. PetPartners, Inc claimed to offer 30 days free of coverage upon registration of my puppy with the [redacted]. I received a call to solicit keeping the plan going and was told that since I had needed to use our Vet for an illness with the puppy that I should file a claim and pay to keep the policy going for just under $30 a month. I agreed and made my first of many attempts to file a medical claim to PetPartners, Inc for the appointment I had during my "free trial" period as well as for the follow up appointment linked to the same problem during my "paid" time with PetPartners,Inc. PetPartners,Inc required automatic monthly payment via credit card for this policy and stated that a form was being sent to me for my Veterinary team at [redacted] Animal Medical Center in [redacted], [redacted] to fill out in order to process and pay my claim(s). I gave my credit card information and paid on the policy for a couple months being told when I reached out twice to PetPartners, Inc (run by [redacted]) prior to April of 2016 that they were "working on reviewing and processing the claim". In April of 2016, I still had received no payment, no paperwork and no further information or follow up on these two claims. Upon repeat contact to the office via phone, I was told that the paperwork needed to be resubmitted although no one at that time would state why the claims were not processed prior to that call. I went to my aforementioned Veterinary office and signed and submitted paperwork to be faxed to PetPartners, Inc ([redacted]) and saw all medical documentation that was accompanying the claim forms via fax as I had to okay the release of my puppies information to PetPartners,Inc. In early April 2016, I called looked up the number for PetPartners, Inc ([redacted]) online and called to inquire again regarding my claim. I spoke to a supervisor named [redacted] and was told they were expediting my claim and that she would ensure I would have a payment within 10 days. I inquired if she meant 10 business days or 10 days and I was told, "No, just 10 days, you'll have the first payment next week." I was aware that I had to pay a $100 deductible on this first claim and that they would then pay 80% of the balance. I was told the second claim was not ready to process yet and that I would receive 80% of the second claim as it fell under the same deductible. On April 14, 2016, a Claim Received Notice was drafted and mailed to me regarding my policy (Policy No: [redacted]) and Claim (Claim No.:[redacted]) stating that they had received the claim information for my puppy and that they requested 30 days to process. This was in direct contradiction to my phone call with the supervisor. Also, the Claim Receipt Notice never stated they would pay on the claim just that they were reviewing it. I called upon receipt of this letter on Saturday,April 23, 2016 and had a long conversation with employee "[redacted]" who told me my Veterinary team had not sent [redacted] the documents for PetPartners,Inc to process which I knew to be untrue as I had watched the documentation be faxed and shown fax received. It was stated no supervisor was there on the weekends. On Monday, April 25, I spoke again to [redacted] and then again to [redacted] and cancelled my policy (they would not backdate the cancellation) and [redacted] stated that she was not bound by our earlier conversation, that our Vet still had not sent information which I signed AGAIN and had resent and that they would "consider" paying the policy. She was RUDE and BELLIGERENT and HUNG UP after telling me to "Have a good day.". I spoke to my Veterinarian again for follow up and was told PetPartners, Inc on behalf of [redacted] has routinely not paid clients of theirs for years and they recommended two other animal insurance carriers. I demand payment of both claims or refund of all policy fees paid.Desired SettlementThis is my formal request to have PetPartners, Inc on behalf of [redacted] to either pay my claims for care of my puppy under Policy Number [redacted] and Claim Number [redacted] or refund ALL MONIES PAID as monthly coverage for medical insurance for my puppy as I feel I was lied to and mislead when first purchasing the policy. I was told when sold the policy by the representative employed by PetPartners, Inc ([redacted]) that all claims were paid within 30 days and had I been properly informed of the amount of time and difficulty involved in processing (or lack thereof) of a claim I would have NEVER signed up. I feel that the [redacted] using their name to try to solicit policy monies and not pay on said claims to be fraud and I will be contacting my credit card company if necessary to file to have charges reversed as I feel I was conned into purchase. No one at PetPartners,Inc has followed though on anything they said nor have they ever reached out to me to inform me there was a problem with my claim and never mailed, emailed or called to tell me that more would be required by either myself or my Veterinary team to insure payment of said claims. I consider this fraud and intend to do all necessary to stop them from operating in this manner with others in the future.Business Response We apologize that this process has taken so long. We have reviewed your policy and our records show that you activated your complimentary trial policy on 12/8/15 which made the policy effective on 12/9/15. We received multiple phones calls from you: one on 12/16/15 where you asked how the insurance worked and how to file a claim. Another call was received on 12/17/15 where you asked for a claim form, which we emailed that same day. An additional call was received on 1/7/16 in which you elected to start an annual policy. The annual policy became effective on 1/8/16. Our next contact with you was not until 4/12/16 where you asked about the status of a claim that you submitted to us in January. The representative at this time explained that we showed no claim in our system and asked if you could resubmit your claim. The claim was received on 4/12/16. Upon review of the claim medical records were needed to complete the review on your claim. Medical records were requested on 4/14/16 and again on 4/21/16. Our customer service supervisor contacted your vet on 4/25/16 in which they indicated they had not sent the requested medical records but said they were working on getting them to us. As of 4/27/16 we had yet to receive the requested medical records from your vet. We continued to contact your vet for the requested medical records. We did finally receive the medical records on 4/28/16. Your claim has now been completed and your explanations of benefits and reimbursement check will be mailed today.

Business is denying a claim for an CCL surgery on our dog using an ambiguous policy as the basis for their refusal to pay. Regarding claim # [redacted] (date of coverage 8/22/14-8/22/15). Three years ago, our dog had CCL surgery on her LEFT leg, upon which AKC paid their contractual amount of $1500. Just recently, our dog has recently had CCL surgery on her RIGHT leg and AKC has denied the claim on the basis of the stated policy, "19. Coverage for more than one diagnosis, treatment, medical management or surgical correction of cruciate ligament damage or rupture for the life of the pet." (Incidentally, this policy was added after we bought this policy.) In our opinion, our dog has had "One diagnosis of cruciate on her RIGHT leg" and AKC should honor their obligation to pay the contractual amount of $1500. This is NOT a repeat incident or injury. This is a completely new injury. They are denying the claim by saying that it does not matter if it is another leg or a completely separate incident. Limiting coverage to only one leg is not logical to me and defies common sense. The analogy is like having health insurance that would cover one broken arm, but not the other. Either you cover the procedure or you do not. Since when is a procedure limited to a specific number of limbs?We have been a very good customer since 2009 and have paid over $3200 is premiums into this policy(with only the one before mentioned claim). Asking AKC to cover their agreed upon contractual amount of only $1500 is not unreasonable. We have talked to AKC several times, and they have been very unhelpful in resolving this issue. According to this website, they are an accredited business and meets the standards which includes a commitment to make a good faith effort to resolve any consumer complaints. To date, I have not seen any demonstration of this good faith effort.Desired SettlementI would like AKC to pay the $1500 that I believe they are contractually obligated to pay towards the cost of the CCL surgery on the RIGHT leg. (This is only a small fraction of what the total surgery actually costs.) Alternately, they can apply the $1500 to the next 2 years of premiums (in Aug. 2015 and Aug. 2016) so I can maintain this insurance. If I have to pay the full cost of the insurance, I cannot afford these premiums and will be forced to cancel the policy. Finally, the least desirable option would be to refund me my premium of $726 that was paid in Aug. 2014 for the full year of insurance since I have not received any benefit of this insurance. Business Response /[redacted]/We have contacted the customer that submitted the above complaint and have reached a resolution.Consumer Response /[redacted]/

Coverage that says they help and never did. I had signed my dog up for this policy in August of 2014. In September my dog ended up in the Vet hospital for a new illness. Let me emphasize NEW. He was diagnosed with an immune related disease that made his platelet count drop drastically. When I signed him up I told the company that he had fevers in the past and they told me it still would not be a problem. So after I submitted everything for a claim I got the letter back saying that it was denied for his fevers. This had NOTHING to do with fevers. Since two doctors were involved there were 2 claims submitted. So in Novemeber I appealed it. That is when I found out the second claimed was completely overlooked. The Vet wrote a letter and we submitted it but apparently that was not good enough. She ended up calling into the insurance company stating that these are separate issues. Now into February I had to call and they told me over the phone that it is still being denied for his fever. Bottom line this company seems like a scam. They claim 14 days. Well this has been 5 months and they have no problem taking your money on time. I have had to call at least 15 times to see what was happening and each time I was told someone would call me back and never did. I don't understand how the vet can be telling this company that there is no relation at all and the claims are getting denied. I would like some kind of reimbursement for all this trouble. What kind of customer service has a customer wait 5 months?Desired SettlementThis claim has cost move $2500. If they can't help me with that I would like a refund of this policy. I have had it for 6 months. I have never had a company be so relaxed on getting something done.Business Response /[redacted]/We have thoroughly reviewed the medical records and claims relating to this complaint and have found the following facts.August 1, 2014Customer called to inquire about purchasing a policy. During this call the policyholder stated she had heard Shar-Peis could be prone to fevers and wanted to get insurance in case that had ever happened. Policyholder repeatedly asked if we would be checking with the vet to determine if anything was in the pet's medical history and if he would be eligible for coverage. Policyholder further clarified the dog had a fever when it was a puppy and wanted to know if that would make everything with a fever in the future ineligible. Agent stated a fever would not make everything with a fever ineligible. Agent discussed with the policyholder that any conditions occurring prior to the policy, according to the medical records, would be deemed pre-existing and would be not be covered. Customer elected to purchase the policy.August 2, 2014Policy was effective.September 5, 2015Dog was presented to veterinarian for symptoms of fever and bilateral epistaxis (bleeding) which started the night before. Medical records from this date also state fever was present the past Tuesday.September 23, 2014Claims for September 5th - 8th visits were received.Upon review of claims and medical records obtained, pet was seen in February 2014 and again in July 2014 for same symptoms of chronic fever and epistaxis with mildly low platelets levels. Customer's complaint stated the condition in question had nothing to do with fevers. However, according to the medical records of September 5th, 2014, the pet was presented for fever and epistaxis. Furthermore, discharge paperwork on September 7th 2014 also states his prognosis being due to the chronic fever. Given this chronic fever and epistaxis started back in February, the claim was denied as pre-existing.The further examination of this claim still concludes the treatments received on September 5 - 8 2014 are related to the chronic fever and epistaxis exhibited back in February and July 2014 which was prior to the policy effective date and is ineligible for coverage.The complaint also mentioned a second claim was submitted and could not be found. The second claim form was included with the submission of the first and was processed together as one being they were for the same condition and hospital. This was not noticed by the CSR when the customer called to inquire. However both forms were received and processed together.Consumer Response /[redacted]/When originally calling in August never once did I say Shar-Pei's could be prone to fever. Never did I say that the dog had a fever when he was a puppy. This company can't even get the facts straight.Claims for September were appealed. The vet had also got involved saying that the fever had NOTHING to do with the current condition. But apparently the insurance knows better. My claim went unanswered for months. And to say they were processed together is untrue. As for the amounts were for just one. Signing up for this was the biggest waste of money.Final Business Response /[redacted]/Based on the medical records, the claim in question was determined to have existed prior to the policy coverage effective date. However, we have discussed possible resolutions with the customer and have found a solution that was satisfactory to the customer.Final Consumer Response /[redacted]/(The consumer indicated he/she ACCEPTED the response from the business.)

Registered my Irish Wolfhound Puppy with [redacted] Was given a free 60-day Insurance contract. Toward the end of that 60-days puppy was diagnosed with Irritable Bowel Syndrome. Submitted the claim to [redacted] Pet Healthcare Plan.After 60-days of review the claim was denied because the insurance company said the illness was present before the policy. Actually that's not true. All puppies occasionally vomit or have diarrhea.This was not a constant issue. Worming cleared up the problem until December 21 and 24, 2013 when vomiting occurred after puppy chewed pizzle sticks (bull [redacted] rawhide) January 1, 2014 puppy vomited a bit of blood. Was taken to [redacted] Veterinary Specialty and Emergency Center [redacted] Kept overnight and given endoscopy and biopsy January 2, 2014. Diagnosis came a week later of mild Irritable bowel Disease. I sent [redacted] Pet Healthcare Plan all the paperwork from the [redacted] within the 180-day time limits. It took them more than a month to deny the claim by which time they knew I would not continue the insurance. No one, the breeder, my vet, and specialists knew or could say what puppy had prior to an actual diagnosis. One episode of vomiting or diarrhea is not enough to deny a claim. [redacted] is using bait and switch tactics. They want clients to continue the insurance, which I did not thank goodness. I don't have ability to download papers. Can send if required.Product_Or_Service: Pet Health Insurance free for 60-daysAccount_Number: XXXXXXXXDesired SettlementI want[redacted] ([redacted]) Pet Healthcare Insurance to do what it promised. To pay as much as their advertising promised. It wasn't revealed that the first 30-days covered accidents...and only the second 30 days covered illness.Business Response We have re-opened claim #XXXXXX for [redacted]. After a thorough review of all medical records, doctor's notes, and claim form we have concluded that the condition did exist prior to the policy effective date of 11/15/13. Unfortunately, the medical records show a chronic history of vomiting and diarrhea with suspect of Irritable Bowel Syndrome that date back to June 2013. The pet was seen multiple times in July -August by its regular vet as well as the emergency clinic. The pet was treated with [redacted] powder in September and October. The pet owner discontinued the [redacted] in November and by December the pet was being treated again for vomiting and history of soft stools. The final diagnosis of Irritable Bowel Syndrome was diagnosed after a biopsy on 1/7/14. While the final diagnosis wasn't determined until January 2014 the pet showed symptoms of the illness prior to the 11-15-13 policy effective date. Our policy does not cover pre-existing conditions.If you have any other questions or concerns please feel free to contact us at X-XXX-XXX-XXXX. Consumer Response My only comment is that despite multiple visits to my vet NO ONE, not even my vet guessed what was wrong with this puppy. No one even hinted to my that this could be Irritable Bowel Syndrome. My vet told e the symptoms could have been caused by any number of things including parasites. No one has a crystal ball in puppy ailments. Until a final diagnosis, no one can call it a pre-existing condition. Every step that I took, including the discontinuance of [redacted] powder was directed by my vet as a test to see what would happen. This is my truthful account.MY CLAIM IS THAT SYMPTOMS COULD HAVE BEEN CAUSED BY A NUMBER OF THINGS, INCLUDING PARASITES.HOW CAN YOU, [redacted] PET INSURANCE, SAY YOU DON'T COVER PRE-EXISTING CONDITIONS WHEN NO VET KNEW OR EVEN SUGGESTED WHAT THOSE CONDITIONS ACTUALLY WERE UNTIL A BIOPSY IN JANUARY 2014? HAD I CONTINUED THE INSURANCE COVERAGE YOU, ACCORDING TO YOUR PAPERS, WOULD HAVE COVERED MY PUPPY'S CLAIM. I wouldn't recommend you [redacted] Pet Insurance) to anyone looking for pet care coverage.

Failure to pay the bill of my sick dog and falure to refund after told they would do so.I am very disappointed with the "[redacted]" or pet partners inc. health care plan for my dog [redacted]. He is a normally very healthy dos and usually does not have any healthy problems. Upon returning from vacation [redacted] was producing blood in his stool. I took him to the vet and went through the long and drawn out process of processing it through the so called "health insurance". After filing you chose three of over 31 reasons to deny my claim! They chose one reason for each item of service from our vet. If humans had this type of insurance the cost would not be an issue. Neither would overpopulation! I have been paying my plan dues and would keep on doing so if it was actually insurance. Unfortunately it is not and all they want to do is take peoples money. I want my plan cancelled immediately and would also like a refund.Desired SettlementI want a refun since there "policy is usless and does not benifit my dog in any way. If I have to pay the vet and not get reimbersed for somthing so trivial I certainly cannot trust them with the chance of somthing bigger happening. Business Response Thank you for your letter dated 11/11/13. We have reviewed the complaint for [redacted] and determined that the policy Mr. [redacted] purchased was a Accident policy. Our Accident policy only provides coverage for 9 specific injuries:1) foreign body removed via sx and/or endoscopy2) hit by car3) Fractures4) Toxin ingestion5) Laceration/bite wounds6) Burns7) Insect/snake bites8)choking/drowning9) head traumaUnfortunately, Mr. [redacted]'s dog had GI upset/diarrhea which is not eligible under the Accident policy. Mr. [redacted]'s policy was cancelled 10/21/13 as he requested and a refund has processed. If you have any additional questions please feel free to contact me directly at [email protected],[redacted]

Indicated by phone that my claim will be honoured and then later refused to pay my claim.I called about my dogs' RIGHT leg that had swelling and discharge. I asked specifically whether treatment will be covered by insurance as his LEFT leg had a similar but different problem a year ago. They said 'Yes, different leg, different incident' so I file a claim as usual. They then refused to pay claiming it was related to his other leg. How can they change their minds? They also refused to pay for treatment of all my pet's other problems claiming they all have the same cause. This is completely unproven and unfounded. Desired SettlementI have cancelled my policy with them. They need to deal fairly and honestly with clientsexplanationBusiness Response We are never able to guarantee coverage before a claim is submitted and a complete investigation has been finalized. This claim was processed according to the treating veterinarian's documentation. Customer's pet was seen in 2013 for a skin infection with a fistula and draining tract, this incident was reimbursed according to the policy terms and conditions. In 2014 a second infection with a fistula and draining tracts was submitted for processing. During the investigation of the claim, the infection was considered to be the same incident because the treating veterinarian explained that while it was a new infection the underlying cause was repeated skin infections, compounded by the pet not being able to get up from a laying position which causes scrapes and wounds on the hind legs, in addition he regularly has soft stool which soils his rear legs causing the infection to become more severe.The policy the customer purchased explains that a recurring, related and/or chronic condition shall be deemed one incident. The per-incident maximum that can be paid on this policy is $1500.00. At this time the customer has been reimbursed the maximum amount allowed by his policy. We have sent him an explanation of why we are unable to continue reimbursing for this incident and hope that with our previous explanation and this information it will eliminate his concerns that this claim was not processed with the information received and according to his policy terms and conditionsConsumer Response Skin infection and fistulas in the leg are not related and the diagnosis on my claim form was changed from 'Pyoderma' to 'Draining tract' on the explanation of benefits form. If you cannot even keep the same diagnosis from what was written, you cannot make a fair and professional claims adjustment. Final Business Response The submitted claims forms for this treatment have included symptoms by the customer and diagnosis by the treating veterinarian:Date of service 2/13- "swelling and discharge from left ankle" (customer statement), "draining cyst"(veterinarians diagnosis)Date of service 2/26- : "skin lesions on body and right rear leg- appears to be a recurrence of problem from June 2013, see attached copies of invoice and claim form" (customer statement) "Dermatitis and right rear leg infection" (veterinarians diagnosis)Date of service 3/10- "oozing sores on right leg" (customer statement), "Draining cyst" (veterinarian diagnosis) Dates of service 3/10, 3/29"oozing sores on the right leg" (customer statement) draining cyst (veterinarian's diagnosis). When we contacted the treating veterinarian, he responded in writing saying "[redacted] has had repeated skin infections and in the last year or two has had much more difficulty getting up from laying position. In addition he has soft stool regularly and often gets stool soiling on his rear legs. Due to his difficulty getting up he scrapes his rear legs. I suspect that some of these infections if not all are related in some way to his age, stool issues and difficulty getting up. These most recent infections were new, but they are related to past ones due to underlying causes. - [redacted]". Pyoderma means any skin disease characterized by the presence of pus. Once the treating veterinarian linked the February 2014 skin infection to the June 2013, the system used the same diagnosis previously submitted, this was corrected as soon as it was brought to our attention and we apologize that it has caused the customer frustration. While the system diagnosis was changed to show pyoderma (skin infection), this did not negate the fact that the February 2014 and June 2013 skin issues are related because of the same underlying cause, which was indicated on submitted claim froms and confirmed by the treating veterinarian.

I turned in a claim in April and I still have not received my check I have called several times and they keep telling me they sent it. I started call I filed a claim in April and still have not received it yet I have several e-mails from them saying the check was send.I called two weeks later and they said they forgot to mail the check and was putting it in the mail I keep calling and they keep saying it been mailed.they are lying [redacted] Is the manager and she told me one the phone that the check was mailed.I don't have it yet.Desired SettlementI pay for services and I want my check for my services that I turned in and I don't want to be lied to every time I call.Business Response We apologize for the inconvenience to the customer on this issue. The claim in question was received on 4/7/16. The claim was processed with no issues and a check was issued on 4/21/16. We received a call from the policyholder on 6/8/16 requesting the status of her check. We informed the customer that the claim had been processed and a check had been mailed. The customer responded that she had not received the check. A new check was re-issued on 6/9/16 and mailed on 6/13/16. We have confirmed that the policyholder has received the re-issued check on 6/17/16.

Did not receive insurance reimbursemen check after calling the customer service line twice. It has been two months and still have not received a checkI submitted a pet insurance claim on 12Aug16, and after waiting a month of not receiving a check, I contacted customer service. On 19Sep16, the representative ([redacted]) told me a check was sent to my address on 23Aug16. She checked to confirm the address with me, and I informed her the address was correct. After telling her I had not received the check, she told me she would contact finance to ensure the check had not been cashed. After not hearing a response back from [redacted] regarding the status of the check, I contacted customer service again on 27Sep16. On 29Sep16, [redacted] from the customer care team responded and said that the check had not been cashed, and that a new check would be printed the following day and sent out. I then sent a follow up e-mail once again stating our address to ensure it would be sent to the right place. After waiting another two weeks and still have not received a check, I contacted customer service on 12Oct16. I confirmed once again the address, and was told to wait another two weeks for the check to arrive. It's been roughly two months since the check has supposedly been sent to the correct address, but have yet to receive it. I have checked with the manager of the apartment complex we live in and has assured me that any mail would be placed in our designated mail box (as it always has in the past). We have not had any issue regarding the mail service in our apartment complex. I do believe that the check from Pet Partners was never sent, and likewise, would like a monetary resolution. We are registered with pet partners under the number DNXXXXXXXX. The claim number is XXXXXXX.Desired SettlementI would like my claim to be settled by having Pet Partners send the check for $115.40, which is the amount I should have been awarded according to the claim. In addition, I would like reimbursement for the two months of pet insurance payments (which would total $188.66) I was making while this claim was being settled. I would like to severe my ties and cancel my pet insurance policy with Pet Partners, because I felt as though I had been wrongfully charged these two months while waiting for my insurance claim check. I have forgone my pet's non-life threatening healthcare needs due to the issue with Pet Partners, out of concern that I would not be reimbursed. As a result, I feel as though I should be reimbursed for these months and would likewise want reimbursement for my policy payments and to cancel my policy as soon as possible.