Pet's Best Insurance Services Reviews (%countItem)
Pet's Best Insurance Services Rating
Address: 2323 S Vista Ave Ste 100, Boise, Idaho, United States, 83705-7343
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Submitted 2 claims for my dog on 7/25, provided invoice and complete vet records and also advised insurance company that I had other coverage and I was going to cancel one policy. Regularly checked status of claim throughout August, told miscellaneous reasons for delay. On 8/21 I received an ambiguous email “We will soon be contacting you by phone to let you know that we need additional information in order to complete the processing of your claim.” Called again was advised that they now need EOBs of other insurance company. Did not have them advised once paid I would provide. Received payment and EOBs from other company and submitted to Petsbest on 8/31, it’s been 17 days since submission, I need Resolution!
Ps, I’ve called several times to inquire, same response they are reviewing the the claim or rereviewing the claim.
I would not recommend this company.
This claim was delayed due to presence of multiple policies. Under our policies, we only reimburse actual out of pocket expenses which means we had to await the EOB from the other insurance company. Once the EOBs were obtained, the claim was added to the processing queu in the order received. When, as here, there are multiple policies, this creates additional reviews to ensure the policyholder receives all available coverage under our policy and also to prevent insurance fraud in the form of recovering from multiple insurance companies for the same event. There were additional issues as the actual EOBs from the other insurance company were not received until 9/25/19. The claim was finalized on 9/26/19.
Complaint: ***
I am rejecting this response because: the insurance company was advised from the submission of the claim that I had another insurance company and after repeated calls to their company at no time was I advised that they needed the EOB from the primary insurance. It wasn’t until after repeated calls and a vague email that I responded to was I told it was necessary for the EOB. The company sent me a letter (Not EOB) that I forwarded to Pets best when they requested additional information. Again after repeated calls I was not told this was unacceptable. Two months later the claim was paid. I won’t recommend This company because they intentionally leave you hanging and do not communicate effectively. Poor management and customer service!
Sincerely
Purchased an accident insurance for a pet dog, "Pecos". I Paid 3 months in advance and was issued a policy on July 25, 2019. I filed an accident claim for Pecos after she was bitten by a rattlesnake on August 19.2019. The covered puppy was about 4 months old when she was bitten and had been to the vet for a general puppy check up. She was too young to get a rattlesnake vaccine.
This was an "Accident Claim" with no prior conditions or other circumstances.. The policy stated that rattlesnake was covered as an accident and accident claims were paid in 5 days.
It has been almost a month and I contacted the company asking for information and date of payment. I have received only scripted responses and information about being paid.
I feel that the company is in default of the terms of the policy and may deny payment .
I purchased it in good faith, paid 3 months in advance, and filed a claim with appropriate billing information from our certified vet. I have complied and they have not.
This complaint appears to be one involving the time it took to process Ms. claim. We generally are able to process claims within 3-5 business days; however, the first claim on a pet for a new policy sometimes takes additional time as medical records may be needed for review. Further, claims are processed in the order received and can be delayed during times of high claim submission. We apologize for this delay. It appears Ms. claim was processed and finalized on 9/20/19. This period is within the terms permitted under state law and within the policy terms.
Complaint: ***
I am rejecting this response because:
The official documents and the advertisement and their website make absolutely NO reference to their reason for the time delay.
I believe their answer to be weasel speak, not an answer from their moral or ethical position.
Also, they paid the claim THE DAY AFTER I FILED THE COMPLAINT. Thanks to the Revdex.com.
I don't feel that they would have paid unless I contacted the Revdex.com and my state Insurance commission.
.... at this point they have paid the claim as per the contract WITH THE EXCEPTION OF THEIR INEXCUSABLE TIME DELAY.
I thank the Revdex.com and ask that they consider my cast in their rating of them, and consider the matter closed.
Thanks Revdex.com for keeping corporations more honest.
Sincerely
Purchased an accident insurance for a pet dog, "Pecos". I Paid 3 months in advance and was issued a policy on July 25, 2019. I filed an accident claim for Pecos after she was bitten by a rattlesnake on August 19.2019. The covered puppy was about 4 months old when she was bitten and had been to the vet for a general puppy check up. She was too young to get a rattlesnake vaccine.
This was an "Accident Claim" with no prior conditions or other circumstances.. The policy stated that rattlesnake was covered as an accident and accident claims were paid in 5 days.
It has been almost a month and I contacted the company asking for information and date of payment. I have received only scripted responses and information about being paid.
I feel that the company is in default of the terms of the policy and may deny payment .
I purchased it in good faith, paid 3 months in advance, and filed a claim with appropriate billing information from our certified vet. I have complied and they have not.
This complaint appears to be one involving the time it took to process Ms. claim. We generally are able to process claims within 3-5 business days; however, the first claim on a pet for a new policy sometimes takes additional time as medical records may be needed for review. Further, claims are processed in the order received and can be delayed during times of high claim submission. We apologize for this delay. It appears Ms. claim was processed and finalized on 9/20/19. This period is within the terms permitted under state law and within the policy terms.
Complaint: ***
I am rejecting this response because:
The official documents and the advertisement and their website make absolutely NO reference to their reason for the time delay.
I believe their answer to be weasel speak, not an answer from their moral or ethical position.
Also, they paid the claim THE DAY AFTER I FILED THE COMPLAINT. Thanks to the Revdex.com.
I don't feel that they would have paid unless I contacted the Revdex.com and my state Insurance commission.
.... at this point they have paid the claim as per the contract WITH THE EXCEPTION OF THEIR INEXCUSABLE TIME DELAY.
I thank the Revdex.com and ask that they consider my cast in their rating of them, and consider the matter closed.
Thanks Revdex.com for keeping corporations more honest.
Sincerely
Purchased an accident insurance for a pet dog, "Pecos". I Paid 3 months in advance and was issued a policy on July 25, 2019. I filed an accident claim for Pecos after she was bitten by a rattlesnake on August 19.2019. The covered puppy was about 4 months old when she was bitten and had been to the vet for a general puppy check up. She was too young to get a rattlesnake vaccine.
This was an "Accident Claim" with no prior conditions or other circumstances.. The policy stated that rattlesnake was covered as an accident and accident claims were paid in 5 days.
It has been almost a month and I contacted the company asking for information and date of payment. I have received only scripted responses and information about being paid.
I feel that the company is in default of the terms of the policy and may deny payment .
I purchased it in good faith, paid 3 months in advance, and filed a claim with appropriate billing information from our certified vet. I have complied and they have not.
This complaint appears to be one involving the time it took to process Ms. claim. We generally are able to process claims within 3-5 business days; however, the first claim on a pet for a new policy sometimes takes additional time as medical records may be needed for review. Further, claims are processed in the order received and can be delayed during times of high claim submission. We apologize for this delay. It appears Ms. claim was processed and finalized on 9/20/19. This period is within the terms permitted under state law and within the policy terms.
Complaint: ***
I am rejecting this response because:
The official documents and the advertisement and their website make absolutely NO reference to their reason for the time delay.
I believe their answer to be weasel speak, not an answer from their moral or ethical position.
Also, they paid the claim THE DAY AFTER I FILED THE COMPLAINT. Thanks to the Revdex.com.
I don't feel that they would have paid unless I contacted the Revdex.com and my state Insurance commission.
.... at this point they have paid the claim as per the contract WITH THE EXCEPTION OF THEIR INEXCUSABLE TIME DELAY.
I thank the Revdex.com and ask that they consider my cast in their rating of them, and consider the matter closed.
Thanks Revdex.com for keeping corporations more honest.
Sincerely
Purchased an accident insurance for a pet dog, "Pecos". I Paid 3 months in advance and was issued a policy on July 25, 2019. I filed an accident claim for Pecos after she was bitten by a rattlesnake on August 19.2019. The covered puppy was about 4 months old when she was bitten and had been to the vet for a general puppy check up. She was too young to get a rattlesnake vaccine.
This was an "Accident Claim" with no prior conditions or other circumstances.. The policy stated that rattlesnake was covered as an accident and accident claims were paid in 5 days.
It has been almost a month and I contacted the company asking for information and date of payment. I have received only scripted responses and information about being paid.
I feel that the company is in default of the terms of the policy and may deny payment .
I purchased it in good faith, paid 3 months in advance, and filed a claim with appropriate billing information from our certified vet. I have complied and they have not.
This complaint appears to be one involving the time it took to process Ms. claim. We generally are able to process claims within 3-5 business days; however, the first claim on a pet for a new policy sometimes takes additional time as medical records may be needed for review. Further, claims are processed in the order received and can be delayed during times of high claim submission. We apologize for this delay. It appears Ms. claim was processed and finalized on 9/20/19. This period is within the terms permitted under state law and within the policy terms.
Complaint: ***
I am rejecting this response because:
The official documents and the advertisement and their website make absolutely NO reference to their reason for the time delay.
I believe their answer to be weasel speak, not an answer from their moral or ethical position.
Also, they paid the claim THE DAY AFTER I FILED THE COMPLAINT. Thanks to the Revdex.com.
I don't feel that they would have paid unless I contacted the Revdex.com and my state Insurance commission.
.... at this point they have paid the claim as per the contract WITH THE EXCEPTION OF THEIR INEXCUSABLE TIME DELAY.
I thank the Revdex.com and ask that they consider my cast in their rating of them, and consider the matter closed.
Thanks Revdex.com for keeping corporations more honest.
Sincerely
I have been with Petsbest for 10 years. I been with the same Vet for 10 years. I never had a problem with getting refunded for any claims for neither one of my dogs. My oldest dog just made 10 years old. He start having a cough back in Feb or Mar 2019. The vet recommended antibiotics for upper respiratory but after the cough continued the vet did x-ray. Bottom line my dog has heart failure. I have submitted claims since March but petsbest refuse to reimburse me. They are requesting soap notes. The vet uses a computer to make his notes. The vet has sent everything that they have asked and I still haven't been reimburse. I don't know a doctor or get that use paper and pen in 2019. I went back to the vet and he wrote the note for the requested dates. Now I'm still waiting. Its been 6 months and I don't understand how is there a problem. Same vet and insurance for 10 years.
Ms.' claim was processed and paid on 9/23/19. SOAP notes are legal documents and part of the recordsVeterinary hospitals are legally required to accurately create and maintain. Once determined the provider did not create the legally required documents, this claim was processed with the records available and the policy holder was reimbursed. Under the terms of the policy, this claim could have been denied due to the provider's failure to provider SOAP notes. We generally try to avoid such denials whenever possible; however, when the records are lacking, this can sometimes cause delays.
I have been with Petsbest for 10 years. I been with the same Vet for 10 years. I never had a problem with getting refunded for any claims for neither one of my dogs. My oldest dog just made 10 years old. He start having a cough back in Feb or Mar 2019. The vet recommended antibiotics for upper respiratory but after the cough continued the vet did x-ray. Bottom line my dog has heart failure. I have submitted claims since March but petsbest refuse to reimburse me. They are requesting soap notes. The vet uses a computer to make his notes. The vet has sent everything that they have asked and I still haven't been reimburse. I don't know a doctor or get that use paper and pen in 2019. I went back to the vet and he wrote the note for the requested dates. Now I'm still waiting. Its been 6 months and I don't understand how is there a problem. Same vet and insurance for 10 years.
Ms.' claim was processed and paid on 9/23/19. SOAP notes are legal documents and part of the recordsVeterinary hospitals are legally required to accurately create and maintain. Once determined the provider did not create the legally required documents, this claim was processed with the records available and the policy holder was reimbursed. Under the terms of the policy, this claim could have been denied due to the provider's failure to provider SOAP notes. We generally try to avoid such denials whenever possible; however, when the records are lacking, this can sometimes cause delays.
I have been with Petsbest for 10 years. I been with the same Vet for 10 years. I never had a problem with getting refunded for any claims for neither one of my dogs. My oldest dog just made 10 years old. He start having a cough back in Feb or Mar 2019. The vet recommended antibiotics for upper respiratory but after the cough continued the vet did x-ray. Bottom line my dog has heart failure. I have submitted claims since March but petsbest refuse to reimburse me. They are requesting soap notes. The vet uses a computer to make his notes. The vet has sent everything that they have asked and I still haven't been reimburse. I don't know a doctor or get that use paper and pen in 2019. I went back to the vet and he wrote the note for the requested dates. Now I'm still waiting. Its been 6 months and I don't understand how is there a problem. Same vet and insurance for 10 years.
Ms.' claim was processed and paid on 9/23/19. SOAP notes are legal documents and part of the recordsVeterinary hospitals are legally required to accurately create and maintain. Once determined the provider did not create the legally required documents, this claim was processed with the records available and the policy holder was reimbursed. Under the terms of the policy, this claim could have been denied due to the provider's failure to provider SOAP notes. We generally try to avoid such denials whenever possible; however, when the records are lacking, this can sometimes cause delays.
I have been with Petsbest for 10 years. I been with the same Vet for 10 years. I never had a problem with getting refunded for any claims for neither one of my dogs. My oldest dog just made 10 years old. He start having a cough back in Feb or Mar 2019. The vet recommended antibiotics for upper respiratory but after the cough continued the vet did x-ray. Bottom line my dog has heart failure. I have submitted claims since March but petsbest refuse to reimburse me. They are requesting soap notes. The vet uses a computer to make his notes. The vet has sent everything that they have asked and I still haven't been reimburse. I don't know a doctor or get that use paper and pen in 2019. I went back to the vet and he wrote the note for the requested dates. Now I'm still waiting. Its been 6 months and I don't understand how is there a problem. Same vet and insurance for 10 years.
Ms.' claim was processed and paid on 9/23/19. SOAP notes are legal documents and part of the recordsVeterinary hospitals are legally required to accurately create and maintain. Once determined the provider did not create the legally required documents, this claim was processed with the records available and the policy holder was reimbursed. Under the terms of the policy, this claim could have been denied due to the provider's failure to provider SOAP notes. We generally try to avoid such denials whenever possible; however, when the records are lacking, this can sometimes cause delays.
I am not sure what all these complaints and poor reviews is stemming from. I have had Pets Best insurance since 2012 and I have had zero issues. Yes, sometimes the claim processing is a little slow but I always get an email telling me that. Everything I thought should be covered has been and things I know are not covered have not been but I know all this because I read my policy. This is not an insurance company that just pays because you walk through their front door at the vet. It's for illness mainly unless you add on a wellness policy. You can't expect them to pay for things that are clearly outlined in the policy that is not covered. A lot of people know there animal is getting sick or suspect something so they sign up and expect to be covered. It doesn't work that way. My only negative is that the price does jump up year to year. It's getting expensive but always covers what it's supposed to.
I am not sure what all these complaints and poor reviews is stemming from. I have had Pets Best insurance since 2012 and I have had zero issues. Yes, sometimes the claim processing is a little slow but I always get an email telling me that. Everything I thought should be covered has been and things I know are not covered have not been but I know all this because I read my policy. This is not an insurance company that just pays because you walk through their front door at the vet. It's for illness mainly unless you add on a wellness policy. You can't expect them to pay for things that are clearly outlined in the policy that is not covered. A lot of people know there animal is getting sick or suspect something so they sign up and expect to be covered. It doesn't work that way. My only negative is that the price does jump up year to year. It's getting expensive but always covers what it's supposed to.
I am not sure what all these complaints and poor reviews is stemming from. I have had Pets Best insurance since 2012 and I have had zero issues. Yes, sometimes the claim processing is a little slow but I always get an email telling me that. Everything I thought should be covered has been and things I know are not covered have not been but I know all this because I read my policy. This is not an insurance company that just pays because you walk through their front door at the vet. It's for illness mainly unless you add on a wellness policy. You can't expect them to pay for things that are clearly outlined in the policy that is not covered. A lot of people know there animal is getting sick or suspect something so they sign up and expect to be covered. It doesn't work that way. My only negative is that the price does jump up year to year. It's getting expensive but always covers what it's supposed to.
I am not sure what all these complaints and poor reviews is stemming from. I have had Pets Best insurance since 2012 and I have had zero issues. Yes, sometimes the claim processing is a little slow but I always get an email telling me that. Everything I thought should be covered has been and things I know are not covered have not been but I know all this because I read my policy. This is not an insurance company that just pays because you walk through their front door at the vet. It's for illness mainly unless you add on a wellness policy. You can't expect them to pay for things that are clearly outlined in the policy that is not covered. A lot of people know there animal is getting sick or suspect something so they sign up and expect to be covered. It doesn't work that way. My only negative is that the price does jump up year to year. It's getting expensive but always covers what it's supposed to.
I adopted my cat, on February 11, 2018. I purchased pet insurance for him on June 23, 2018. On July 6th the 14 day waiting period had passed and now he was fully insured. On June 8, 2018 My cat had a bump on his body. The vet had aspirated the bump and performed a cytology. She could not find any infection but gave antibiotics and sent the him home. Later on June 18th the bump and ruptured which according to the vet was a good sign. The sight was cleaned out and he was given an injection of antibiotics. On July 31 my cat was brought back to the vet for another bump. The bump was cultured. On August 3 a culture was again taken because nothing grew on the previous culture. On August 20th the culture came back as Nocardia. Pets Best denied all claims because this was a previous condition. They cannot prove that Nocardia was present in all previous visits and an infection can be anything from a common cold to this. Since Nocardia was never treated until August 20th we must assume that that was when the Nocardia was diagnosed. I have asked them many times to prove that Nocardia was present prior to August 20 and they evade the question by saying it is a previous condition. I have all correspondences between Pets Best and myself. I have all Vet charges and records if needed and can provide further details if needed.
Mr. policy-like all pet insurance policies-exclude Pre-existing Conditions from coverage. Unfortunately, Mr. understanding of his policy—that Pets Best “prove that Nocardia was present in all previous visits…”—is not the correct standard to determine whether the Pre-existing Condition Exclusion is applicable. The terms of the policy define “Pre-existing Condition” to include “Any condition for which a veterinarian provided medical advice, the Pet received treatment for, or the Pet displayed signs or symptoms consistent with the stated Condition prior to the effective date of a Pet insurance policy (Policy Effective Date) or during any Waiting Period.”
As explained to Mr. on his First and Second Level Appeals prior to this complaint, medical records (from both the regular veterinarian and a specialist) document that the pet’s bump was recurrent in nature and began prior to policy inception. Nonetheless, when Mr. Submitted his Second Level Appeal, the case was sent for review by an independent veterinarian who concluded:
Felix’s medical history is classic for Nocardiosis. A recurrent, resistant cutaneous infection which eventually spread to the thoracic cavity. Irregardless to the fact that a culture to document the causative organism was not performed initially in the treatment of his infection, Felix’s initial infection is documented in his medical records on June 8, 2018, prior to the inception of his insurance policy on June 21, 2018.
Three experts in the field of veterinary medicine have confirmed that the lumps were recurrent in nature beginning on a date prior to policy inception. Unfortunately, no veterinary professionals have opined otherwise. We are constrained to adjudicate claims based on the medical records in this instance. These records are very clear on the recurrent nature of the bump that began before the policy was purchased. Unfortunately, this means the claims were properly denied.
Complaint: ***
I am rejecting this response because:
I have repeatedly asked, and the insurance company has repeatedly ignored and or evaded my question. The question is clear in my two appeals letters. WHERE in any records has Felix's Nocardia been identified during the look back period.
Although Felix presented an abscess during the look back period he was treated for an infection and considered cured. There were no approved medications administered for Nocardia. It was not until August, after the look back period that Nocardia was diagnosed and treated with approved Antibiotics. As stated before symptoms can mean any illness but until the illness is specifically diagnosed it cannot be construed as a preexisting condition. The policy, I believe is written to try and disadvantage me to encompass a infection as everything and so if Felix came in to the Vet and now had a foot pain they could say it was due to the infection and not pay it either.
AGAIN: If you can show me where Norcardia was diagnosed during or before the look back period I will accept that. You say numerous Veterinarians said it is a common for these symptoms to present itself as Norcardia and that is why they are rejecting the claim. Can they also say that there are no other illnesses that present the same symptoms? If so they why did the Veterinarians not treat it as Nocardia in the first place?
Sincerely
I adopted my cat, on February 11, 2018. I purchased pet insurance for him on June 23, 2018. On July 6th the 14 day waiting period had passed and now he was fully insured. On June 8, 2018 My cat had a bump on his body. The vet had aspirated the bump and performed a cytology. She could not find any infection but gave antibiotics and sent the him home. Later on June 18th the bump and ruptured which according to the vet was a good sign. The sight was cleaned out and he was given an injection of antibiotics. On July 31 my cat was brought back to the vet for another bump. The bump was cultured. On August 3 a culture was again taken because nothing grew on the previous culture. On August 20th the culture came back as Nocardia. Pets Best denied all claims because this was a previous condition. They cannot prove that Nocardia was present in all previous visits and an infection can be anything from a common cold to this. Since Nocardia was never treated until August 20th we must assume that that was when the Nocardia was diagnosed. I have asked them many times to prove that Nocardia was present prior to August 20 and they evade the question by saying it is a previous condition. I have all correspondences between Pets Best and myself. I have all Vet charges and records if needed and can provide further details if needed.
Mr. policy-like all pet insurance policies-exclude Pre-existing Conditions from coverage. Unfortunately, Mr. understanding of his policy—that Pets Best “prove that Nocardia was present in all previous visits…”—is not the correct standard to determine whether the Pre-existing Condition Exclusion is applicable. The terms of the policy define “Pre-existing Condition” to include “Any condition for which a veterinarian provided medical advice, the Pet received treatment for, or the Pet displayed signs or symptoms consistent with the stated Condition prior to the effective date of a Pet insurance policy (Policy Effective Date) or during any Waiting Period.”
As explained to Mr. on his First and Second Level Appeals prior to this complaint, medical records (from both the regular veterinarian and a specialist) document that the pet’s bump was recurrent in nature and began prior to policy inception. Nonetheless, when Mr. Submitted his Second Level Appeal, the case was sent for review by an independent veterinarian who concluded:
Felix’s medical history is classic for Nocardiosis. A recurrent, resistant cutaneous infection which eventually spread to the thoracic cavity. Irregardless to the fact that a culture to document the causative organism was not performed initially in the treatment of his infection, Felix’s initial infection is documented in his medical records on June 8, 2018, prior to the inception of his insurance policy on June 21, 2018.
Three experts in the field of veterinary medicine have confirmed that the lumps were recurrent in nature beginning on a date prior to policy inception. Unfortunately, no veterinary professionals have opined otherwise. We are constrained to adjudicate claims based on the medical records in this instance. These records are very clear on the recurrent nature of the bump that began before the policy was purchased. Unfortunately, this means the claims were properly denied.
Complaint: ***
I am rejecting this response because:
I have repeatedly asked, and the insurance company has repeatedly ignored and or evaded my question. The question is clear in my two appeals letters. WHERE in any records has Felix's Nocardia been identified during the look back period.
Although Felix presented an abscess during the look back period he was treated for an infection and considered cured. There were no approved medications administered for Nocardia. It was not until August, after the look back period that Nocardia was diagnosed and treated with approved Antibiotics. As stated before symptoms can mean any illness but until the illness is specifically diagnosed it cannot be construed as a preexisting condition. The policy, I believe is written to try and disadvantage me to encompass a infection as everything and so if Felix came in to the Vet and now had a foot pain they could say it was due to the infection and not pay it either.
AGAIN: If you can show me where Norcardia was diagnosed during or before the look back period I will accept that. You say numerous Veterinarians said it is a common for these symptoms to present itself as Norcardia and that is why they are rejecting the claim. Can they also say that there are no other illnesses that present the same symptoms? If so they why did the Veterinarians not treat it as Nocardia in the first place?
Sincerely
I adopted my cat, on February 11, 2018. I purchased pet insurance for him on June 23, 2018. On July 6th the 14 day waiting period had passed and now he was fully insured. On June 8, 2018 My cat had a bump on his body. The vet had aspirated the bump and performed a cytology. She could not find any infection but gave antibiotics and sent the him home. Later on June 18th the bump and ruptured which according to the vet was a good sign. The sight was cleaned out and he was given an injection of antibiotics. On July 31 my cat was brought back to the vet for another bump. The bump was cultured. On August 3 a culture was again taken because nothing grew on the previous culture. On August 20th the culture came back as Nocardia. Pets Best denied all claims because this was a previous condition. They cannot prove that Nocardia was present in all previous visits and an infection can be anything from a common cold to this. Since Nocardia was never treated until August 20th we must assume that that was when the Nocardia was diagnosed. I have asked them many times to prove that Nocardia was present prior to August 20 and they evade the question by saying it is a previous condition. I have all correspondences between Pets Best and myself. I have all Vet charges and records if needed and can provide further details if needed.
Mr. policy-like all pet insurance policies-exclude Pre-existing Conditions from coverage. Unfortunately, Mr. understanding of his policy—that Pets Best “prove that Nocardia was present in all previous visits…”—is not the correct standard to determine whether the Pre-existing Condition Exclusion is applicable. The terms of the policy define “Pre-existing Condition” to include “Any condition for which a veterinarian provided medical advice, the Pet received treatment for, or the Pet displayed signs or symptoms consistent with the stated Condition prior to the effective date of a Pet insurance policy (Policy Effective Date) or during any Waiting Period.”
As explained to Mr. on his First and Second Level Appeals prior to this complaint, medical records (from both the regular veterinarian and a specialist) document that the pet’s bump was recurrent in nature and began prior to policy inception. Nonetheless, when Mr. Submitted his Second Level Appeal, the case was sent for review by an independent veterinarian who concluded:
Felix’s medical history is classic for Nocardiosis. A recurrent, resistant cutaneous infection which eventually spread to the thoracic cavity. Irregardless to the fact that a culture to document the causative organism was not performed initially in the treatment of his infection, Felix’s initial infection is documented in his medical records on June 8, 2018, prior to the inception of his insurance policy on June 21, 2018.
Three experts in the field of veterinary medicine have confirmed that the lumps were recurrent in nature beginning on a date prior to policy inception. Unfortunately, no veterinary professionals have opined otherwise. We are constrained to adjudicate claims based on the medical records in this instance. These records are very clear on the recurrent nature of the bump that began before the policy was purchased. Unfortunately, this means the claims were properly denied.
Complaint: ***
I am rejecting this response because:
I have repeatedly asked, and the insurance company has repeatedly ignored and or evaded my question. The question is clear in my two appeals letters. WHERE in any records has Felix's Nocardia been identified during the look back period.
Although Felix presented an abscess during the look back period he was treated for an infection and considered cured. There were no approved medications administered for Nocardia. It was not until August, after the look back period that Nocardia was diagnosed and treated with approved Antibiotics. As stated before symptoms can mean any illness but until the illness is specifically diagnosed it cannot be construed as a preexisting condition. The policy, I believe is written to try and disadvantage me to encompass a infection as everything and so if Felix came in to the Vet and now had a foot pain they could say it was due to the infection and not pay it either.
AGAIN: If you can show me where Norcardia was diagnosed during or before the look back period I will accept that. You say numerous Veterinarians said it is a common for these symptoms to present itself as Norcardia and that is why they are rejecting the claim. Can they also say that there are no other illnesses that present the same symptoms? If so they why did the Veterinarians not treat it as Nocardia in the first place?
Sincerely
I adopted my cat, on February 11, 2018. I purchased pet insurance for him on June 23, 2018. On July 6th the 14 day waiting period had passed and now he was fully insured. On June 8, 2018 My cat had a bump on his body. The vet had aspirated the bump and performed a cytology. She could not find any infection but gave antibiotics and sent the him home. Later on June 18th the bump and ruptured which according to the vet was a good sign. The sight was cleaned out and he was given an injection of antibiotics. On July 31 my cat was brought back to the vet for another bump. The bump was cultured. On August 3 a culture was again taken because nothing grew on the previous culture. On August 20th the culture came back as Nocardia. Pets Best denied all claims because this was a previous condition. They cannot prove that Nocardia was present in all previous visits and an infection can be anything from a common cold to this. Since Nocardia was never treated until August 20th we must assume that that was when the Nocardia was diagnosed. I have asked them many times to prove that Nocardia was present prior to August 20 and they evade the question by saying it is a previous condition. I have all correspondences between Pets Best and myself. I have all Vet charges and records if needed and can provide further details if needed.
Mr. policy-like all pet insurance policies-exclude Pre-existing Conditions from coverage. Unfortunately, Mr. understanding of his policy—that Pets Best “prove that Nocardia was present in all previous visits…”—is not the correct standard to determine whether the Pre-existing Condition Exclusion is applicable. The terms of the policy define “Pre-existing Condition” to include “Any condition for which a veterinarian provided medical advice, the Pet received treatment for, or the Pet displayed signs or symptoms consistent with the stated Condition prior to the effective date of a Pet insurance policy (Policy Effective Date) or during any Waiting Period.”
As explained to Mr. on his First and Second Level Appeals prior to this complaint, medical records (from both the regular veterinarian and a specialist) document that the pet’s bump was recurrent in nature and began prior to policy inception. Nonetheless, when Mr. Submitted his Second Level Appeal, the case was sent for review by an independent veterinarian who concluded:
Felix’s medical history is classic for Nocardiosis. A recurrent, resistant cutaneous infection which eventually spread to the thoracic cavity. Irregardless to the fact that a culture to document the causative organism was not performed initially in the treatment of his infection, Felix’s initial infection is documented in his medical records on June 8, 2018, prior to the inception of his insurance policy on June 21, 2018.
Three experts in the field of veterinary medicine have confirmed that the lumps were recurrent in nature beginning on a date prior to policy inception. Unfortunately, no veterinary professionals have opined otherwise. We are constrained to adjudicate claims based on the medical records in this instance. These records are very clear on the recurrent nature of the bump that began before the policy was purchased. Unfortunately, this means the claims were properly denied.
Complaint: ***
I am rejecting this response because:
I have repeatedly asked, and the insurance company has repeatedly ignored and or evaded my question. The question is clear in my two appeals letters. WHERE in any records has Felix's Nocardia been identified during the look back period.
Although Felix presented an abscess during the look back period he was treated for an infection and considered cured. There were no approved medications administered for Nocardia. It was not until August, after the look back period that Nocardia was diagnosed and treated with approved Antibiotics. As stated before symptoms can mean any illness but until the illness is specifically diagnosed it cannot be construed as a preexisting condition. The policy, I believe is written to try and disadvantage me to encompass a infection as everything and so if Felix came in to the Vet and now had a foot pain they could say it was due to the infection and not pay it either.
AGAIN: If you can show me where Norcardia was diagnosed during or before the look back period I will accept that. You say numerous Veterinarians said it is a common for these symptoms to present itself as Norcardia and that is why they are rejecting the claim. Can they also say that there are no other illnesses that present the same symptoms? If so they why did the Veterinarians not treat it as Nocardia in the first place?
Sincerely
I paid for the top tier policy Pets Best offered, for both of my cats. When one of them became ill, the only claim I have ever filed was denied because supposedly he had a "pre-existing condition". The only thing pre-existing about his condition was that this company doesn't want to pay for claims made on policies that are being paid for. Not only did it take significantly longer for the original claim denial to come through, but the denial of my appeal then took a further two months. The date of the visit to the animal hospital was in Mid May, I filed the claim immediately, and the first denial didn't come until the end of June. It is now mid-August, and I just received the denial of my appeal today. I am disgusted with this company. Their supposed care and concern for pets and owners, seems to be a guise for only caring about their bank balances. What a scam!
Hi ***, thank you for your review. The claim was denied accordingly as you disclosed upon online self-enrollment that your pet suffered from Asthma prior to the policy effective date. We still requested medical records from your vet to check whether the claimed condition was related or not. Medical records from your vet indicate in fact the claimed condition was Asthma, which per your information, your pet suffered from prior to coverage. If you disagree with the claim decision, you are welcome to file an appeal with supporting documents. We wish you the best.
I paid for the top tier policy Pets Best offered, for both of my cats. When one of them became ill, the only claim I have ever filed was denied because supposedly he had a "pre-existing condition". The only thing pre-existing about his condition was that this company doesn't want to pay for claims made on policies that are being paid for. Not only did it take significantly longer for the original claim denial to come through, but the denial of my appeal then took a further two months. The date of the visit to the animal hospital was in Mid May, I filed the claim immediately, and the first denial didn't come until the end of June. It is now mid-August, and I just received the denial of my appeal today. I am disgusted with this company. Their supposed care and concern for pets and owners, seems to be a guise for only caring about their bank balances. What a scam!
Hi ***, thank you for your review. The claim was denied accordingly as you disclosed upon online self-enrollment that your pet suffered from Asthma prior to the policy effective date. We still requested medical records from your vet to check whether the claimed condition was related or not. Medical records from your vet indicate in fact the claimed condition was Asthma, which per your information, your pet suffered from prior to coverage. If you disagree with the claim decision, you are welcome to file an appeal with supporting documents. We wish you the best.
I paid for the top tier policy Pets Best offered, for both of my cats. When one of them became ill, the only claim I have ever filed was denied because supposedly he had a "pre-existing condition". The only thing pre-existing about his condition was that this company doesn't want to pay for claims made on policies that are being paid for. Not only did it take significantly longer for the original claim denial to come through, but the denial of my appeal then took a further two months. The date of the visit to the animal hospital was in Mid May, I filed the claim immediately, and the first denial didn't come until the end of June. It is now mid-August, and I just received the denial of my appeal today. I am disgusted with this company. Their supposed care and concern for pets and owners, seems to be a guise for only caring about their bank balances. What a scam!
Hi ***, thank you for your review. The claim was denied accordingly as you disclosed upon online self-enrollment that your pet suffered from Asthma prior to the policy effective date. We still requested medical records from your vet to check whether the claimed condition was related or not. Medical records from your vet indicate in fact the claimed condition was Asthma, which per your information, your pet suffered from prior to coverage. If you disagree with the claim decision, you are welcome to file an appeal with supporting documents. We wish you the best.