Pet's Best Insurance Services

This Policy was purchased on January 15, 2019 with illness coverage beginning January 29, 2019. Under the terms of the policy, “Pre-existing Conditions” are defined as: “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.”
Ms. contends “Nowhere on any vet record does it state that my dog has had this prior. There is no proof and nothing noting this.” However, the records obtained from *** dated April 27, 2019 show the following entry on page 1: “O stated p is uncomfortable when getting picked up O stated she thinks around the stoomach (sic) area. O stated it started around jan when p came back from groomers. P goes down the stairs hesitated but still jumps normal and jumps of (sic) the sofa all the time.” *** was diagnosed with IVDD on this date based in part on this record of ***’s symptoms. These symptoms are consistent with the diagnosed IVDD and the timeline places symptoms before illness coverage began. As a result, this condition was excluded as a “Pre-existing Condition.”
Upon review, January 29, 2019 was the date the coverage for illnesses began. No definitive date was given as to when *** was seen at the groomers. If this visit occurred on January 29, 2019, Ms. may submit a receipt and statement from her financial provider showing the date of this transaction for our additional review.
Ms. has expressed her belief that “This company is just ripping people off” both in the Revdex.com Complaint and similarly, albeit with much more colorful language, when she inquired with our customer care agent and was informed of why her claim was denied. Unfortunately, we are bound to make these determinations based on the medical records provided which, in this case, document symptoms before coverage was available.

Unfortunately, Ms.' rejection of our response simply restates the original complaint. We have already identified the records that reference ***'s symptoms. Ultimately, Ms. is taking issue with the terms of her policy which define and determine "Pre-existing Conditions" based on when the pet displayed signs or symptoms of the condition. This determination is not based on the date of diagnosis. ***'s symptoms are documented to have occurred prior to expiration of the waiting period in January.

*** Attachments Redacted by Revdex.com

We have reviewed Mr. contention here and on his previous appeal of his claim denials. Unfortunately, the mass Mr. discusses is the same mass that has come back or reoccurred on multiple occasions. This fact is identified and set forth in the pet’s medical records. Pets Best’s house veterinarian likewise confirmed that the records document this same mass. Due to the mass first appearing prior to inception of the policy, the Pre-existing Condition exclusion is applicable.

We have reviewed Mr. contention here and on his previous appeal of his claim denials. Unfortunately, the mass Mr. discusses is the same mass that has come back or reoccurred on multiple occasions. This fact is identified and set forth in the pet’s medical records. Pets Best’s house veterinarian likewise confirmed that the records document this same mass. Due to the mass first appearing prior to inception of the policy, the Pre-existing Condition exclusion is applicable.

We have reviewed Mr. contention here and on his previous appeal of his claim denials. Unfortunately, the mass Mr. discusses is the same mass that has come back or reoccurred on multiple occasions. This fact is identified and set forth in the pet’s medical records. Pets Best’s house veterinarian likewise confirmed that the records document this same mass. Due to the mass first appearing prior to inception of the policy, the Pre-existing Condition exclusion is applicable.

We have reviewed Mr. contention here and on his previous appeal of his claim denials. Unfortunately, the mass Mr. discusses is the same mass that has come back or reoccurred on multiple occasions. This fact is identified and set forth in the pet’s medical records. Pets Best’s house veterinarian likewise confirmed that the records document this same mass. Due to the mass first appearing prior to inception of the policy, the Pre-existing Condition exclusion is applicable.

Hi ***, thank you for your review. Our records indicate we did not receive any information from your vet regarding the specifics of this claim. The reason the claim was denied was because you upgraded your policy and, as we advised, this requires a brand new plan, all new waiting periods and pre-existing issues would apply, even if we covered them under the lower plan. However, because you indicated this claim was for something unrelated to anything claimed prior, we asked that you provide the supporting documents which confirm this is a new condition. We never received this information from you. You are welcome to submit for review. Have a good day.

Hi ***, thank you for your review. Our records indicate we did not receive any information from your vet regarding the specifics of this claim. The reason the claim was denied was because you upgraded your policy and, as we advised, this requires a brand new plan, all new waiting periods and pre-existing issues would apply, even if we covered them under the lower plan. However, because you indicated this claim was for something unrelated to anything claimed prior, we asked that you provide the supporting documents which confirm this is a new condition. We never received this information from you. You are welcome to submit for review. Have a good day.

Hi ***, thank you for your review. Our records indicate we did not receive any information from your vet regarding the specifics of this claim. The reason the claim was denied was because you upgraded your policy and, as we advised, this requires a brand new plan, all new waiting periods and pre-existing issues would apply, even if we covered them under the lower plan. However, because you indicated this claim was for something unrelated to anything claimed prior, we asked that you provide the supporting documents which confirm this is a new condition. We never received this information from you. You are welcome to submit for review. Have a good day.

Hi ***, thank you for your review. Our records indicate we did not receive any information from your vet regarding the specifics of this claim. The reason the claim was denied was because you upgraded your policy and, as we advised, this requires a brand new plan, all new waiting periods and pre-existing issues would apply, even if we covered them under the lower plan. However, because you indicated this claim was for something unrelated to anything claimed prior, we asked that you provide the supporting documents which confirm this is a new condition. We never received this information from you. You are welcome to submit for review. Have a good day.

Hi ***, we appreciate your concern for affordable coverage. Our records indicate you requested a phone call on May 17th, 2019 to switch from a full policy to an accident only plan. We called you but there was no answer and we left a detailed voicemail. We cannot make any changes to our member’s policies without their permission. We are sorry to see you have cancelled your policy and wish you the best.

Hi ***, we appreciate your concern for affordable coverage. Our records indicate you requested a phone call on May 17th, 2019 to switch from a full policy to an accident only plan. We called you but there was no answer and we left a detailed voicemail. We cannot make any changes to our member’s policies without their permission. We are sorry to see you have cancelled your policy and wish you the best.

Hi ***, we appreciate your concern for affordable coverage. Our records indicate you requested a phone call on May 17th, 2019 to switch from a full policy to an accident only plan. We called you but there was no answer and we left a detailed voicemail. We cannot make any changes to our member’s policies without their permission. We are sorry to see you have cancelled your policy and wish you the best.

Hi ***, we appreciate your concern for affordable coverage. Our records indicate you requested a phone call on May 17th, 2019 to switch from a full policy to an accident only plan. We called you but there was no answer and we left a detailed voicemail. We cannot make any changes to our member’s policies without their permission. We are sorry to see you have cancelled your policy and wish you the best.

We are sorry to hear Mr. is frustrated with his claim and experience with Pets Best. Unfortunately, the policy Mr. purchased only covers neutering procedure if the Wellness rider was purchased or in limited instances where only covers neutering in limited circumstances and also requires purchase of a rider for Wellness coverage. Mr. had initially purchased this Wellness rider, but opted to cancel and received a refund check as a result.
Applicable Provisions of the Policy.
Turning to the policy itself, the section entitled “Exclusions Applicable to All Plans,” number 14, excludes:
Preventative and elective procedures, including, but not limited to: tail docking; ear crops; nail trims; declaws; dewclaw removal; elective gastropexy; and anal gland expression and removal. Claims for Pets that are found to be healthy and presenting with no clinical symptoms are also excluded.
Under this section, treatment and procedures that are preventative or performed to minimize potential future issues are not covered.
Number 17 further excludes:
Vaccinations and routine annual exams, bloodwork, spay, neuter, and routine diagnostics, except as provided by the Wellness Benefit if purchased.
Medical Records and Appeal Decision.
The policy definitions above were included in the Appeal Denial Letter with the following explanation:
Dr. *** authored a letter dated March 20, 2019 stating: “Please be advised that we made a strong recommendation to *** to have ‘Bruno’ neutered because of his prostatemagally.” The “Conclusions” and “Recommendations” sections do not show that a neuter is necessary for treatment of this condition.
1st Level Appeal Outcome: Upheld.
Unfortunately, the neuter is not eligible under “Prostatemagally” as it is not a curative treatment for the condition, but rather a preventative measure to decrease likelihood, or prevent future complications or illness. Stated differently, the neuter does not treat the Prostatemagally itself but is recommended to prevent other related complications. Dr. *** letter does not support or prove neuter was[/]is medically necessary and curative of this condition. Coverage for neuter is available only under the optional Wellness plan. Wellness coverage was removed on July 21, 2018 at the policyholder’s request and a refund of $212.91 process shortly thereafter. Since the Wellness ride was cancelled and not in effect, no coverage is available.
The quoted portion of the first sentence was the entirety of Dr. *** supporting letter. Looking at the medical records themselves sheds additional light on the nature of the condition present at that time. Records from Dr. *** note:
CONCLUSIONS:
2. There is moderate to marked prostatomegaly, likely representing benign prostatic hyperplasia. Prostatitis is less likely and prostatic neoplasia is unlikely. It is presumed that the more cranially positioned structure represent a normal urinary bladder, though a paraprostatic pseudocyst cannot be definitively excluded.
RECOMMENDATIONS: Consider repeat 3 view fasted abdominal radiographs in 12-24 hours following medical management to ensure normal passage of gastric contents, unless there is a concern for a toxin. If further evaluation of the prostate is desired, this can be performed using ultrasound and fine needle aspirates.
Records from the emergency visit conclude “Advised should follow up with family vet to discuss neuter.” A review of the invoice for the neuter reads: “Neuter – Canine Routine > 80 lbs”.
Minor Mistake by Customer Care in Advising Mr. of Coverage for Neuter.
As is standard protocol, Mr. was advised at the beginning of the call that the representative was not guaranteeing coverage, that no decision could be made about the claim until it was submitted, and that elective procedures would not be covered. This information is set forth in the policy terms.
Under the policy sections noted above, coverage for neutering procedures is only available with the Wellness rider. There is no provision or exception in the policy permitting coverage for a neuter if a veterinarian determines the procedure is medically necessary. Since Mr. remove the Wellness option, no coverage would be available for a neuter.
Unfortunately, Mr. was advised that a neuter may be covered as an Illness if it was medically necessary to treat the condition and the only treatment option available. However, even applying this erroneous standard, the neuter was not a procedure to treat the enlarged prostate. It was performed to minimize risk of future complications.
Because Mr. opted to remove Wellness coverage, the procedure is excluded from coverage. Even applying the erroneous standard, the records and veterinarian letter demonstrate it was prostate, not the testicles that were swollen and the neuter was clearly advised and performed to reduce future complications.
Additional Contentions.
Addressing the remaining concerns in Mr.’s complaint, Pets Best did not alter any documents submitted. Whether a claim is a Wellness, Illness, Accident, or other is not determined by the policy holder; rather, it is the substance of the claims and records that govern.
Conclusion.
Having reviewed Mr.’s claims, records, and appeal in great detail, the claims were processed correctly. Unfortunately, we are obligated to apply the terms of the insurance policy and doing so sometimes requires denial of claims.

We are sorry to hear Mr. is frustrated with his claim and experience with Pets Best. Unfortunately, the policy Mr. purchased only covers neutering procedure if the Wellness rider was purchased or in limited instances where only covers neutering in limited circumstances and also requires purchase of a rider for Wellness coverage. Mr. had initially purchased this Wellness rider, but opted to cancel and received a refund check as a result.
Applicable Provisions of the Policy.
Turning to the policy itself, the section entitled “Exclusions Applicable to All Plans,” number 14, excludes:
Preventative and elective procedures, including, but not limited to: tail docking; ear crops; nail trims; declaws; dewclaw removal; elective gastropexy; and anal gland expression and removal. Claims for Pets that are found to be healthy and presenting with no clinical symptoms are also excluded.
Under this section, treatment and procedures that are preventative or performed to minimize potential future issues are not covered.
Number 17 further excludes:
Vaccinations and routine annual exams, bloodwork, spay, neuter, and routine diagnostics, except as provided by the Wellness Benefit if purchased.
Medical Records and Appeal Decision.
The policy definitions above were included in the Appeal Denial Letter with the following explanation:
Dr. *** authored a letter dated March 20, 2019 stating: “Please be advised that we made a strong recommendation to *** to have ‘Bruno’ neutered because of his prostatemagally.” The “Conclusions” and “Recommendations” sections do not show that a neuter is necessary for treatment of this condition.
1st Level Appeal Outcome: Upheld.
Unfortunately, the neuter is not eligible under “Prostatemagally” as it is not a curative treatment for the condition, but rather a preventative measure to decrease likelihood, or prevent future complications or illness. Stated differently, the neuter does not treat the Prostatemagally itself but is recommended to prevent other related complications. Dr. *** letter does not support or prove neuter was[/]is medically necessary and curative of this condition. Coverage for neuter is available only under the optional Wellness plan. Wellness coverage was removed on July 21, 2018 at the policyholder’s request and a refund of $212.91 process shortly thereafter. Since the Wellness ride was cancelled and not in effect, no coverage is available.
The quoted portion of the first sentence was the entirety of Dr. *** supporting letter. Looking at the medical records themselves sheds additional light on the nature of the condition present at that time. Records from Dr. *** note:
CONCLUSIONS:
2. There is moderate to marked prostatomegaly, likely representing benign prostatic hyperplasia. Prostatitis is less likely and prostatic neoplasia is unlikely. It is presumed that the more cranially positioned structure represent a normal urinary bladder, though a paraprostatic pseudocyst cannot be definitively excluded.
RECOMMENDATIONS: Consider repeat 3 view fasted abdominal radiographs in 12-24 hours following medical management to ensure normal passage of gastric contents, unless there is a concern for a toxin. If further evaluation of the prostate is desired, this can be performed using ultrasound and fine needle aspirates.
Records from the emergency visit conclude “Advised should follow up with family vet to discuss neuter.” A review of the invoice for the neuter reads: “Neuter – Canine Routine > 80 lbs”.
Minor Mistake by Customer Care in Advising Mr. of Coverage for Neuter.
As is standard protocol, Mr. was advised at the beginning of the call that the representative was not guaranteeing coverage, that no decision could be made about the claim until it was submitted, and that elective procedures would not be covered. This information is set forth in the policy terms.
Under the policy sections noted above, coverage for neutering procedures is only available with the Wellness rider. There is no provision or exception in the policy permitting coverage for a neuter if a veterinarian determines the procedure is medically necessary. Since Mr. remove the Wellness option, no coverage would be available for a neuter.
Unfortunately, Mr. was advised that a neuter may be covered as an Illness if it was medically necessary to treat the condition and the only treatment option available. However, even applying this erroneous standard, the neuter was not a procedure to treat the enlarged prostate. It was performed to minimize risk of future complications.
Because Mr. opted to remove Wellness coverage, the procedure is excluded from coverage. Even applying the erroneous standard, the records and veterinarian letter demonstrate it was prostate, not the testicles that were swollen and the neuter was clearly advised and performed to reduce future complications.
Additional Contentions.
Addressing the remaining concerns in Mr.’s complaint, Pets Best did not alter any documents submitted. Whether a claim is a Wellness, Illness, Accident, or other is not determined by the policy holder; rather, it is the substance of the claims and records that govern.
Conclusion.
Having reviewed Mr.’s claims, records, and appeal in great detail, the claims were processed correctly. Unfortunately, we are obligated to apply the terms of the insurance policy and doing so sometimes requires denial of claims.

We are sorry to hear Mr. is frustrated with his claim and experience with Pets Best. Unfortunately, the policy Mr. purchased only covers neutering procedure if the Wellness rider was purchased or in limited instances where only covers neutering in limited circumstances and also requires purchase of a rider for Wellness coverage. Mr. had initially purchased this Wellness rider, but opted to cancel and received a refund check as a result.
Applicable Provisions of the Policy.
Turning to the policy itself, the section entitled “Exclusions Applicable to All Plans,” number 14, excludes:
Preventative and elective procedures, including, but not limited to: tail docking; ear crops; nail trims; declaws; dewclaw removal; elective gastropexy; and anal gland expression and removal. Claims for Pets that are found to be healthy and presenting with no clinical symptoms are also excluded.
Under this section, treatment and procedures that are preventative or performed to minimize potential future issues are not covered.
Number 17 further excludes:
Vaccinations and routine annual exams, bloodwork, spay, neuter, and routine diagnostics, except as provided by the Wellness Benefit if purchased.
Medical Records and Appeal Decision.
The policy definitions above were included in the Appeal Denial Letter with the following explanation:
Dr. *** authored a letter dated March 20, 2019 stating: “Please be advised that we made a strong recommendation to *** to have ‘Bruno’ neutered because of his prostatemagally.” The “Conclusions” and “Recommendations” sections do not show that a neuter is necessary for treatment of this condition.
1st Level Appeal Outcome: Upheld.
Unfortunately, the neuter is not eligible under “Prostatemagally” as it is not a curative treatment for the condition, but rather a preventative measure to decrease likelihood, or prevent future complications or illness. Stated differently, the neuter does not treat the Prostatemagally itself but is recommended to prevent other related complications. Dr. *** letter does not support or prove neuter was[/]is medically necessary and curative of this condition. Coverage for neuter is available only under the optional Wellness plan. Wellness coverage was removed on July 21, 2018 at the policyholder’s request and a refund of $212.91 process shortly thereafter. Since the Wellness ride was cancelled and not in effect, no coverage is available.
The quoted portion of the first sentence was the entirety of Dr. *** supporting letter. Looking at the medical records themselves sheds additional light on the nature of the condition present at that time. Records from Dr. *** note:
CONCLUSIONS:
2. There is moderate to marked prostatomegaly, likely representing benign prostatic hyperplasia. Prostatitis is less likely and prostatic neoplasia is unlikely. It is presumed that the more cranially positioned structure represent a normal urinary bladder, though a paraprostatic pseudocyst cannot be definitively excluded.
RECOMMENDATIONS: Consider repeat 3 view fasted abdominal radiographs in 12-24 hours following medical management to ensure normal passage of gastric contents, unless there is a concern for a toxin. If further evaluation of the prostate is desired, this can be performed using ultrasound and fine needle aspirates.
Records from the emergency visit conclude “Advised should follow up with family vet to discuss neuter.” A review of the invoice for the neuter reads: “Neuter – Canine Routine > 80 lbs”.
Minor Mistake by Customer Care in Advising Mr. of Coverage for Neuter.
As is standard protocol, Mr. was advised at the beginning of the call that the representative was not guaranteeing coverage, that no decision could be made about the claim until it was submitted, and that elective procedures would not be covered. This information is set forth in the policy terms.
Under the policy sections noted above, coverage for neutering procedures is only available with the Wellness rider. There is no provision or exception in the policy permitting coverage for a neuter if a veterinarian determines the procedure is medically necessary. Since Mr. remove the Wellness option, no coverage would be available for a neuter.
Unfortunately, Mr. was advised that a neuter may be covered as an Illness if it was medically necessary to treat the condition and the only treatment option available. However, even applying this erroneous standard, the neuter was not a procedure to treat the enlarged prostate. It was performed to minimize risk of future complications.
Because Mr. opted to remove Wellness coverage, the procedure is excluded from coverage. Even applying the erroneous standard, the records and veterinarian letter demonstrate it was prostate, not the testicles that were swollen and the neuter was clearly advised and performed to reduce future complications.
Additional Contentions.
Addressing the remaining concerns in Mr.’s complaint, Pets Best did not alter any documents submitted. Whether a claim is a Wellness, Illness, Accident, or other is not determined by the policy holder; rather, it is the substance of the claims and records that govern.
Conclusion.
Having reviewed Mr.’s claims, records, and appeal in great detail, the claims were processed correctly. Unfortunately, we are obligated to apply the terms of the insurance policy and doing so sometimes requires denial of claims.

We are sorry to hear Mr. is frustrated with his claim and experience with Pets Best. Unfortunately, the policy Mr. purchased only covers neutering procedure if the Wellness rider was purchased or in limited instances where only covers neutering in limited circumstances and also requires purchase of a rider for Wellness coverage. Mr. had initially purchased this Wellness rider, but opted to cancel and received a refund check as a result.
Applicable Provisions of the Policy.
Turning to the policy itself, the section entitled “Exclusions Applicable to All Plans,” number 14, excludes:
Preventative and elective procedures, including, but not limited to: tail docking; ear crops; nail trims; declaws; dewclaw removal; elective gastropexy; and anal gland expression and removal. Claims for Pets that are found to be healthy and presenting with no clinical symptoms are also excluded.
Under this section, treatment and procedures that are preventative or performed to minimize potential future issues are not covered.
Number 17 further excludes:
Vaccinations and routine annual exams, bloodwork, spay, neuter, and routine diagnostics, except as provided by the Wellness Benefit if purchased.
Medical Records and Appeal Decision.
The policy definitions above were included in the Appeal Denial Letter with the following explanation:
Dr. *** authored a letter dated March 20, 2019 stating: “Please be advised that we made a strong recommendation to *** to have ‘Bruno’ neutered because of his prostatemagally.” The “Conclusions” and “Recommendations” sections do not show that a neuter is necessary for treatment of this condition.
1st Level Appeal Outcome: Upheld.
Unfortunately, the neuter is not eligible under “Prostatemagally” as it is not a curative treatment for the condition, but rather a preventative measure to decrease likelihood, or prevent future complications or illness. Stated differently, the neuter does not treat the Prostatemagally itself but is recommended to prevent other related complications. Dr. *** letter does not support or prove neuter was[/]is medically necessary and curative of this condition. Coverage for neuter is available only under the optional Wellness plan. Wellness coverage was removed on July 21, 2018 at the policyholder’s request and a refund of $212.91 process shortly thereafter. Since the Wellness ride was cancelled and not in effect, no coverage is available.
The quoted portion of the first sentence was the entirety of Dr. *** supporting letter. Looking at the medical records themselves sheds additional light on the nature of the condition present at that time. Records from Dr. *** note:
CONCLUSIONS:
2. There is moderate to marked prostatomegaly, likely representing benign prostatic hyperplasia. Prostatitis is less likely and prostatic neoplasia is unlikely. It is presumed that the more cranially positioned structure represent a normal urinary bladder, though a paraprostatic pseudocyst cannot be definitively excluded.
RECOMMENDATIONS: Consider repeat 3 view fasted abdominal radiographs in 12-24 hours following medical management to ensure normal passage of gastric contents, unless there is a concern for a toxin. If further evaluation of the prostate is desired, this can be performed using ultrasound and fine needle aspirates.
Records from the emergency visit conclude “Advised should follow up with family vet to discuss neuter.” A review of the invoice for the neuter reads: “Neuter – Canine Routine > 80 lbs”.
Minor Mistake by Customer Care in Advising Mr. of Coverage for Neuter.
As is standard protocol, Mr. was advised at the beginning of the call that the representative was not guaranteeing coverage, that no decision could be made about the claim until it was submitted, and that elective procedures would not be covered. This information is set forth in the policy terms.
Under the policy sections noted above, coverage for neutering procedures is only available with the Wellness rider. There is no provision or exception in the policy permitting coverage for a neuter if a veterinarian determines the procedure is medically necessary. Since Mr. remove the Wellness option, no coverage would be available for a neuter.
Unfortunately, Mr. was advised that a neuter may be covered as an Illness if it was medically necessary to treat the condition and the only treatment option available. However, even applying this erroneous standard, the neuter was not a procedure to treat the enlarged prostate. It was performed to minimize risk of future complications.
Because Mr. opted to remove Wellness coverage, the procedure is excluded from coverage. Even applying the erroneous standard, the records and veterinarian letter demonstrate it was prostate, not the testicles that were swollen and the neuter was clearly advised and performed to reduce future complications.
Additional Contentions.
Addressing the remaining concerns in Mr.’s complaint, Pets Best did not alter any documents submitted. Whether a claim is a Wellness, Illness, Accident, or other is not determined by the policy holder; rather, it is the substance of the claims and records that govern.
Conclusion.
Having reviewed Mr.’s claims, records, and appeal in great detail, the claims were processed correctly. Unfortunately, we are obligated to apply the terms of the insurance policy and doing so sometimes requires denial of claims.

Hi ***, we apologize for the frustration. The medical records we received from your vet indicate the UTI’s were related to the defect in the pet’s anatomy which was present prior to coverage. If you disagree with this decision you are welcome to file an appeal with supporting documents. Please let us know if you would like us to send you an appeal form.

Hi ***, we apologize for the frustration. The medical records we received from your vet indicate the UTI’s were related to the defect in the pet’s anatomy which was present prior to coverage. If you disagree with this decision you are welcome to file an appeal with supporting documents. Please let us know if you would like us to send you an appeal form.

Hi ***, we apologize for the frustration. The medical records we received from your vet indicate the UTI’s were related to the defect in the pet’s anatomy which was present prior to coverage. If you disagree with this decision you are welcome to file an appeal with supporting documents. Please let us know if you would like us to send you an appeal form.