Pet's Best Insurance Services Reviews (%countItem)
Pet's Best Insurance Services Rating
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Our rightful claim and appeal have been wrongfully denied.
Policy Number: ***
Claim Number: ***
If this is not covered by insurance, then what is? How we would ever know what lies beneath the surface when there is no outward indication of a condition? Elbow dysplasia is NOT an exempted condition; it is specifically included in the examples of covered conditions identified on the Petsbest website.
We noticed *** minor left elbow swelling coincidentally just after the 14-day insurance waiting period for illness and conditions ended on January 27th, 2018.
We had been researching and deciding on pet insurance for several months, initially planning on *** due to the Seattle Times recommendation, but when we tried to act on the *** quote we found out that *** was being audited and not currently issuing new policies. So, at that point we continued to research and bought Petsbest instead, since it was also highly rated.
We assumed from our own brief, uneducated internet search that a hygroma or bug bite was the cause of the minor elbow swelling, as it was initially only on one side, with no lameness or pain. *** breeder, who has bred Rhodesian Ridgebacks for decades and is very active within the breed community, has never had elbow dysplasia in her well-documented line. *** was first seen on January 29th by West Seattle Animal Hospital, who then referred *** to Animal Surgical Clinic of Seattle. In the weeks following our noticing the minor swelling on the left elbow, the swelling became visible on both elbows and the CT then confirmed diagnosis of elbow dysplasia. *** still exhibits no lameness or pain. There are no plans for surgery. Veterinary clinic summaries have been emailed to Petsbest for all clinic visits, as well as detailed CT results.
Based on Petsbest's own definition, *** elbow dysplasia was not a pre-existing condition.
Medical records from West Seattle Animal Hospital dated January 29, 2018 document *** is presented for an exam due to a fluctuant swelling present over the left lateral elbow. Doctor's exam notes document pain reaction present upon flexion of both elbows and lists differential diagnosis including Elbow Dysplasia, Hygroma, or Traumatic Injury. Doctor prescribes rest, exercise restriction sedative and pain management with a recommendation for pet to be examined by an orthopedic specialist. Pet is seen at Animal Surgical Clinic of Seattle on February 27, 2018 for a CT scan of both elbows. The CT scan revealed "Moderate degeneration changes in both elbows. Large ununited anconeal process apparent bilaterally" and pet is definitively diagnosed with Bilateral Ununited Anconeal Processes (UAPs). w/ secondary elbow degenerative joint disease.
Based on the presentation of the symptoms of Elbow Dysplasia just three days past the expiration of the illness waiting period, must consider this chronic degenerative condition to have been present during the illness waiting period, if not present prior to policy purchase completely. Appeal review finds original denial of Elbow Dysplasia / Secondary Degenerative Joint Disease as a pre-existing condition to be correct.
After thorough review and consideration, we must uphold our previous claim decision. *** Elbow Dysplasia was present prior to the expiration of the policy waiting period, pre-existed your policy, and accordingly is not part of policy coverage.
Illnesses are subject to a 14 day waiting period which is outlined on page 7 of your insuring agreement, entitled “Policy Benefits in Detail” under section:
2 C. WAITING PERIODS:
1. 14 days following the Policy Effective Date for any Illnesses and any related Conditions.
Illnesses present inside the waiting period are classified as pre existing conditions on page 18 of your insuring agreement, entitled “What Isn’t Covered” under section:
9 A. PRE-EXISTING CONDITIONS: In determining which Conditions are Pre-Existing, we look at the 18 months preceding the Policy Effective Date and exclude any Conditions that were Present during that period. Conditions that are Present during the policy Waiting Period described in 2.C. are also deemed to be Pre-Existing Conditions if they are Present at any time preceding the Policy Effective Date or the expiration of any Waiting Period.
Pre existing conditions are further defined on page 21 of your insuring agreement, in section 10 entitled “Definitions”:
10 S. PRE-EXISTING CONDITION: 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.
We regret that we are unable to reprocess *** claims for payment. We are obligated to uphold the provisions of the policy.
Complaint: ***
I am rejecting this response because: Again, if this were a discovery of cancer symptoms, there would be no question. Our vets are adamant that this was not a pre-existing condition, by documented definitions according to Petsbest. Elbow dysplasia is specifically NOT an exempted condition, according to Petsbest.
Sincerely
Medical records from West Seattle Animal Hospital dated January 29, 2018 document *** is presented for an exam due to a fluctuant swelling present over the left lateral elbow. Doctor's exam notes document pain reaction present upon flexion of both elbows and lists differential diagnosis including Elbow Dysplasia, Hygroma, or Traumatic Injury. Doctor prescribes rest, exercise restriction sedative and pain management with a recommendation for pet to be examined by an orthopedic specialist. Pet is seen at Animal Surgical Clinic of Seattle on February 27, 2018 for a CT scan of both elbows. The CT scan revealed "Moderate degeneration changes in both elbows. Large ununited anconeal process apparent bilaterally" and pet is definitively diagnosed with Bilateral Ununited Anconeal Processes (UAPs). w/ secondary elbow degenerative joint disease.
Based on the presentation of the symptoms of Elbow Dysplasia just three days past the expiration of the illness waiting period, must consider this chronic degenerative condition to have been present during the illness waiting period, if not present prior to policy purchase completely. Appeal review finds original denial of Elbow Dysplasia / Secondary Degenerative Joint Disease as a pre-existing condition to be correct.
After thorough review and consideration, we must uphold our previous claim decision. *** Elbow Dysplasia was present prior to the expiration of the policy waiting period, pre-existed your policy, and accordingly is not part of policy coverage.
Complaint: ***
I am rejecting this response because: There was absolutely no evidence of *** elbow dysplasia prior to Petsbest effective coverage, and this diagnosis was entirely unexpected. As mentioned in our appeal, we were actively researching and attempting to buy insurance coverage for several months prior to the effective date of our Petsbest coverage, completely unrelated to the surprise appearance of minor elbow swelling just after the effective coverage began. We initially planned on *** due to the Seattle Times recommendation, but when we tried to act on the *** quote we found out that *** was being audited and not currently issuing new policies. So, at that point we continued to research and bought Petsbest instead, since it was also highly rated. In addition, elbow dysplasia is specifically listed on the Petsbest website as a COVERED condition!Our surgeon concurs. When a pet is taken to the vet and is diagnosed with cancer, clearly it will have been growing for at least some length of time prior to evidence of illness, and Petsbest certainly covers cancer when the pet presents with initial symptoms of cancer. *** condition meets that same standard and should definitely be covered, as it was discovered and presented AFTER the waiting period.
Sincerely
Buyer beware!!!!!
This is to inform Revdex.com and future customers of Pets Bets Insurance of the dealing which I have had with the mentioned company. Dealings I believe to be of false and fraudulent behavior. I have been a customer of Pets Best Insurance since 2012 and have not received a single payment from them. I have sent invoices over with Doctors signatures and have been on calls with Management, all have resulted in no payment at all.
I have dealt with two individuals that have both told me they are part of the Management team and will make sure as a customer I am taken care of. To date all I have received are statements like “sorry to hear that you are not happy” the reason is that we recently switch underwriters , they are very backed up but we will make sure your invoices are pushed to the top of the line.
The other thing I have heard is that we will send you a check for the payment(s) you are owed. At one point I was given an internal routing number. But to this day I still have not received a single payment,
Below is list of some of the invoices that they have not paid on.
April 20, 2014 #431770 $286.50
April 21, 2014 #431416 $570.50
April 24, 2914 #432665 $956.50
April 29, 2014 #434150 $264.00
May 15, 2014 #439668 $166.00
May 18, 2014 # 440526 $54.82
Aug 1. 2014 #465951 $1450.00
Aug 1, 2014 # 423266 $951.32
All of these have been sent over with explanations and signatures. All of which have not been paid.
I have many other unpaid invoices that I can list here, but I think my point has clearly been made. I have not gotten paid. I will continue to post not only on Revdex.com but all social outlets I can find until this matter is resolve by Pets Best Insurance.
I do not recommend and will never recommend Pets Best Insurance to any pet parent. As a consumer and pet lover I always want what’s best for my doggies and want to be able to care for all their needs. I never expected to sign up for insurance service that really does nothing to help me do that!
I have been a good customer and stuck with them in hopes of the company doing what they said they would.
The two Management people I have had countless of calls with are Sean Hughes and Michael M. Jackson. I am not sure as to why I was given so many different reasons as to why I am not receiving payment. As mentioned I still have not received a penny!
I sincerely urge upper management to investigate what is going on within the company. I am hoping what has happened to me is not what the company has set out to achieve. Sadly at this point I am very disappointed that an insurance company would allow this to happen.
All I can really say is Buyer Beware.
Hi ***, we are sorry to hear you had a frustrating experience. Our records show we processed and paid several claims for your pet via check, not direct deposit. Additionally, we do not have anyone with those names working at Pets Best. We would like to clear up any confusion. Please contact us if you have further questions or concerns. We wish you and your pet the best in 2019.
Buyer beware!!!!!
This is to inform Revdex.com and future customers of Pets Bets Insurance of the dealing which I have had with the mentioned company. Dealings I believe to be of false and fraudulent behavior. I have been a customer of Pets Best Insurance since 2012 and have not received a single payment from them. I have sent invoices over with Doctors signatures and have been on calls with Management, all have resulted in no payment at all.
I have dealt with two individuals that have both told me they are part of the Management team and will make sure as a customer I am taken care of. To date all I have received are statements like “sorry to hear that you are not happy” the reason is that we recently switch underwriters , they are very backed up but we will make sure your invoices are pushed to the top of the line.
The other thing I have heard is that we will send you a check for the payment(s) you are owed. At one point I was given an internal routing number. But to this day I still have not received a single payment,
Below is list of some of the invoices that they have not paid on.
April 20, 2014 #431770 $286.50
April 21, 2014 #431416 $570.50
April 24, 2914 #432665 $956.50
April 29, 2014 #434150 $264.00
May 15, 2014 #439668 $166.00
May 18, 2014 # 440526 $54.82
Aug 1. 2014 #465951 $1450.00
Aug 1, 2014 # 423266 $951.32
All of these have been sent over with explanations and signatures. All of which have not been paid.
I have many other unpaid invoices that I can list here, but I think my point has clearly been made. I have not gotten paid. I will continue to post not only on Revdex.com but all social outlets I can find until this matter is resolve by Pets Best Insurance.
I do not recommend and will never recommend Pets Best Insurance to any pet parent. As a consumer and pet lover I always want what’s best for my doggies and want to be able to care for all their needs. I never expected to sign up for insurance service that really does nothing to help me do that!
I have been a good customer and stuck with them in hopes of the company doing what they said they would.
The two Management people I have had countless of calls with are Sean Hughes and Michael M. Jackson. I am not sure as to why I was given so many different reasons as to why I am not receiving payment. As mentioned I still have not received a penny!
I sincerely urge upper management to investigate what is going on within the company. I am hoping what has happened to me is not what the company has set out to achieve. Sadly at this point I am very disappointed that an insurance company would allow this to happen.
All I can really say is Buyer Beware.
Hi ***, we are sorry to hear you had a frustrating experience. Our records show we processed and paid several claims for your pet via check, not direct deposit. Additionally, we do not have anyone with those names working at Pets Best. We would like to clear up any confusion. Please contact us if you have further questions or concerns. We wish you and your pet the best in 2019.
Buyer beware!!!!!
This is to inform Revdex.com and future customers of Pets Bets Insurance of the dealing which I have had with the mentioned company. Dealings I believe to be of false and fraudulent behavior. I have been a customer of Pets Best Insurance since 2012 and have not received a single payment from them. I have sent invoices over with Doctors signatures and have been on calls with Management, all have resulted in no payment at all.
I have dealt with two individuals that have both told me they are part of the Management team and will make sure as a customer I am taken care of. To date all I have received are statements like “sorry to hear that you are not happy” the reason is that we recently switch underwriters , they are very backed up but we will make sure your invoices are pushed to the top of the line.
The other thing I have heard is that we will send you a check for the payment(s) you are owed. At one point I was given an internal routing number. But to this day I still have not received a single payment,
Below is list of some of the invoices that they have not paid on.
April 20, 2014 #431770 $286.50
April 21, 2014 #431416 $570.50
April 24, 2914 #432665 $956.50
April 29, 2014 #434150 $264.00
May 15, 2014 #439668 $166.00
May 18, 2014 # 440526 $54.82
Aug 1. 2014 #465951 $1450.00
Aug 1, 2014 # 423266 $951.32
All of these have been sent over with explanations and signatures. All of which have not been paid.
I have many other unpaid invoices that I can list here, but I think my point has clearly been made. I have not gotten paid. I will continue to post not only on Revdex.com but all social outlets I can find until this matter is resolve by Pets Best Insurance.
I do not recommend and will never recommend Pets Best Insurance to any pet parent. As a consumer and pet lover I always want what’s best for my doggies and want to be able to care for all their needs. I never expected to sign up for insurance service that really does nothing to help me do that!
I have been a good customer and stuck with them in hopes of the company doing what they said they would.
The two Management people I have had countless of calls with are Sean Hughes and Michael M. Jackson. I am not sure as to why I was given so many different reasons as to why I am not receiving payment. As mentioned I still have not received a penny!
I sincerely urge upper management to investigate what is going on within the company. I am hoping what has happened to me is not what the company has set out to achieve. Sadly at this point I am very disappointed that an insurance company would allow this to happen.
All I can really say is Buyer Beware.
Hi ***, we are sorry to hear you had a frustrating experience. Our records show we processed and paid several claims for your pet via check, not direct deposit. Additionally, we do not have anyone with those names working at Pets Best. We would like to clear up any confusion. Please contact us if you have further questions or concerns. We wish you and your pet the best in 2019.
I am writing to make a complaint in regards to a denied pet insurance claim. The company has wrongfully denied my claim for reimbursement for the veterinary services performed on my pet. The company claims that the accident that occurred that injured my dog and prompted the need for surgery and x-rays was a pre-existing condition. However, they have received all the necessary documentation from both veterinarians and surgeons stating that my pet indeed injured himself on 3/11/2018 (the first day for accident coverage to begin) and that his injury was indeed accidental. All medical records sent to the company are clearly dated for 3/12/2018 (the initial veterinary visit), 3/13/2018 (the surgery performed date), and 3/14/2018 (the post surgery observation stay). All of these dates are clearly in the covered ranged stated in their policy agreement, including the date in which the accident occurred.
I have already contacted both the animal hospital (where surgery was performed) and the veterinarian's office (initial visit and time of first set of x-rays). All of whom, agree that the insurance company is being unfair, unjust, and unlawful for not honoring the policy that is in place. Both feel and have stated that the insurance company is not behaving in an acceptable manner towards covering the cost of the medical services. Both have agreed to assist if needed to verify all that I have stated to the insurance company to be true. Both have already sent in medical records proving that indeed my pet had his accident well within the covered time frame and that his accident, cannot be considered pre-existing because by the very nature of the word accident, is an occurrence that can happen at anytime and cannot be pre-existing. Additionally, they have the medical evidence (x-rays) showing that his injury (broken elbow) was new and showed no signs of any sort of bone fusing or netting that would give way to being a "pre-existing" condition.
This policy was purchased on 3/8/2018 with a waiting period for accidental injuries that ends on 3/11/2018
Medical records from Veterinary Specialty Hospital dated March 13, 2018 give the following history:
"Owner was out of town when the injury occurred. Reports Gizmo got his paw stuck under the fence. After his paw was removed Gizmo starting limping on his right thoracic limb. His limping seems to improve, but then returned on Sunday (03/11/18). Radiographs of the right elbow revealed the fracture. Gizmo is over all doing well at home. He is using the limb consistently and does not appear overtly painful."
Based on this history, trauma / accident occurred prior to 03/11/2018 (as it improved and then returned on 3/11/2018)- therefore occurred during the accident waiting period or prior to the policy being purchased.
This claim appears to have been denied correctly.
Complaint: ***
I am rejecting this response because:
As can been seen from the attached document signed by Gizmo's veterinarian at the Butterfield Animal Hospital. His veterinarian Dr. S states "The injury to Gizmo's right thoracic limb occurred on 3/11/2018. We saw Gizmo on 3/12/2018 for his initial exam and diagnosis." Dr. S referred Gizmo to the Veterinary Specialty Hospital after his diagnosis, due to the complexity of his fracture. His visit to the Speciality Hospital (which can be seen in the invoices) was on 3/13/2018, which was also the date of his surgery. The nurse at the Veterinary Specialty Hospital,in her haste to get Gizmo into surgery made the statement that you are using to deny my claim. I have spoken to the Veterinary Speciality Hospital in regards to this, and they too will be providing me a letter, which will also confirm the dates that I have labeled out as well as validating the dates and statements from the Butterfield Animal Hospital.
Sincerely
Complaint: ***
Is this admission that, my claim was wrongfully denied?
Is the letter that I submitted not enough proof that, Gizmo indeed was within the covered range? The letter is on offical letterhead and signed by the examining doctor. I am in process of getting another letter by the surgeon who performed the surgery to further validate that Gizmo was in the covered dates for insurance coverage.
What other proof is required to show that the claim was wrongfully denied? The first letter however, should be more than sufficient and substantial to validate Gizmo's injury and the validity of me submitting my claim.
Sincerely
I'm sorry you are unhappy with the outcome of your claim. If you have any further documentation you would like reviewed, please submit it with an appeal.
I am writing to make a complaint in regards to a denied pet insurance claim. The company has wrongfully denied my claim for reimbursement for the veterinary services performed on my pet. The company claims that the accident that occurred that injured my dog and prompted the need for surgery and x-rays was a pre-existing condition. However, they have received all the necessary documentation from both veterinarians and surgeons stating that my pet indeed injured himself on 3/11/2018 (the first day for accident coverage to begin) and that his injury was indeed accidental. All medical records sent to the company are clearly dated for 3/12/2018 (the initial veterinary visit), 3/13/2018 (the surgery performed date), and 3/14/2018 (the post surgery observation stay). All of these dates are clearly in the covered ranged stated in their policy agreement, including the date in which the accident occurred.
I have already contacted both the animal hospital (where surgery was performed) and the veterinarian's office (initial visit and time of first set of x-rays). All of whom, agree that the insurance company is being unfair, unjust, and unlawful for not honoring the policy that is in place. Both feel and have stated that the insurance company is not behaving in an acceptable manner towards covering the cost of the medical services. Both have agreed to assist if needed to verify all that I have stated to the insurance company to be true. Both have already sent in medical records proving that indeed my pet had his accident well within the covered time frame and that his accident, cannot be considered pre-existing because by the very nature of the word accident, is an occurrence that can happen at anytime and cannot be pre-existing. Additionally, they have the medical evidence (x-rays) showing that his injury (broken elbow) was new and showed no signs of any sort of bone fusing or netting that would give way to being a "pre-existing" condition.
This policy was purchased on 3/8/2018 with a waiting period for accidental injuries that ends on 3/11/2018
Medical records from Veterinary Specialty Hospital dated March 13, 2018 give the following history:
"Owner was out of town when the injury occurred. Reports Gizmo got his paw stuck under the fence. After his paw was removed Gizmo starting limping on his right thoracic limb. His limping seems to improve, but then returned on Sunday (03/11/18). Radiographs of the right elbow revealed the fracture. Gizmo is over all doing well at home. He is using the limb consistently and does not appear overtly painful."
Based on this history, trauma / accident occurred prior to 03/11/2018 (as it improved and then returned on 3/11/2018)- therefore occurred during the accident waiting period or prior to the policy being purchased.
This claim appears to have been denied correctly.
Complaint: ***
I am rejecting this response because:
As can been seen from the attached document signed by Gizmo's veterinarian at the Butterfield Animal Hospital. His veterinarian Dr. S states "The injury to Gizmo's right thoracic limb occurred on 3/11/2018. We saw Gizmo on 3/12/2018 for his initial exam and diagnosis." Dr. S referred Gizmo to the Veterinary Specialty Hospital after his diagnosis, due to the complexity of his fracture. His visit to the Speciality Hospital (which can be seen in the invoices) was on 3/13/2018, which was also the date of his surgery. The nurse at the Veterinary Specialty Hospital,in her haste to get Gizmo into surgery made the statement that you are using to deny my claim. I have spoken to the Veterinary Speciality Hospital in regards to this, and they too will be providing me a letter, which will also confirm the dates that I have labeled out as well as validating the dates and statements from the Butterfield Animal Hospital.
Sincerely
Complaint: ***
Is this admission that, my claim was wrongfully denied?
Is the letter that I submitted not enough proof that, Gizmo indeed was within the covered range? The letter is on offical letterhead and signed by the examining doctor. I am in process of getting another letter by the surgeon who performed the surgery to further validate that Gizmo was in the covered dates for insurance coverage.
What other proof is required to show that the claim was wrongfully denied? The first letter however, should be more than sufficient and substantial to validate Gizmo's injury and the validity of me submitting my claim.
Sincerely
I'm sorry you are unhappy with the outcome of your claim. If you have any further documentation you would like reviewed, please submit it with an appeal.
I am writing to make a complaint in regards to a denied pet insurance claim. The company has wrongfully denied my claim for reimbursement for the veterinary services performed on my pet. The company claims that the accident that occurred that injured my dog and prompted the need for surgery and x-rays was a pre-existing condition. However, they have received all the necessary documentation from both veterinarians and surgeons stating that my pet indeed injured himself on 3/11/2018 (the first day for accident coverage to begin) and that his injury was indeed accidental. All medical records sent to the company are clearly dated for 3/12/2018 (the initial veterinary visit), 3/13/2018 (the surgery performed date), and 3/14/2018 (the post surgery observation stay). All of these dates are clearly in the covered ranged stated in their policy agreement, including the date in which the accident occurred.
I have already contacted both the animal hospital (where surgery was performed) and the veterinarian's office (initial visit and time of first set of x-rays). All of whom, agree that the insurance company is being unfair, unjust, and unlawful for not honoring the policy that is in place. Both feel and have stated that the insurance company is not behaving in an acceptable manner towards covering the cost of the medical services. Both have agreed to assist if needed to verify all that I have stated to the insurance company to be true. Both have already sent in medical records proving that indeed my pet had his accident well within the covered time frame and that his accident, cannot be considered pre-existing because by the very nature of the word accident, is an occurrence that can happen at anytime and cannot be pre-existing. Additionally, they have the medical evidence (x-rays) showing that his injury (broken elbow) was new and showed no signs of any sort of bone fusing or netting that would give way to being a "pre-existing" condition.
This policy was purchased on 3/8/2018 with a waiting period for accidental injuries that ends on 3/11/2018
Medical records from Veterinary Specialty Hospital dated March 13, 2018 give the following history:
"Owner was out of town when the injury occurred. Reports Gizmo got his paw stuck under the fence. After his paw was removed Gizmo starting limping on his right thoracic limb. His limping seems to improve, but then returned on Sunday (03/11/18). Radiographs of the right elbow revealed the fracture. Gizmo is over all doing well at home. He is using the limb consistently and does not appear overtly painful."
Based on this history, trauma / accident occurred prior to 03/11/2018 (as it improved and then returned on 3/11/2018)- therefore occurred during the accident waiting period or prior to the policy being purchased.
This claim appears to have been denied correctly.
Complaint: ***
I am rejecting this response because:
As can been seen from the attached document signed by Gizmo's veterinarian at the Butterfield Animal Hospital. His veterinarian Dr. S states "The injury to Gizmo's right thoracic limb occurred on 3/11/2018. We saw Gizmo on 3/12/2018 for his initial exam and diagnosis." Dr. S referred Gizmo to the Veterinary Specialty Hospital after his diagnosis, due to the complexity of his fracture. His visit to the Speciality Hospital (which can be seen in the invoices) was on 3/13/2018, which was also the date of his surgery. The nurse at the Veterinary Specialty Hospital,in her haste to get Gizmo into surgery made the statement that you are using to deny my claim. I have spoken to the Veterinary Speciality Hospital in regards to this, and they too will be providing me a letter, which will also confirm the dates that I have labeled out as well as validating the dates and statements from the Butterfield Animal Hospital.
Sincerely
Complaint: ***
Is this admission that, my claim was wrongfully denied?
Is the letter that I submitted not enough proof that, Gizmo indeed was within the covered range? The letter is on offical letterhead and signed by the examining doctor. I am in process of getting another letter by the surgeon who performed the surgery to further validate that Gizmo was in the covered dates for insurance coverage.
What other proof is required to show that the claim was wrongfully denied? The first letter however, should be more than sufficient and substantial to validate Gizmo's injury and the validity of me submitting my claim.
Sincerely
I'm sorry you are unhappy with the outcome of your claim. If you have any further documentation you would like reviewed, please submit it with an appeal.
I am writing to make a complaint in regards to a denied pet insurance claim. The company has wrongfully denied my claim for reimbursement for the veterinary services performed on my pet. The company claims that the accident that occurred that injured my dog and prompted the need for surgery and x-rays was a pre-existing condition. However, they have received all the necessary documentation from both veterinarians and surgeons stating that my pet indeed injured himself on 3/11/2018 (the first day for accident coverage to begin) and that his injury was indeed accidental. All medical records sent to the company are clearly dated for 3/12/2018 (the initial veterinary visit), 3/13/2018 (the surgery performed date), and 3/14/2018 (the post surgery observation stay). All of these dates are clearly in the covered ranged stated in their policy agreement, including the date in which the accident occurred.
I have already contacted both the animal hospital (where surgery was performed) and the veterinarian's office (initial visit and time of first set of x-rays). All of whom, agree that the insurance company is being unfair, unjust, and unlawful for not honoring the policy that is in place. Both feel and have stated that the insurance company is not behaving in an acceptable manner towards covering the cost of the medical services. Both have agreed to assist if needed to verify all that I have stated to the insurance company to be true. Both have already sent in medical records proving that indeed my pet had his accident well within the covered time frame and that his accident, cannot be considered pre-existing because by the very nature of the word accident, is an occurrence that can happen at anytime and cannot be pre-existing. Additionally, they have the medical evidence (x-rays) showing that his injury (broken elbow) was new and showed no signs of any sort of bone fusing or netting that would give way to being a "pre-existing" condition.
This policy was purchased on 3/8/2018 with a waiting period for accidental injuries that ends on 3/11/2018
Medical records from Veterinary Specialty Hospital dated March 13, 2018 give the following history:
"Owner was out of town when the injury occurred. Reports Gizmo got his paw stuck under the fence. After his paw was removed Gizmo starting limping on his right thoracic limb. His limping seems to improve, but then returned on Sunday (03/11/18). Radiographs of the right elbow revealed the fracture. Gizmo is over all doing well at home. He is using the limb consistently and does not appear overtly painful."
Based on this history, trauma / accident occurred prior to 03/11/2018 (as it improved and then returned on 3/11/2018)- therefore occurred during the accident waiting period or prior to the policy being purchased.
This claim appears to have been denied correctly.
Complaint: ***
I am rejecting this response because:
As can been seen from the attached document signed by Gizmo's veterinarian at the Butterfield Animal Hospital. His veterinarian Dr. S states "The injury to Gizmo's right thoracic limb occurred on 3/11/2018. We saw Gizmo on 3/12/2018 for his initial exam and diagnosis." Dr. S referred Gizmo to the Veterinary Specialty Hospital after his diagnosis, due to the complexity of his fracture. His visit to the Speciality Hospital (which can be seen in the invoices) was on 3/13/2018, which was also the date of his surgery. The nurse at the Veterinary Specialty Hospital,in her haste to get Gizmo into surgery made the statement that you are using to deny my claim. I have spoken to the Veterinary Speciality Hospital in regards to this, and they too will be providing me a letter, which will also confirm the dates that I have labeled out as well as validating the dates and statements from the Butterfield Animal Hospital.
Sincerely
Complaint: ***
Is this admission that, my claim was wrongfully denied?
Is the letter that I submitted not enough proof that, Gizmo indeed was within the covered range? The letter is on offical letterhead and signed by the examining doctor. I am in process of getting another letter by the surgeon who performed the surgery to further validate that Gizmo was in the covered dates for insurance coverage.
What other proof is required to show that the claim was wrongfully denied? The first letter however, should be more than sufficient and substantial to validate Gizmo's injury and the validity of me submitting my claim.
Sincerely
I'm sorry you are unhappy with the outcome of your claim. If you have any further documentation you would like reviewed, please submit it with an appeal.
I purchased a policy from Pets Best Insurance in April of 2017. I have since had to have my dog in for CCL surgery and have had the claim rejected both initially and through appeal based on pre-existing conditions. Pets Best definition of pre-existing condition is very broad that any limp or strain or lameness, even when not initially associated with the CCL, or suggested by the veterinarian as being caused by a CCL is taken as pre-existing. The company was more than willing to accept claims regarding the issue in question until it reached above the threshold of the deductible, then they rejected the claim as pre-existing based on a lameness issue that was looked at by the veterinarian within the first six months of the policy (July 2017). During this veterinarian visit there was no mention of CCL tear on the leg. The company blatantly uses the vague terminology in it's policy to work around their obligation to provide the reimbursement for any payments that fall over the deductible.
Good afternoon,
The claim in question was denied under the policy exclusion that excludes coverage for any cruciate ligament injury in which signs or symptoms occur in the first six months of the policy.
Medical records from Animal Clinic of Clifton document examination and NSAID therapy for lameness in the right stifle on July 19, 2017. At this time, doctor notes a primary differential diagnosis of a partial cruciate tear. Pet is presented for examination at this hospital oncea again January 25, 2018 with history of limited weight bearing lameness. Notes refer to a left hind lameness previously in July. Referral for a orthopedic specialist consultation is pursued with examination taking place February 6, 2018. History notes state "Wilbur has a history of intermittent left hindleg lameness since July 2017. The owner reports that initially he would hold the leg up for only a few steps when he first got up after resting, especially after going for a run. He did rest him for a few months but the lameness did not completely resolve."
Radiographs of the left stifle and hips were taken. The left stifle was found to have increased joint effusion and a mineralized opacity within the craniolateral portion of the stifle joint. Doctor notes indicate "we discussed stifle exploratory to evaluate the cruciate ligament, mensicus and long digital extensor tendong versus treatment for the iliopsoas muscle first and then surgery if this is resolved and he is still favoring the leg. We elected for treatment of the iliopsoas muscle first as this is the least invasion option. If this is unsuccessful in resolving the lameness we will consider surgery in the future."
Once again on February 19, 2018 pet is presented for examination due to lameness. Records document the following history:
"Wilbur was seen preiovusly for a left hindleg lameness due to changes in his stifle but also iliopsoas muscle strain. He had improved initially with medication for the muscle strain but then the lameness significantly worsened. At that time he was noted to have instability in his stifle consistent with a cranial cruciate ligmant injury. He was brought in today for surgery to stabilize the stifle."Symptoms of lameness in the left hind limb are documented on several occasions throughout two separate medical record files as being present since July 2017. Pet is diagnosed with both an iliopsoas muscle strain as well as suspected concurrent cruciate ligament tear in the left hind limb."
Current claims for the cruciate injury repair have been properly excluded as symptoms of the condition presented within the first 6 months of the policy.
Complaint: ***
I am rejecting this response because:
The explanation that the left hind leg had lameness prior to the 6 month period is based on discussions with the vet in January 2018, during which it is entirely possible that I mistook/misremembered that it was the RIGHT leg that was treated in July 2017. There is no treatment nor examination from the vet with regards to the LEFT leg seen in the history. Pets Best claim that there is, is not valid. They can look at the copy of the history, which they have two copies of, and see that there is no treatment for the left leg, just notes, which are again, based on discussion between the vet and myself during the examination.
Sincerely
Complaint: ***
I am rejecting this response because:
I am confused. The policy, which I paid over $59 a month
for, can have a claim denied for hearsay, without any kind of factual evidence
or proof of a condition (especially if it’s over the deductible as Pets Best
didn’t have a problem with the x-rays and other exams that came before the
surgery that fell under the deductible limit on the same leg). Your denial of the claim is because a note was made about lameness in the leg, just a "note", no proof of one in the medical history. It is entirely
possible that the mention of lameness in the leg could be incorrect based on a
foggy memory or confusion from the owner (myself). Again please note that there
was no mention from the veterinarian in July 2017 that lameness in the leg
existed in the medical history. There is only a note in January 2018 that
lameness was seen in the leg earlier (which again could be because I had the
wrong leg in the pre-exam discussion with the vet in January).
Help me understand this by putting it in terms of a person…
let’s say someone went into a doctor’s office to have his/her leg checked and
during the pre-exam discussion it was mentioned that the person believes that
one of his/her legs was hurting a while back, but couldn’t remember if it was
the leg currently being looked at, and no doctor was sought out for it and it
got better. After the doctor looked at the leg it was decided a minor knee
scope was needed to clean it out. Now, if
that person had the human equivalent of Pets Best insurance the claim would be
denied because he/she mentioned in a pre-exam discussion that one of his/her legs
was hurting awhile back, which was noted by the doctor, and it would be
considered a pre-existing condition, even if the person wasn’t sure it was the
leg that had the scope done.
Is that correct? How is that ethical?
Sincerely
Signs or symptoms of an illness or condition present prior to the purchase of the policy or the policy waiting period make that condition pre-existing to coverage and ineligible for reimbursement.
I purchased a policy from Pets Best Insurance in April of 2017. I have since had to have my dog in for CCL surgery and have had the claim rejected both initially and through appeal based on pre-existing conditions. Pets Best definition of pre-existing condition is very broad that any limp or strain or lameness, even when not initially associated with the CCL, or suggested by the veterinarian as being caused by a CCL is taken as pre-existing. The company was more than willing to accept claims regarding the issue in question until it reached above the threshold of the deductible, then they rejected the claim as pre-existing based on a lameness issue that was looked at by the veterinarian within the first six months of the policy (July 2017). During this veterinarian visit there was no mention of CCL tear on the leg. The company blatantly uses the vague terminology in it's policy to work around their obligation to provide the reimbursement for any payments that fall over the deductible.
Good afternoon,
The claim in question was denied under the policy exclusion that excludes coverage for any cruciate ligament injury in which signs or symptoms occur in the first six months of the policy.
Medical records from Animal Clinic of Clifton document examination and NSAID therapy for lameness in the right stifle on July 19, 2017. At this time, doctor notes a primary differential diagnosis of a partial cruciate tear. Pet is presented for examination at this hospital oncea again January 25, 2018 with history of limited weight bearing lameness. Notes refer to a left hind lameness previously in July. Referral for a orthopedic specialist consultation is pursued with examination taking place February 6, 2018. History notes state "Wilbur has a history of intermittent left hindleg lameness since July 2017. The owner reports that initially he would hold the leg up for only a few steps when he first got up after resting, especially after going for a run. He did rest him for a few months but the lameness did not completely resolve."
Radiographs of the left stifle and hips were taken. The left stifle was found to have increased joint effusion and a mineralized opacity within the craniolateral portion of the stifle joint. Doctor notes indicate "we discussed stifle exploratory to evaluate the cruciate ligament, mensicus and long digital extensor tendong versus treatment for the iliopsoas muscle first and then surgery if this is resolved and he is still favoring the leg. We elected for treatment of the iliopsoas muscle first as this is the least invasion option. If this is unsuccessful in resolving the lameness we will consider surgery in the future."
Once again on February 19, 2018 pet is presented for examination due to lameness. Records document the following history:
"Wilbur was seen preiovusly for a left hindleg lameness due to changes in his stifle but also iliopsoas muscle strain. He had improved initially with medication for the muscle strain but then the lameness significantly worsened. At that time he was noted to have instability in his stifle consistent with a cranial cruciate ligmant injury. He was brought in today for surgery to stabilize the stifle."Symptoms of lameness in the left hind limb are documented on several occasions throughout two separate medical record files as being present since July 2017. Pet is diagnosed with both an iliopsoas muscle strain as well as suspected concurrent cruciate ligament tear in the left hind limb."
Current claims for the cruciate injury repair have been properly excluded as symptoms of the condition presented within the first 6 months of the policy.
Complaint: ***
I am rejecting this response because:
The explanation that the left hind leg had lameness prior to the 6 month period is based on discussions with the vet in January 2018, during which it is entirely possible that I mistook/misremembered that it was the RIGHT leg that was treated in July 2017. There is no treatment nor examination from the vet with regards to the LEFT leg seen in the history. Pets Best claim that there is, is not valid. They can look at the copy of the history, which they have two copies of, and see that there is no treatment for the left leg, just notes, which are again, based on discussion between the vet and myself during the examination.
Sincerely
Complaint: ***
I am rejecting this response because:
I am confused. The policy, which I paid over $59 a month
for, can have a claim denied for hearsay, without any kind of factual evidence
or proof of a condition (especially if it’s over the deductible as Pets Best
didn’t have a problem with the x-rays and other exams that came before the
surgery that fell under the deductible limit on the same leg). Your denial of the claim is because a note was made about lameness in the leg, just a "note", no proof of one in the medical history. It is entirely
possible that the mention of lameness in the leg could be incorrect based on a
foggy memory or confusion from the owner (myself). Again please note that there
was no mention from the veterinarian in July 2017 that lameness in the leg
existed in the medical history. There is only a note in January 2018 that
lameness was seen in the leg earlier (which again could be because I had the
wrong leg in the pre-exam discussion with the vet in January).
Help me understand this by putting it in terms of a person…
let’s say someone went into a doctor’s office to have his/her leg checked and
during the pre-exam discussion it was mentioned that the person believes that
one of his/her legs was hurting a while back, but couldn’t remember if it was
the leg currently being looked at, and no doctor was sought out for it and it
got better. After the doctor looked at the leg it was decided a minor knee
scope was needed to clean it out. Now, if
that person had the human equivalent of Pets Best insurance the claim would be
denied because he/she mentioned in a pre-exam discussion that one of his/her legs
was hurting awhile back, which was noted by the doctor, and it would be
considered a pre-existing condition, even if the person wasn’t sure it was the
leg that had the scope done.
Is that correct? How is that ethical?
Sincerely
Signs or symptoms of an illness or condition present prior to the purchase of the policy or the policy waiting period make that condition pre-existing to coverage and ineligible for reimbursement.
I purchased a policy from Pets Best Insurance in April of 2017. I have since had to have my dog in for CCL surgery and have had the claim rejected both initially and through appeal based on pre-existing conditions. Pets Best definition of pre-existing condition is very broad that any limp or strain or lameness, even when not initially associated with the CCL, or suggested by the veterinarian as being caused by a CCL is taken as pre-existing. The company was more than willing to accept claims regarding the issue in question until it reached above the threshold of the deductible, then they rejected the claim as pre-existing based on a lameness issue that was looked at by the veterinarian within the first six months of the policy (July 2017). During this veterinarian visit there was no mention of CCL tear on the leg. The company blatantly uses the vague terminology in it's policy to work around their obligation to provide the reimbursement for any payments that fall over the deductible.
Good afternoon,
The claim in question was denied under the policy exclusion that excludes coverage for any cruciate ligament injury in which signs or symptoms occur in the first six months of the policy.
Medical records from Animal Clinic of Clifton document examination and NSAID therapy for lameness in the right stifle on July 19, 2017. At this time, doctor notes a primary differential diagnosis of a partial cruciate tear. Pet is presented for examination at this hospital oncea again January 25, 2018 with history of limited weight bearing lameness. Notes refer to a left hind lameness previously in July. Referral for a orthopedic specialist consultation is pursued with examination taking place February 6, 2018. History notes state "Wilbur has a history of intermittent left hindleg lameness since July 2017. The owner reports that initially he would hold the leg up for only a few steps when he first got up after resting, especially after going for a run. He did rest him for a few months but the lameness did not completely resolve."
Radiographs of the left stifle and hips were taken. The left stifle was found to have increased joint effusion and a mineralized opacity within the craniolateral portion of the stifle joint. Doctor notes indicate "we discussed stifle exploratory to evaluate the cruciate ligament, mensicus and long digital extensor tendong versus treatment for the iliopsoas muscle first and then surgery if this is resolved and he is still favoring the leg. We elected for treatment of the iliopsoas muscle first as this is the least invasion option. If this is unsuccessful in resolving the lameness we will consider surgery in the future."
Once again on February 19, 2018 pet is presented for examination due to lameness. Records document the following history:
"Wilbur was seen preiovusly for a left hindleg lameness due to changes in his stifle but also iliopsoas muscle strain. He had improved initially with medication for the muscle strain but then the lameness significantly worsened. At that time he was noted to have instability in his stifle consistent with a cranial cruciate ligmant injury. He was brought in today for surgery to stabilize the stifle."Symptoms of lameness in the left hind limb are documented on several occasions throughout two separate medical record files as being present since July 2017. Pet is diagnosed with both an iliopsoas muscle strain as well as suspected concurrent cruciate ligament tear in the left hind limb."
Current claims for the cruciate injury repair have been properly excluded as symptoms of the condition presented within the first 6 months of the policy.
Complaint: ***
I am rejecting this response because:
The explanation that the left hind leg had lameness prior to the 6 month period is based on discussions with the vet in January 2018, during which it is entirely possible that I mistook/misremembered that it was the RIGHT leg that was treated in July 2017. There is no treatment nor examination from the vet with regards to the LEFT leg seen in the history. Pets Best claim that there is, is not valid. They can look at the copy of the history, which they have two copies of, and see that there is no treatment for the left leg, just notes, which are again, based on discussion between the vet and myself during the examination.
Sincerely
Complaint: ***
I am rejecting this response because:
I am confused. The policy, which I paid over $59 a month
for, can have a claim denied for hearsay, without any kind of factual evidence
or proof of a condition (especially if it’s over the deductible as Pets Best
didn’t have a problem with the x-rays and other exams that came before the
surgery that fell under the deductible limit on the same leg). Your denial of the claim is because a note was made about lameness in the leg, just a "note", no proof of one in the medical history. It is entirely
possible that the mention of lameness in the leg could be incorrect based on a
foggy memory or confusion from the owner (myself). Again please note that there
was no mention from the veterinarian in July 2017 that lameness in the leg
existed in the medical history. There is only a note in January 2018 that
lameness was seen in the leg earlier (which again could be because I had the
wrong leg in the pre-exam discussion with the vet in January).
Help me understand this by putting it in terms of a person…
let’s say someone went into a doctor’s office to have his/her leg checked and
during the pre-exam discussion it was mentioned that the person believes that
one of his/her legs was hurting a while back, but couldn’t remember if it was
the leg currently being looked at, and no doctor was sought out for it and it
got better. After the doctor looked at the leg it was decided a minor knee
scope was needed to clean it out. Now, if
that person had the human equivalent of Pets Best insurance the claim would be
denied because he/she mentioned in a pre-exam discussion that one of his/her legs
was hurting awhile back, which was noted by the doctor, and it would be
considered a pre-existing condition, even if the person wasn’t sure it was the
leg that had the scope done.
Is that correct? How is that ethical?
Sincerely
Signs or symptoms of an illness or condition present prior to the purchase of the policy or the policy waiting period make that condition pre-existing to coverage and ineligible for reimbursement.
I purchased a policy from Pets Best Insurance in April of 2017. I have since had to have my dog in for CCL surgery and have had the claim rejected both initially and through appeal based on pre-existing conditions. Pets Best definition of pre-existing condition is very broad that any limp or strain or lameness, even when not initially associated with the CCL, or suggested by the veterinarian as being caused by a CCL is taken as pre-existing. The company was more than willing to accept claims regarding the issue in question until it reached above the threshold of the deductible, then they rejected the claim as pre-existing based on a lameness issue that was looked at by the veterinarian within the first six months of the policy (July 2017). During this veterinarian visit there was no mention of CCL tear on the leg. The company blatantly uses the vague terminology in it's policy to work around their obligation to provide the reimbursement for any payments that fall over the deductible.
Good afternoon,
The claim in question was denied under the policy exclusion that excludes coverage for any cruciate ligament injury in which signs or symptoms occur in the first six months of the policy.
Medical records from Animal Clinic of Clifton document examination and NSAID therapy for lameness in the right stifle on July 19, 2017. At this time, doctor notes a primary differential diagnosis of a partial cruciate tear. Pet is presented for examination at this hospital oncea again January 25, 2018 with history of limited weight bearing lameness. Notes refer to a left hind lameness previously in July. Referral for a orthopedic specialist consultation is pursued with examination taking place February 6, 2018. History notes state "Wilbur has a history of intermittent left hindleg lameness since July 2017. The owner reports that initially he would hold the leg up for only a few steps when he first got up after resting, especially after going for a run. He did rest him for a few months but the lameness did not completely resolve."
Radiographs of the left stifle and hips were taken. The left stifle was found to have increased joint effusion and a mineralized opacity within the craniolateral portion of the stifle joint. Doctor notes indicate "we discussed stifle exploratory to evaluate the cruciate ligament, mensicus and long digital extensor tendong versus treatment for the iliopsoas muscle first and then surgery if this is resolved and he is still favoring the leg. We elected for treatment of the iliopsoas muscle first as this is the least invasion option. If this is unsuccessful in resolving the lameness we will consider surgery in the future."
Once again on February 19, 2018 pet is presented for examination due to lameness. Records document the following history:
"Wilbur was seen preiovusly for a left hindleg lameness due to changes in his stifle but also iliopsoas muscle strain. He had improved initially with medication for the muscle strain but then the lameness significantly worsened. At that time he was noted to have instability in his stifle consistent with a cranial cruciate ligmant injury. He was brought in today for surgery to stabilize the stifle."Symptoms of lameness in the left hind limb are documented on several occasions throughout two separate medical record files as being present since July 2017. Pet is diagnosed with both an iliopsoas muscle strain as well as suspected concurrent cruciate ligament tear in the left hind limb."
Current claims for the cruciate injury repair have been properly excluded as symptoms of the condition presented within the first 6 months of the policy.
Complaint: ***
I am rejecting this response because:
The explanation that the left hind leg had lameness prior to the 6 month period is based on discussions with the vet in January 2018, during which it is entirely possible that I mistook/misremembered that it was the RIGHT leg that was treated in July 2017. There is no treatment nor examination from the vet with regards to the LEFT leg seen in the history. Pets Best claim that there is, is not valid. They can look at the copy of the history, which they have two copies of, and see that there is no treatment for the left leg, just notes, which are again, based on discussion between the vet and myself during the examination.
Sincerely
Complaint: ***
I am rejecting this response because:
I am confused. The policy, which I paid over $59 a month
for, can have a claim denied for hearsay, without any kind of factual evidence
or proof of a condition (especially if it’s over the deductible as Pets Best
didn’t have a problem with the x-rays and other exams that came before the
surgery that fell under the deductible limit on the same leg). Your denial of the claim is because a note was made about lameness in the leg, just a "note", no proof of one in the medical history. It is entirely
possible that the mention of lameness in the leg could be incorrect based on a
foggy memory or confusion from the owner (myself). Again please note that there
was no mention from the veterinarian in July 2017 that lameness in the leg
existed in the medical history. There is only a note in January 2018 that
lameness was seen in the leg earlier (which again could be because I had the
wrong leg in the pre-exam discussion with the vet in January).
Help me understand this by putting it in terms of a person…
let’s say someone went into a doctor’s office to have his/her leg checked and
during the pre-exam discussion it was mentioned that the person believes that
one of his/her legs was hurting a while back, but couldn’t remember if it was
the leg currently being looked at, and no doctor was sought out for it and it
got better. After the doctor looked at the leg it was decided a minor knee
scope was needed to clean it out. Now, if
that person had the human equivalent of Pets Best insurance the claim would be
denied because he/she mentioned in a pre-exam discussion that one of his/her legs
was hurting awhile back, which was noted by the doctor, and it would be
considered a pre-existing condition, even if the person wasn’t sure it was the
leg that had the scope done.
Is that correct? How is that ethical?
Sincerely
Signs or symptoms of an illness or condition present prior to the purchase of the policy or the policy waiting period make that condition pre-existing to coverage and ineligible for reimbursement.
On May 23, 2017, "Pets Best Insurance" made a charge to my bank account without my consent for $ 209.06, but I do not know the company and I have never had contact with it, so I do not know the reason why they did it.
Good morning,
Last May a policy was purchased through our online enrollment by *** for a Jack Russel Terrier named *** using the credit card you are referencing. On 10/2/2017 a credit card dispute was filed for the charges and nobody at the phone number listed on the policy would speak to us regarding the charge. On 10/11/2017 we allowed the requested charge back to be processed, refunding the entire amount.
Complaint: ***
I am rejecting this response because:
I think there is some confusion. Pets Best Insurance has made two charges to my account that I did not authorize, the first on May 23, 2017 and the second on August 24, 2017, each in the amount of $ 209.06 dlls. Effectively, I requested and received a refund of $ 209.06 dlls for the charge made on August 24, 2017, but that was not the case with May 23, 2017 charge, which is why I resorted to this complain.
Honestly, I don´t know who *** or her dog is.
I´m in the best disposition to provide any information that helps to solve this problem.
Sincerely
Mr.,
Thank you for the further explanation. I do see that ori***l charge on 5/22/2017 and have directed our accounting team to refund that charge immediately. It may take a couple of days for your credit card to process the refund.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID, and find that this resolution is satisfactory to me.
Thanks for your help.
On May 23, 2017, "Pets Best Insurance" made a charge to my bank account without my consent for $ 209.06, but I do not know the company and I have never had contact with it, so I do not know the reason why they did it.
Good morning,
Last May a policy was purchased through our online enrollment by *** for a Jack Russel Terrier named *** using the credit card you are referencing. On 10/2/2017 a credit card dispute was filed for the charges and nobody at the phone number listed on the policy would speak to us regarding the charge. On 10/11/2017 we allowed the requested charge back to be processed, refunding the entire amount.
Complaint: ***
I am rejecting this response because:
I think there is some confusion. Pets Best Insurance has made two charges to my account that I did not authorize, the first on May 23, 2017 and the second on August 24, 2017, each in the amount of $ 209.06 dlls. Effectively, I requested and received a refund of $ 209.06 dlls for the charge made on August 24, 2017, but that was not the case with May 23, 2017 charge, which is why I resorted to this complain.
Honestly, I don´t know who *** or her dog is.
I´m in the best disposition to provide any information that helps to solve this problem.
Sincerely
Mr.,
Thank you for the further explanation. I do see that ori***l charge on 5/22/2017 and have directed our accounting team to refund that charge immediately. It may take a couple of days for your credit card to process the refund.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID, and find that this resolution is satisfactory to me.
Thanks for your help.
On May 23, 2017, "Pets Best Insurance" made a charge to my bank account without my consent for $ 209.06, but I do not know the company and I have never had contact with it, so I do not know the reason why they did it.
Good morning,
Last May a policy was purchased through our online enrollment by *** for a Jack Russel Terrier named *** using the credit card you are referencing. On 10/2/2017 a credit card dispute was filed for the charges and nobody at the phone number listed on the policy would speak to us regarding the charge. On 10/11/2017 we allowed the requested charge back to be processed, refunding the entire amount.
Complaint: ***
I am rejecting this response because:
I think there is some confusion. Pets Best Insurance has made two charges to my account that I did not authorize, the first on May 23, 2017 and the second on August 24, 2017, each in the amount of $ 209.06 dlls. Effectively, I requested and received a refund of $ 209.06 dlls for the charge made on August 24, 2017, but that was not the case with May 23, 2017 charge, which is why I resorted to this complain.
Honestly, I don´t know who *** or her dog is.
I´m in the best disposition to provide any information that helps to solve this problem.
Sincerely
Mr.,
Thank you for the further explanation. I do see that ori***l charge on 5/22/2017 and have directed our accounting team to refund that charge immediately. It may take a couple of days for your credit card to process the refund.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID, and find that this resolution is satisfactory to me.
Thanks for your help.
On May 23, 2017, "Pets Best Insurance" made a charge to my bank account without my consent for $ 209.06, but I do not know the company and I have never had contact with it, so I do not know the reason why they did it.
Good morning,
Last May a policy was purchased through our online enrollment by *** for a Jack Russel Terrier named *** using the credit card you are referencing. On 10/2/2017 a credit card dispute was filed for the charges and nobody at the phone number listed on the policy would speak to us regarding the charge. On 10/11/2017 we allowed the requested charge back to be processed, refunding the entire amount.
Complaint: ***
I am rejecting this response because:
I think there is some confusion. Pets Best Insurance has made two charges to my account that I did not authorize, the first on May 23, 2017 and the second on August 24, 2017, each in the amount of $ 209.06 dlls. Effectively, I requested and received a refund of $ 209.06 dlls for the charge made on August 24, 2017, but that was not the case with May 23, 2017 charge, which is why I resorted to this complain.
Honestly, I don´t know who *** or her dog is.
I´m in the best disposition to provide any information that helps to solve this problem.
Sincerely
Mr.,
Thank you for the further explanation. I do see that ori***l charge on 5/22/2017 and have directed our accounting team to refund that charge immediately. It may take a couple of days for your credit card to process the refund.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID, and find that this resolution is satisfactory to me.
Thanks for your help.
I purchased coverage for my dog in August, 2017. I submitted my first claim, which was denied because the date of service was within the 14 day waiting period. My second claim was denied as well, in spite of it being for a covered condition and covered medications. I called today to get clarification before I send another claim and was told that the claim review people had deemed it pre-existing and chronic, therefore nothing would be covered. The representative with whom I first spoke took the tactic of talking over me the entire time I was on the phone, wouldn't stop talking when I asked her to, and when I had to raise my voice to get her attention, she told me she'd email a form and hung up. The second person took very much the same tactic of talking over me (I'm seeing a trend in bowling customers over to get them off the phone), when I asked to speak to a supervisor, they were all conveniently on the phone. This company is operating a scam, and based on previous reports and complaints, I can see that I am not the only one who feels this way.
Your policy, like all pet insurance policies issued in the United States, contains an exclusion for conditions that are present either before the policy is purchased, or during a short waiting period after purchasing the policy. In the case of your Pets Best policy, that waiting period is one of the shorter ones offered at 14 days long. The policy in question was purchased on 8/8/2017 with a waiting period that expired on 8/22/2017. On 8/19/2017 your pet was taken to the vet for a skin condition and that claim was denied as being inside the waiting period. That condition is then excluded from the policy going forward as having pre-existed the coverage period.
On 1/15/2018 your pet was once again brought to the veterinarian for a skin condition, treated with the same medications as the previous visit and diagnosed as Atopy, a chronic skin allergy. At this time we pulled 18 months of medical records from your treating veterinarian to investigate whether this claim was related to the previous claim denied during the waiting period. These records showed that the condition denied on 8/8/2017 was treated on 11/1/2017, 11/15/2017, and 12/4/2017, showing a continuation of the same treatment plan for the same condition.
Additionally, these records show that the same condition was treated on 8/5/2017, three days before purchasing the policy, and Otitis (another symptom of chronic Atopy) was diagnosed on 1/19/2017, 4/5/2017, and 4/18/2017, indicating that the condition likely predated the policy by at least 8 months.
The policy purchased does not cover conditions that pre-date the purchase of the coverage. Insurance is a tool by which large numbers of people pool their resources and their potential risk so that those who need the benefits can share in them when an unexpected illness occurs. The system cannot work if people can wait until their pets are ill before they buy a policy, as the premiums would be far too expensive to cover all the known risks coming in.
As the condition being claimed was pre-existing, the denial of the claim was appropriate. As coverage was available for any number of other conditions that were not pre-existing to the policy, a refund is not possible.
Complaint: ***
I am rejecting this response because:
As per the conversation that I had with Pets Best on the date that I submitted this complaint, they themselves admit that they have determined with the help of staff with a "veterinary background", not Veterinarians, that my dog's issue is "chronic". My vet at no time has indicated that this is chronic. A chronic ailment, by definition would be one that automatically reappears when treatment is stopped. That the ailment is only not present by virtue of the presence of medication, and that is not the case here. This company has falsified my initial application in saying that I claimed that my dog had never had any prior illness. Their statement of that is false. I never claimed that she never had anything, nor have I omitted any documents for their review. The only way to appeal a decision is to take my dog for a second opinion to a vet that is of their choosing. I do not see how that could possibly be impartial. That would be akin to me going to a doctor that is on the insurance companies payroll and expecting a clean bill of health. If you follow the money, you will find the problem.
Sincerely
I purchased coverage for my dog in August, 2017. I submitted my first claim, which was denied because the date of service was within the 14 day waiting period. My second claim was denied as well, in spite of it being for a covered condition and covered medications. I called today to get clarification before I send another claim and was told that the claim review people had deemed it pre-existing and chronic, therefore nothing would be covered. The representative with whom I first spoke took the tactic of talking over me the entire time I was on the phone, wouldn't stop talking when I asked her to, and when I had to raise my voice to get her attention, she told me she'd email a form and hung up. The second person took very much the same tactic of talking over me (I'm seeing a trend in bowling customers over to get them off the phone), when I asked to speak to a supervisor, they were all conveniently on the phone. This company is operating a scam, and based on previous reports and complaints, I can see that I am not the only one who feels this way.
Your policy, like all pet insurance policies issued in the United States, contains an exclusion for conditions that are present either before the policy is purchased, or during a short waiting period after purchasing the policy. In the case of your Pets Best policy, that waiting period is one of the shorter ones offered at 14 days long. The policy in question was purchased on 8/8/2017 with a waiting period that expired on 8/22/2017. On 8/19/2017 your pet was taken to the vet for a skin condition and that claim was denied as being inside the waiting period. That condition is then excluded from the policy going forward as having pre-existed the coverage period.
On 1/15/2018 your pet was once again brought to the veterinarian for a skin condition, treated with the same medications as the previous visit and diagnosed as Atopy, a chronic skin allergy. At this time we pulled 18 months of medical records from your treating veterinarian to investigate whether this claim was related to the previous claim denied during the waiting period. These records showed that the condition denied on 8/8/2017 was treated on 11/1/2017, 11/15/2017, and 12/4/2017, showing a continuation of the same treatment plan for the same condition.
Additionally, these records show that the same condition was treated on 8/5/2017, three days before purchasing the policy, and Otitis (another symptom of chronic Atopy) was diagnosed on 1/19/2017, 4/5/2017, and 4/18/2017, indicating that the condition likely predated the policy by at least 8 months.
The policy purchased does not cover conditions that pre-date the purchase of the coverage. Insurance is a tool by which large numbers of people pool their resources and their potential risk so that those who need the benefits can share in them when an unexpected illness occurs. The system cannot work if people can wait until their pets are ill before they buy a policy, as the premiums would be far too expensive to cover all the known risks coming in.
As the condition being claimed was pre-existing, the denial of the claim was appropriate. As coverage was available for any number of other conditions that were not pre-existing to the policy, a refund is not possible.
Complaint: ***
I am rejecting this response because:
As per the conversation that I had with Pets Best on the date that I submitted this complaint, they themselves admit that they have determined with the help of staff with a "veterinary background", not Veterinarians, that my dog's issue is "chronic". My vet at no time has indicated that this is chronic. A chronic ailment, by definition would be one that automatically reappears when treatment is stopped. That the ailment is only not present by virtue of the presence of medication, and that is not the case here. This company has falsified my initial application in saying that I claimed that my dog had never had any prior illness. Their statement of that is false. I never claimed that she never had anything, nor have I omitted any documents for their review. The only way to appeal a decision is to take my dog for a second opinion to a vet that is of their choosing. I do not see how that could possibly be impartial. That would be akin to me going to a doctor that is on the insurance companies payroll and expecting a clean bill of health. If you follow the money, you will find the problem.
Sincerely
I purchased coverage for my dog in August, 2017. I submitted my first claim, which was denied because the date of service was within the 14 day waiting period. My second claim was denied as well, in spite of it being for a covered condition and covered medications. I called today to get clarification before I send another claim and was told that the claim review people had deemed it pre-existing and chronic, therefore nothing would be covered. The representative with whom I first spoke took the tactic of talking over me the entire time I was on the phone, wouldn't stop talking when I asked her to, and when I had to raise my voice to get her attention, she told me she'd email a form and hung up. The second person took very much the same tactic of talking over me (I'm seeing a trend in bowling customers over to get them off the phone), when I asked to speak to a supervisor, they were all conveniently on the phone. This company is operating a scam, and based on previous reports and complaints, I can see that I am not the only one who feels this way.
Your policy, like all pet insurance policies issued in the United States, contains an exclusion for conditions that are present either before the policy is purchased, or during a short waiting period after purchasing the policy. In the case of your Pets Best policy, that waiting period is one of the shorter ones offered at 14 days long. The policy in question was purchased on 8/8/2017 with a waiting period that expired on 8/22/2017. On 8/19/2017 your pet was taken to the vet for a skin condition and that claim was denied as being inside the waiting period. That condition is then excluded from the policy going forward as having pre-existed the coverage period.
On 1/15/2018 your pet was once again brought to the veterinarian for a skin condition, treated with the same medications as the previous visit and diagnosed as Atopy, a chronic skin allergy. At this time we pulled 18 months of medical records from your treating veterinarian to investigate whether this claim was related to the previous claim denied during the waiting period. These records showed that the condition denied on 8/8/2017 was treated on 11/1/2017, 11/15/2017, and 12/4/2017, showing a continuation of the same treatment plan for the same condition.
Additionally, these records show that the same condition was treated on 8/5/2017, three days before purchasing the policy, and Otitis (another symptom of chronic Atopy) was diagnosed on 1/19/2017, 4/5/2017, and 4/18/2017, indicating that the condition likely predated the policy by at least 8 months.
The policy purchased does not cover conditions that pre-date the purchase of the coverage. Insurance is a tool by which large numbers of people pool their resources and their potential risk so that those who need the benefits can share in them when an unexpected illness occurs. The system cannot work if people can wait until their pets are ill before they buy a policy, as the premiums would be far too expensive to cover all the known risks coming in.
As the condition being claimed was pre-existing, the denial of the claim was appropriate. As coverage was available for any number of other conditions that were not pre-existing to the policy, a refund is not possible.
Complaint: ***
I am rejecting this response because:
As per the conversation that I had with Pets Best on the date that I submitted this complaint, they themselves admit that they have determined with the help of staff with a "veterinary background", not Veterinarians, that my dog's issue is "chronic". My vet at no time has indicated that this is chronic. A chronic ailment, by definition would be one that automatically reappears when treatment is stopped. That the ailment is only not present by virtue of the presence of medication, and that is not the case here. This company has falsified my initial application in saying that I claimed that my dog had never had any prior illness. Their statement of that is false. I never claimed that she never had anything, nor have I omitted any documents for their review. The only way to appeal a decision is to take my dog for a second opinion to a vet that is of their choosing. I do not see how that could possibly be impartial. That would be akin to me going to a doctor that is on the insurance companies payroll and expecting a clean bill of health. If you follow the money, you will find the problem.
Sincerely
I purchased coverage for my dog in August, 2017. I submitted my first claim, which was denied because the date of service was within the 14 day waiting period. My second claim was denied as well, in spite of it being for a covered condition and covered medications. I called today to get clarification before I send another claim and was told that the claim review people had deemed it pre-existing and chronic, therefore nothing would be covered. The representative with whom I first spoke took the tactic of talking over me the entire time I was on the phone, wouldn't stop talking when I asked her to, and when I had to raise my voice to get her attention, she told me she'd email a form and hung up. The second person took very much the same tactic of talking over me (I'm seeing a trend in bowling customers over to get them off the phone), when I asked to speak to a supervisor, they were all conveniently on the phone. This company is operating a scam, and based on previous reports and complaints, I can see that I am not the only one who feels this way.
Your policy, like all pet insurance policies issued in the United States, contains an exclusion for conditions that are present either before the policy is purchased, or during a short waiting period after purchasing the policy. In the case of your Pets Best policy, that waiting period is one of the shorter ones offered at 14 days long. The policy in question was purchased on 8/8/2017 with a waiting period that expired on 8/22/2017. On 8/19/2017 your pet was taken to the vet for a skin condition and that claim was denied as being inside the waiting period. That condition is then excluded from the policy going forward as having pre-existed the coverage period.
On 1/15/2018 your pet was once again brought to the veterinarian for a skin condition, treated with the same medications as the previous visit and diagnosed as Atopy, a chronic skin allergy. At this time we pulled 18 months of medical records from your treating veterinarian to investigate whether this claim was related to the previous claim denied during the waiting period. These records showed that the condition denied on 8/8/2017 was treated on 11/1/2017, 11/15/2017, and 12/4/2017, showing a continuation of the same treatment plan for the same condition.
Additionally, these records show that the same condition was treated on 8/5/2017, three days before purchasing the policy, and Otitis (another symptom of chronic Atopy) was diagnosed on 1/19/2017, 4/5/2017, and 4/18/2017, indicating that the condition likely predated the policy by at least 8 months.
The policy purchased does not cover conditions that pre-date the purchase of the coverage. Insurance is a tool by which large numbers of people pool their resources and their potential risk so that those who need the benefits can share in them when an unexpected illness occurs. The system cannot work if people can wait until their pets are ill before they buy a policy, as the premiums would be far too expensive to cover all the known risks coming in.
As the condition being claimed was pre-existing, the denial of the claim was appropriate. As coverage was available for any number of other conditions that were not pre-existing to the policy, a refund is not possible.
Complaint: ***
I am rejecting this response because:
As per the conversation that I had with Pets Best on the date that I submitted this complaint, they themselves admit that they have determined with the help of staff with a "veterinary background", not Veterinarians, that my dog's issue is "chronic". My vet at no time has indicated that this is chronic. A chronic ailment, by definition would be one that automatically reappears when treatment is stopped. That the ailment is only not present by virtue of the presence of medication, and that is not the case here. This company has falsified my initial application in saying that I claimed that my dog had never had any prior illness. Their statement of that is false. I never claimed that she never had anything, nor have I omitted any documents for their review. The only way to appeal a decision is to take my dog for a second opinion to a vet that is of their choosing. I do not see how that could possibly be impartial. That would be akin to me going to a doctor that is on the insurance companies payroll and expecting a clean bill of health. If you follow the money, you will find the problem.
Sincerely