Pets Best Insurance

Claim file attached
Attachment redacted by Revdex.com

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
That is unacceptableYou have all the records everythingIt took Petsbest 1/months to tell me you were not going to payBoth vets said it was chronic kidney failure and that is supposed to be covered according to your policy
Regards,
Shelli Rich

Complaint: ***I am rejecting this response becauseSincerely,*** ***

I am sorry to see that your pet was diagnosed with Parvovirus The insurance policy that you purchased has a 14-day waiting period before benefits go into effect, with an exclusion that excludes any condition that manifests during that period As your policy was purchased on 9/4/2015,
and your first claim for this condition was incurred on 9/17/2015, the condition falls within the waiting period and is excluded from coverage If you would like to file an appeal, please contact customer service at 1-877-738-

Your policy has very specific exclusions regarding dental treatment, especially anything related to periodontal disease Your pet had nine teeth extracted This is almost always due to periodontal disease, but we wanted to get your pets medical records to try and see if there was another
reason for the extractions Your records took some time to obtain, and once they were received they confirmed that the extractions were due to periodontal disease and were appropriately denied

There is nothing I can add to my previous response The pre-authorization was not able to be approved due to findings in the medical records that the condition pre-existed coverage, and the company is willing to cancel the policy in question back to December of if it is being asserted that the reinstatement of coverage was not requested The fact that a pre-authorization for coverage under that policy is being disputed appears to negate the idea that the policy should not currently be in force, but if this is the outcome desired it can be achieved

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***

The denial of this claim was due to the diagnosis that you provided on the claim form matching with a condition that you admit your pet was diagnosed with before pet insurance was procured.  All pet insurance companies must deny pre-existing conditions in order to keep the coverage affordable....

 According to your provided summary, your pet was diagnosed with Atopy (a common skin allergy in dogs) in 2014.  On the claim form that you submitted to us you wrote "The vet diagnosed that he is having a skin infection likely secondary to an allergy."
Reinforcing your own narrative of the condition, we gathered your pet's medical records from Red Cedar Animal Hospital and Lake Lansing Road Animal Clinic.  The notes for your visit on 11-4-2014 at Red Cedar Animal Hospital indicate a diagnosis of Atopy.  Your visit of 10/21/2015 at Lake Lansing Road Animal Hospital (the date of service in question) indicate a "suspected allergies" diagnosis.
As you indicate that the condition being claimed is a condition that your pet was diagnosed with prior to purchasing coverage, and your veterinary records support this statement, it appears that this condition was appropriately denied as a pre-existing condition.

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 9 days after the coverage went into effect.  The policy in question...

clearly excludes any condition that is present either before the policy is taken out. or during the short 2-week waiting period.  The pet's poor condition only 9 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 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 treatment. Once healed or cured, these are not considered pre-existing conditions." (https://www.petsbest.com/coverage) What normal 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 false pretenses.
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.
No claims were filed under this policy for over a year. The one dated January 25, 2016 is the first and ONLY claim ever filed with your organization. You have yet to still respond to this claim and reimburse for it. The reason I was given as to why it has taken longer than 3-5 days in your first email was due to an increase in claims being filed. If 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 policy. This 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 mine. It 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 expected. Therefore; I am seeking a reimbursement for the 1 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 her. However; [redacted]alled me yesterday stating that your office called them requesting 18 months worth of medical records. How is this possible to produce those when I haven't owned the dog for 18 months? 
[redacted]
[redacted]

The claim in question was paid on 12/22.

Ms. [redacted]'s complaint is being handled on appeal, by way of a consumer complaint with her state's Department of Insurance, and via communications with the carrier who underwrites her policy.  While we are working our way through those three channels, there is nothing further I can add by way of...

the Revdex.com.  We are in regular communication with Ms. [redacted], as is the carrier who underwrites her policy.  All indications at this time indicate that the condition she is claiming began several months before she purchased coverage.  As the coverage she purchased does not cover pre-existing conditions (as no pet insurance in the country does) the claim was denied as being outside the coverage purchased.  The denial appears to have been appropriate.

Medical records obtained from your veterinarian indicate that your pet was diagnosed with a chronic, incurable skin condition known as Atopy.  This diagnosis was made in September of 2016.  You purchased your policy with Pets Best in November.  As such, this condition was pre-existing...

to coverage and denied under the pre-existing condition exclusion that exists in all pet insurance policies.  The office visit for which the first claim was made was described in the medical records as a "recheck skin" appointment.  As the condition was pre-existing the denial was appropriate.  We cannot refund premium because a claim for a clearly excluded condition was denied as coverage was present for every other condition your pet may have come down with during the coverage period.

Complaint: [redacted]I am rejecting this response because:
I have already submitted my dog medical record which clearly indicates there was no "pre-existing condition"! The hospital report also states that the injury was actually due to an accident which is the TITLE of the plan I purchased from you after being mislead by one of your sales reps at the time who not only assured that my dog will be covered for any type of accidents including ACL but they also said it will take effect in 14 days or so!! 
Your response MAKES ZERO SENSE, your business is SKETCH!!!
 
You will be hearing from my lawyer :) 
Sincerely,[redacted]

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 50 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.

Complaint: [redacted]I am rejecting this response because: [redacted]'s exam and treatment record does not mention periodontal disease.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.

Complaint: [redacted]I am rejecting this response because:I stand corrected on the blood glucose reading in October. But, as stated by my veterinarian, and backed up by AAHA diabetes guidelines, that a one time elevated blood glucose reading in a non fasting and stressed animal is by far a sign or symptom of diabetes. I will follow with the second level appeal as agreed upon, but would like to keep this complaint open pending the outcome of the second appeal. Sincerely,[redacted]

[redacted]The policy you purchased has very specific exclusions for dental conditions.  We had understood that you were claiming the extractions as part of your medical coverage.  As such, we have to get very specific records to determine if these extractions fall under the narrow window...

of coverage that the policy provides.  As I now understand from your complaint that you are not actually claiming these extractions, only the associated cleaning, we will process the claim accordingly and will have it completed today.Thank you for the clarification, and I apologize for the delay.