Pets Best Insurance

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 No claims were filed under this policy for over a yearThe one dated January 25, is the first and ONLY claim ever filed with your organizationYou have yet to still respond to this claim and reimburse for itThe reason I was given as to why it has taken longer than 3-days in your first email was due to an increase in claims being filedIf that is the case; your company should have taken the appropriate action to staff your facility so that customers--such as myself; are not incurring the lag time of being reimbursed for their policyThis is a company operation issue; not a customer issue.When looking at multiple reviews of your company online; there are quite a few complaints listed stating the same concerns as mineIt seems as though this is your practice to either stall or deny claims on a consistent basis.I delivered my promise by paying for your service each month; your company however; has not delivered the service that was offered and expectedTherefore; I am seeking a reimbursement for the year of premiums that I paid and DID NOT file a claim with your company.Additionally; when I completed the application for my dog; your company was aware I had just rescued herHowever; [redacted] *alled me yesterday stating that your office called them requesting months worth of medical recordsHow is this possible to produce those when I haven't owned the dog for months? [redacted] ***

Revdex.com: I have reviewed the response made by the business in re [redacted] and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.Our claim is for the dental cleaning AND the lump removal and biopsy The dental cleaning should have paid immediately since it is part of the wellness plan we have This has been done before (refer to claim sent in June) In addition our claim is still being held up due to an error on your part You did not address this in your response You are requiring us to submit the name of the vet from the records You have stated that you cannot process the claim unless you have the name of the vet First of all you processed a claim back in August using these records and it was not a problem then Possibly due to the fact you did not have to pay out any money Secondly these medical records mentions nothing about the lumps and biopsy so there for they are irrelevant to our claim We again have asked the vet to send them to you stamped with their name and we are expecting to have to take time off yet again to actually get the medical records and fax them ourselves like we had to with the last claim By the way the last claim for ear infections took two months to process which involved my husband taking time off of work to go get the records and emailing them to you since Pets Best claimed the vet did not send them and they did However this will now start the whole wait time over again Which means by the time it is all said and done it will be a month since we submitted the claim [redacted]

*** ***First, it's ridiculous to ask the customer to keep a full medical history record for that long when the Vet did not even keep.Second, it's ridiculous when you are trying to link the cat's illness to one depression when they are about year old.Please don't waste your and our time

To be clear, we cannot pay any claim that is lacking a full medical history as is outlined in the policy contract As a third-party claims firm processing claims for your insurance company, *** *** *** ***y, we are as bound by the contract as you are The policy documents are emailed immediately upon enrollment and you are given days to look them over and cancel the policy with a full refund if you are unhappy with the policy

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. Regards, *** ***
My Policy # with Pets Best - *** Policy under my name *** ***

Hello Ms***,
The policy you purchased has a repetitive activity exclusion, designed to ensure that the rates being charged to everyone are not covering pre-existing or behavioral problems that lead to repeated treatment This includes regular dog fights as they are preventable by
separation of the dogs that don't get along The records we obtained from your veterinarian indicate that this bite wound is the fourth such that your pet has suffered in the past months (5/5/2016, 5/30/2016, 6/4/and 8/19/2016) Your policy has a clear exclusion against this if it occurred twice in the previous months As such, your claim was appropriately denied
As to your concern about a foot cyst claim, I see no such claim in our records One of your pets did present a claim for a tumor on the foot about months ago, but that claim was paid in full after deductible and coinsurance so I am not sure what the complaint is
If you would like further explanation or to discuss, please feel free to call our customer service department at 1-877-738- It is much easier to have these conversations directly rather than through a third party such as the Revdex.com

The quoted language states "3-days on average" Most claims are processed within that time, which is what maintains the average within that range Stating an average claims turn-around is not a guarantee of individual performance any more than stating that most claims are processed within that time frameWe are unable to refund premium for a contract that has been performed, in that premium was paid, claims were incurred, and the claim was paid within a legally reasonable time as is established by state statute To do so would both unjustly enrich the policyholder as she would receive the benefit without paying for the coverage, would violate the mutual contract as the conditions for a refund are established therein and are in no way tied to a 3-day claim turn around, and is beyond the authority that Pets Best has been granted by the company that issued the insurance policy* *** *** *** ***While Pets Best apologizes to our customer that our performance was not what was expected, there is nothing further we can do short of cancelling the policy effective today and refunding a pro-rate share of currently unearned premium

The budget policy that was purchased is for accidental injuries only It contains a specific exclusion against illnesses As the claim in question was for an illness, as confirmed in your complaint, the claim was appropriately denied For the purposes of the coverage purchased, an
accidental injury is defined in your policy as follows: Covered Accidental Injuries include: trauma; poisoning; bite (animal, insect, snake); hit by car or moving vehicle; foreign body ingestion requiring surgical intervention; bone fracture; laceration; cut; abrasion; wound; torn nail; and other such related medical problems directly attributable to Accidental Injury. Additional Coverage LimitationsDisease conditions including, but not limited to: bacterial; metabolic; viral; viral like; or cancer are not consideredAccidental InjuriesCruciate injury and patellar luxation are not considered Accidental Injury and as such are directly excluded. Medical records obtained from Arizona Animal Hospital indicate that the rule out diagnoses are gastroenteritis or pancreatitis Both of these are illnesses and not accidental injuries Had medical insurance been purchased rather than accidental injury insurance, this would certainly have been a covered claim

The policy has very clear language, and the website is very clear in explaining that luxating patellas have a one-year waiting period that can be waived by submitting a form from your veterinarian indicating that the condition is not present when the pet enrolled Lacking that form, the one
year waiting period outlined in the policy was enforced.https://www.petsbest.com/pet-insurance-plans/pet-health-checklist

I'm sorry, but I am not following your complaint Your last statement was that you could not get it in to us timely because your veterinarian was on vacation If you are now stating that you did turn in the form on time then please forward evidence of such to our customer service department at 1-877-738-

The claim for dental services has not been denied, it has been marked as incomplete due to a lack of information required to process it Our pet medical health insurance covers dental cleanings performed by a veterinarian only In this case, the dental cleaning was performed at a pet
store by a company called *** This is highly unusual as non-anesthetic dentistry goes against the standard of care established by the veterinary industry What is needed to complete the claim and process it is the name and contact information of the veterinarian who performed the procedure Once that is received we will be able to move ahead with the claim

Complaint: ***I am rejecting this response because: that's the most bs I ever heardif it cost you too much to fulfill your obligations you should charge more or not be in this businessi dont care if that's actually in whatever document you're talking about, I made sure that my dog will be covered for all COMMON SENSE accidents and looked at the exclusion list, I even asked your rep and they confirmed that my dog will be coveredattached is a transcript with your sale rep confirming the acl is covered by your accident insurancei expect you to reimburse the fees I paid or I will not only SUE you but also tear up your sketch business everywhere Sincerely,*** ***

Complaint: ***I am rejecting this response because:
Please see attached documents, further proving that this company is only taking advantage of their customersMy pet was denied pre-authorization of her surgery, when the surgery is a follow up treatment which was recommended by the OphthalmologistThe exams with the Opthalmologist were already reimbursed, but according to their denial letter, my pet had this condition prior to the start of her policy, which is completely false, since they themselves already reimbursed the eye examThey will deny the reimbursement of the surgery even if I pay for it and submit it as a claim, as stated in their pre-authorization responseI do not wish to get correspondence back and forth from the companyI want the Revdex.com to look into the fraudulent activity of this company, and how they are abusing their customersAs you can see in the attached files, they continue to take payments for both pets, up to December when it was only for pet, which is the one I am currently asking for the pre-authorization, therefore the policy began several months ago prior to any conditionCan you please look into this businessIt does not help the consumer to get correspondence from them since they state the same reasons over and over.
Sincerely,*** ***

Insurance is a device whereby a group of people pool their risk and their money so that in the future, when an unexpected problem arises, they can all share in the premium to defray the loss. Insurance doesn't work if it includes benefits for conditions and problems that exist prior to the
policy being purchased, as it removes the requirement that the problem be unexpected and replaces it with a sure loss. Premiums under these conditions would be far too high for individuals to afford, and would not provide any actual savings in the event of a loss.Medical records obtained from *** *** *** indicate that your pet was diagnosed with recurrent ear and skin infections beginning at least ten months prior to coverage being purchased. When the same condition occurs on 12/4/2016, 2/3/2017, 2/27/2017, and 5/25/2017, a policy purchased on 10/24/will not cover the same condition when it is claimed again on 12/6/2017. Pre-existing conditions are specifically excluded for the reasons stated above.We cannot refund premium for periods of time in which coverage was in place. The coverage was available for any non-excluded condition, meaning any future unexpected illness or injury excluding any expected pre-existing conditions. As the coverage was available, the premium is not refundable.Your policy was cancelled yesterday at your request. Due to the abusive behavior that you have displayed to our customer service department on multiple occasions, I must insist that any future communications be restricted to writing and addressed to the attention of the company's legal counsel

Good afternoon,
Your policy, including both pets, was cancelled on 11/30/for failure to pay your premium When you called and asked to reinstate your pets only one of the pets qualified under our underwriting guidelines to be reinstated We have continued to bill you premium for
the pet that was reinstated at your request on 11/30/ If you claim that reinstatement was done in error I am able to reverse it and cancel your remaining pet back to 11/30/
When you called us back on 12/14/you were verbally abusive to the individual who took your phone call and indicated that you had retained your brother, who is an attorney, and are in the process of suing the company At that time you were informed that it is against the law for us to speak directly with you once you are represented by an attorney, and indicated that all further communication with our office would need to take place between your attorney and our legal department
As far as your claim for an eye condition, this claim has not been denied You have requested a pre-authorization on the claim which we are in the process of completing From the records it appears that there are indications that the condition was present before the policy was purchased If this is the case, we will be unable to pay the claim, but your claim has not yet been denied, we are simply unable to pre-authorize given the records we have on file Once the procedure has been completed you can file the claim and the medical records generated at that time may be able to fill in the gaps that prevented your claim from receiving pre-authorization Our inability to pre-authorize your claim does not mean it will be denied once it is submitted, it only means we cannot pre-authorize it based on the records we have currently
I hope this clarifies the situation for you

Revdex.com:
I have reviewed the response made by the business in reference to *** ** *** and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.The Pets Best Insurance is primarily an online pet insurance companyIf the sale rep did not go through that specific policy requirement with the customer over the phone, the customer had to wait for almost two weeks to receive the policy package to review the detailsTo be honest, in this case, the sale rep did not mention a single word about that and I did not read the fine print-outs after two weeks that I purchased the policyMeanwhile, asking the customer to keep the medical history record is a big burdenI don't know how they keep their own health record and I certainly would ask the record from the doctorIn this case, the vet's office did not even keep records for that long (>years), or it could be that they just don't want to dig it out.While I appreciate the timely response from the Pets Best Insurance, the response did not address the issue at allIf they don't want to cover the cost on the ground of lacking a complete medical history, please be clearPlease be aware that they have received the medical history for this illness and this is the only illness that my cat had since I become a policy holder back in If they decided that they are not going to process my claim because I was not able provide the medical record back in 2010, please be clear about it.*** *** *** *** *** *** *** * *** *** * *** ** *** *** ***
***
*** **

Complaint: ***I am rejecting this response because:Sincerely,*** **

We emailed a statement and refund receipt that was processed on 07/17/for $to *** yesterday. We also explained there will be an additional refund of $processed on 07/22/ The charges were due to multiple cancellations and re-instatements run on the same day
causing a system error I have attached a statement and receipt of the refunds here

Attachment redacted by Revdex.com

Claim file attached
Attachment redacted by Revdex.com