Pets Best Insurance

Your policy has already been cancelled as requested yesterday and a pro-rata refund has already been applied.  If you would like to appeal the denial of your claim for dental extractions, please follow the instructions provided in your policy form or contact our customer service department at...

1-877-738-7237.

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 way. This company misrepresented themselves, and charged me for a service I never actually received. All I want is a refund of the money I paid them.
Sincerely,
[redacted]

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.

Mr. [redacted],
Your policy was purchased on 2/13/2016.  According to records from your veterinarian, your pet's blood glucose level in October 2015 was 130, not 105.  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.

Complaint: [redacted]TThese are not the same documents they provided me. They never said I was getting 41.49 it was 41.57 I have the letter they mailed stating that and the original document they sent me said 41.57. There was never at anytime on phone or in print there was ever mentioned the total 41.49I am rejecting this response because:Sincerely,[redacted]

Please refer to your policy form, page 5 under the section "Additional Coverage Limitations".
"Additional Coverage Limitations - ... Cruciate injury and patellar luxation are not considered Accidental Injury and as such are directly excluded."
 
The condition you are claiming is plainly...

excluded under the policy language.  The policy you purchased is a very inexpensive policy with very limited benefits and is not intended for an injury of this type.

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.

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 2013 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]
[redacted]

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.

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

As I previously mentioned, if you disagree with the findings of your claim, please feel free to avail yourself of the appeals procedure available to you in your policy form.

The decision to categorize the pet's diagnosis as Intervertebral Disc Disease (IVDD), rather than an injury that would have been covered by the accidental-injury-only policy that was purchased, was one made by the treating veterinarian per the medical records we received directly from the...

clinic.Specifically, the veterinarian's notes indicate "still suspect IVDD based on onset and clinical signs - recommend referral for neurology consult +/- surgery, aggressive anti-inflammatory tx (treatment) if surgery is declined."Based on the treating veterinarian's notes, we must continue to uphold the original determination. Intervertebral Disc Disease is a degenerative condition, and therefore is not eligible under an accident only policy.

The claim in question was paid last week.  No new requests for medical records have been made.