Pets Best Insurance

Mr***, Your policy was purchased on 2/13/ According to records from your veterinarian, your pet's blood glucose level in October was 130, not This is 30% above "normal" Upon receipt of your second level appeal, we will send all documentation, including the letter from your veterinarian, to an independent medical examiner for evaluation If he agrees with your argument and there is evidence to support it, we will overturn the denial and pay your claim

Good afternoon,The medical records of the pet in question show that the cat was showing symptoms of kidney failure, including increased kidney blood values, generalized muscle atrophy, poor body condition and hard stool only days after the coverage went into effect The policy in question clearly excludes any condition that is present either before the policy is taken outor during the short 2-week waiting period The pet's poor condition only days after the coverage went into effect strongly indicate that the condition had been ongoing for quite some time, and the claim was appropriately denied as pre-existing the coverage.Should the policyholder wish to dispute this finding, she can avail herself of the claims appeal process contained within her policy This can include an independent veterinary review of her records by an unbiased veterinarian we have employed for this purpose

Complaint: [redacted] I am rejecting this response because:Bentley, my dog was ill for a completely different illness when I first purchased the insuranceHe was completely healed and well until I had to take him to the vet on 09/28/I am NOT admitting that those two occurances that happened on two different dates are related because they are NOTI don't understand why you people don't understand that! I had to file an appeal for two claims I placed (one that is approximately $and the other around $1000) because Pets Best stated that his symptoms was pre-existingThis is UNTRUE, it is NOT pre-exisiting, the illness from 09/28-10-are completely unrelated to his illness from 09/His diagnosis from 09/was Hypertrophic Osteodystrophy his illness from 09/is a bacterial infectionI filed another claim on 10/for a balance of $4,(approximate) and that was denied as Pets Best claimed that this is a pre-existing symptom despite the letters from TWO different vets stating that this started on the 28th of September and was confirmed on 10/03! I submitted this claim with the documents and the letters and still it was denied! It's increasingly frustrating that I have to file an appeal each time even AFTER providing the necessary documentsIt's such a hassle and honestly I feel like a victim at this point! I will file a complaint for the department of state licensing Sincerely, [redacted] ***

Good afternoon,The policy that you purchased has a very clear exclusion against the payment of boarding fees The policy is designed to cover the treatment of medical and health problems that your pet may develop after the policy has been purchased, and in order to keep costs affordable includes exclusions to boarding fees, grooming fees, bathing fees, food, toys and all other non-medical, non-veterinary expenses This is standard across the pet insurance industry.We have received your previous messages indicating that the boarding that your pet received was "medically necessary"We informed you at that time that if the fees were actually for hospitalization, tpo please submit supporting documentation such as revised medical records or a letter from your veterinarian stating so and we will be happy to reprocess your claim To date we have not received anything, but this offer remains open

The policy in question has a one year waiting period for cruciate ligament injuries That waiting period can be shortened by sending in a form completed by your veterinarian during the first days of the policy indicating that your pet is not suffering from any symptoms of such This form is sent along with your policy and declarations page As that form was not filled out and returned, instead a different form that applies a 10% discount was returned, your pet has a one year waiting period for that condition Your claim was properly denied as having occurred during that waiting period

Complaint: [redacted] I am rejecting this response because their statement ignores the fact, that on their own website, pre-existing conditions are defined as, "Any illness or injury that begins before your policy is effective, or during your waiting period, will be considered “pre-existing”Some conditions, like broken legs or kennel cough, heal or are curable and require no further treatmentOnce healed or cured, these are not considered pre-existing conditions." (https://www.petsbest.com/coverage) What person, wouldn't consider an ear infection, one of these conditions that can be healed, and therefor, not a pre-existing condition? I cancelled my policy because I was mislead, and my money was taken under pretenses Sincerely, [redacted] ***

Complaint: [redacted] I am rejecting this response on ethical grounds: There are different types of business practice - ethical ones and those based on financial greedIt is 100% clear that Pets Best is just another one of those based on financial greedI forgot to mention the deductible I would have had to pay above my monthly rate, $for one dog, $for the other, should my dogs have gotten ill (which they never did)It seems only very neglected, seriously ill dogs might just benefit somewhat from this insurance, that is if they did not have any pre-existing conditions from the startLaws should be made to prevent such unethical lawlessness Sincerely, [redacted]

The claim in question has been processed

Your policy was purchased on 6/20/and contained a 14-day waiting period that expired on 7/4/ Any condition present prior to 7/4/is pre-existing to your policy and is not provided coverage under the terms of your insurance contract Records obtained from your treating veterinarian state that as of 7/15/the symptoms of the claimed illness had been present for month This places the symptoms at 6/15/2016, both prior to the purchase of the policy and prior to the expiration of the waiting period For this reason your claim was denied Should you wish to follow through with an appeal, we have already sent you instructions and the paperwork to do so We will be happy to review any new documentation you can provide that supports your assertion that the condition did not in fact pre-exist the coverage Thank you

Your claim wasn't covered as the condition being claimed, severe periodontal disease, is a direct exclusion to coverage The diagnosis was confirmed through your pet's medical records that indicated severe tartar and loose teeth from periodontal disease

The website also says for complete details to review your policy documents, and gives you access to sample policy documents before the purchase is made We then give you thirty days to examine those documents and cancel for a full refund should you be unhappy with the language in the policy that you purchased

Good morning, In your complaint you admit that your pet was ill when you purchased the policy Insurance is designed to cover unexpected future incidents of illness or injury to your pet, which is why it contains an exclusion against any illness that your pet has at the time the insurance is purchased or that manifests within days of taking out your policy In your complaint you argue that your pet was symptomatic of illness from the day you purchased your policy up through 9/28/when your claim was incurred, yet you say that the illness that your pet had on 9/was not the same illness that your pet had on 9/or 9/ Your policy contains an appeal clause that allows you to appeal the decision made I see that you have already filed this appeal and it is pending a decision Your policy allows days for a response to your appeal, and it was received days ago You will be hearing from our appeals department within the next days, most likely within the next weeks

Complaint: [redacted] I am rejecting this response because:As reported to Pets Best during my appeal and second appeal, with supporting documentation from Spot On Vet, those dates are incorrect of the mass and vomiting and coughing! Which is Why I appealed it twice after verbally explaining to their reps on the phone who then guided me to appeal it again and again because they understood that! How is it that Pets Best STILL is denying based off the FIRST claim which was FLAWED?!?!?! I didn't see the vet on May 1st nor May 4th! I reported to Spot On Vet only that I had started an insurance policy on the 4thPets Best is a terrible company with poor business practice and they should absolutely refund me for the claim, and the months wasted while they took their time reviewing those appeals to only deny with the same reasoning as the first denial Sincerely, [redacted]

Complaint: [redacted] I am rejecting this response because:The attachment I provided was disregarded, and their response wasn't relevant to my concerns in any wayThis company misrepresented themselves, and charged me for a service I never actually receivedAll I want is a refund of the money I paid them Sincerely, [redacted] ***

Complaint: [redacted] I am rejecting this response because: I don't want to deal with Pets Best any longer, their reasoning make no senseHave them cancel the policy back to December, and return the monthly dues of $ from December, January, and February back to the card on file Sincerely, [redacted] ***

Revdex.com: I have reviewed the response made by the business in reference t [redacted] and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Verbiage direct from Pets Bests website includes: Pets Best processes claims in only 3-business days on average (this is also called “claim turnaround time” or “TAT” for short)Once the claim is processed, we can release the reimbursement paymentOur customers can provide us their direct deposit information so that the funds will get released directly into their checking or savings accountThis is all easily managed in their online customer portal or by contacting customer care.Some pet insurers don’t offer direct deposit and will only reimburse you with a checkSo even if they process the claim in 7-business days, you still have to wait for a check to be processed, printed, and then mailed before you’ll receive your reimbursement.Imagine if you paid a $2,veterinary bill upfront and then your pet insurance took 4-weeks to pay you backIf that was on your credit card, you’d be charged interestIf you paid with your checking or savings, your available cash reserves would be on hold for weeks until you got paid backThis is why Pets Best puts so much emphasis on processing claims quicklyIt’s stressful enough worrying about your pet when they’re sick or injured, so we want to relieve the financial stress as soon as possible.- See more at: https://www.petsbest.com/blog/fast-claims-reimbursements-are-important/#sthash.t...⇄ [redacted] ***

Thank you for bringing this matter to our attention The claim in question is being reprocessed for payment today

Unfortunately, there is nothing that Pets Best can do in this situation We are a third party administrator of an insurance contract between the policyholder and the insurance carrier The policy in question provides a set amount of wellness benefits per policy year These benefits reset upon renewal, which is communicated by mail days ahead of the renewal date Pets Best cannot pay for services that are not eligible because all the benefits have been used during the current policy year

Ms [redacted] , I wish I could respond more directly to your complaint, but I cannot find any policyholder in our system by your name Is there another name the policy may be under, or can you provide the policy number? Thank you

My apologies That cancellation should have been processed as you requested I have made sure that it went into effect today and your refund should be on its way