Pets Best Insurance

Revdex.com:
I have reviewed the response made by the business in reference to [redacted] and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
My cat did not have any symptoms. He was healthy and I got the insurance because my cat was 16 years old.  He went in for a physical and blood work and the results showed kidney failure.  The doctor prescribed a special diet, well since March the company gave me story after story did not get records, when the vet office said they faxed numerous times. I even picked up a copy and faxed over myself. then after 2 months they now needed doctor notes then shortly after that closed the case because it was open too long. Then I had to go to vet clinic again to pick up doctors notes and faxed after [redacted] said she faxed numerous times. at this time [redacted] said the insurance sounds like a scam and I should check them out.  Finally in June they said they received paperwork and my cat died June 5.  I did not hear from them til June 30 when they said he was not covered.  Well, [redacted] said they would take down Petsbest insurance because this happened once before.  I felt I need to tell others, this is not right that they string you along. Then come up with he had prior signs and symptoms.
Regards,
[redacted]

Complaint: [redacted]I am rejecting this response because:
I completed the exam and form. It's no my fault your office lost the form. I still have official documents of the exam date and findings prior to the deadline. Sincerely,[redacted]

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 14 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 9/28/2016 when your claim was incurred, yet you say that the illness that your pet had on 9/28 was not the same illness that your pet had on 9/10 or 9/26.  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 30 days for a response to your appeal, and it was received 5 days ago.  You will be hearing from our appeals department within the next 25 days, most likely within the next 2 weeks.

The chat transcript you attached was from two days ago indicating that you do not have a policy.  The answer the sales representative gave you was correct.  The accident/illness plan that she described and quoted you does cover ACL injuries after a one year waiting period which can be waived with an exam and certificate from your veterinarian.  The discounted accident-only plan that you purchased does not cover this condition, as is clearly outlined in your policy form.

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 3-5 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 payment. Our customers can provide us their direct deposit information so that the funds will get released directly into their checking or savings account. This 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 check. So even if they process the claim in 7-10 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 $2,000 veterinary bill upfront and then your pet insurance took 4-5 weeks to pay you back. If that was on your credit card, you’d be charged interest. If you paid with your checking or savings, your available cash reserves would be on hold for weeks until you got paid back. This is why Pets Best puts so much emphasis on processing claims quickly. It’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]
[redacted]

I am sorry that your veterinarian was on vacation and this made it difficult for you to get this form completed on time, but the policy form has very specific provisions that have to be followed.  Your policy has a waiting period of 1 year on seven (7) conditions.  This waiting period can...

be reduced to 14 days if you get an examination in the first 30 days of your coverage and submit a form certifying this within the first 45 days of your coverage.  This form and these instruction were provided to you with your policy documents the day you purchased the policy.  We are unable to extend the period in which the form must be received beyond 45 days as it is specified in the contract and we are required by state regulations to treat all policyholders fairly and equally under the terms of the policy as filed and approved by your state department of insurance.

Complaint: [redacted]I am rejecting this response because:
I don't want to deal with Pets Best any longer, their reasoning make no sense. Have them cancel the policy back to December, and return the monthly dues of $54.03  from December, January, and February back to the card on file. 
Sincerely,[redacted]

We have reviewed your claim three times now at original submission and again on both a first and second level appeal. Your policy was purchased on 5/4/2017 and contains a 14 day waiting period before coverage is effective for medical conditions.  Medical records obtained from Spot On Veterinary...

clearly indicate that signs of vomiting and gagging were noted on 5/1/2017 (3 days before policy was purchased) and the mass on the left hip was noted on 5/4/2017 (the day the policy was purchased).  Both of these conditions are excluded as occurring before the policy was purchased or during the exclusionary waiting period, and as such were appropriately denied. We cannot refund premiums for coverage periods that have already passed, as your insurance coverage was in force during those periods and would have covered any non-excluded, new conditions that arose during that time. As your policy is already cancelled, you have already received a refund for any unused premiums.

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 4th. Pets 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]

[redacted] thank you for taking the time to provide us with your feedback—it is reviews like yours that help us to continually improve. We value you as a member of the Pets Best family and have reviewed the claim submitted for [redacted] and reprocessed in your favor. Reimbursement for [redacted]’s claim was...

processed via check on January 22nd, 2016. We apologize for troubling you, please contact us with any questions or concerns. We hope [redacted] is feeling much better!

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.

The claim in question has been processed.

Please review the section of your policy entitled "Your Duties in the Event of a Loss."  As the policyholder you are required to authorize the release of all medical records, including and especially those from before the policy was purchased.  A claim that is not complying with this...

provision of the policy cannot be processed until the records have been received.

Complaint: [redacted]I am rejecting this response because:Bentley, my dog was ill for a completely different illness when I first purchased the insurance. He was completely healed and well until I had to take him to the vet on 09/28/2016. I am NOT admitting that those two occurances that happened on two different dates are related because they are NOT. I 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 $545 and the other around $1000) because Pets Best stated that his symptoms was pre-existing. This is UNTRUE, it is NOT pre-exisiting, the illness from 09/28-10-04 are completely unrelated to his illness from 09/10. His diagnosis from 09/10 was Hypertrophic Osteodystrophy his illness from 09/28 is a bacterial infection. I filed another claim on 10/03 for a balance of $4,775 (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 documents. It'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]

Hi [redacted],
Thank you for sharing your experience with Pets Best. We are sorry to hear you’ve cancelled your policy—we prefer to have a word with our policyholders before they cancel so they understand the implications of cancellation, especially, as in [redacted] case, if we’ve covered...

conditions. That said, we’re disappointed to hear your hold times were unsatisfactory and your cancellation experience arduous. Pets Best is committed to delivering some of the lowest hold times in the pet insurance industry. To illustrate, this June we’ve answered 89.3% of our calls in 60 seconds or less. Regardless, your experience—while out-of-the-ordinary—was unsatisfactory and we apologize. We have looked into your cancellation dispute and will be contacting you by phone to discuss your refund. Please keep us in mind if you are interested in insuring [redacted] in the future. We wish you the best.

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 10 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 on ethical grounds: There are different types of business practice - ethical ones and those based on financial greed.. It is 100% clear that Pets Best is just another one of those based on financial greed. I forgot to mention the deductible I would have had to pay above my monthly rate, $500 for one dog, $250 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 start. Laws should be made to prevent such unethical lawlessness. 
Sincerely,
[redacted]

Your policy was purchased on 6/20/2016 and contained a 14-day waiting period that expired on 7/4/2016.  Any condition present prior to 7/4/2016 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 7/15/2016 the symptoms of the claimed illness had been present for 1 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.

The finding that hepatic lipidosis is secondary to the lymphoma event is one that was based upon a review of your pet's medical records.  This decision can be appealed per the appeal options listed in the policy form.  This can include a review by an independent third-party veterinarian of...

the medical records and medical history of your pet.  Should you choose to avail yourself of this option, we would be happy to review the appeal.

You don't need to file anything further.  Your appeal has been received and is being processed.  As soon as it is complete you will receive an answer at the address on file.