PTZ Insurance Agency, Ltd.

We apologize for the customer’s disappointment with their recent claims experience.  On June 27, 2106 we received a Claim Form for “Resorptive Lesions –multiple teeth, Periodontal disease stage 2 to 3” dated April 4, 2016.  This was rejected as an incomplete claim submission and a...

request was sent to the customer to advise them in order to submit a complete claim, we require a claim form, invoice and medical records.  We did not receive anything further from the customer, leading the claim to remain rejected.On December 1, 2016 the customer spoke with one of our customer care representatives and was advised we did not have the necessary documents to process the claim.  The representative also explained to the customer that their policy does not provide coverage for dental procedures or dental related.As per the customer’s selected policy terms and conditions:EXCLUSIONSThe Insurer shall not be liable for:4. Claims for dental procedures and/or dental diseases.The customer opted to cancel their coverage due to this exclusion.  We are committed to working with the customer to help them understand the claims submission process and their coverage. We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.[redacted] Customer Solutions Specialist[redacted]

Initial Business Response /* (1000, 5, 2015/04/06) */
Please be advised that Management has reviewed the claims and medical history on file and based on this review, the original declination of this claim stands. The onset of the condition being claimed against falls within the 14 day...

illness wait period on the policy and is therefore restricted to First Time Illness limits under the Supplemental Coverage. Supplemental Coverage is provided to assist with illnesses that occur within the 14 day wait period of the policy that would not have otherwise been available for coverage. Please be advised that First Time Illness Coverage is limited to a specific maximum benefit amount per policy term. Therefore, upon the specified renewal date this condition is now considered a second time occurrence and no longer available for coverage. Please note that all conditions claimed are assessed based on the onset date. The onset date is the date the first signs and symptoms of the condition first appear. In most cases, the onset date is different than the date the pet received the actual treatment or even the date a diagnosis was made. We have backdated the cancellation to the date the customer gave notice. A prorated refund will be issued back to the policy holder through the method of payment on file.

Please be advised that management has further reviewed the customer’s account and claim.   We can confirm that the customer’s 24PetWatch Gift policy was effective November 23, 2015. On November 25th 2015, the customer had contacted our insurance sales team to purchase their 24PetWatch Classic policy by phone. This policy had an effective date of November 26, 2015.   The onset date of the condition being claimed was noted as November 23, 2015, meaning that this condition falls within the 24PetWatch Gift policy. Unfortunately, Suspected Allergies – Otitis Externa, Alopecia are not a named peril under the 24PetWatch Gift policy.   The customer’s 24PetWatch Classic policy has been cancelled effective December 25, 2015.   Lukasz [redacted] Manager, Customer Solutions T: [redacted] ext. [redacted] E: lukasz.[redacted]@pethealthinc.com

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

[redacted] Inc. is the administrator of pet insurance products in the United States responding on behalf of [redacted] Insurance Company (NAIC # [redacted]. We apologize for the customer’s disappointment with their recent experience.   On October 20, 2016 a package was issued to the...

customer explaining our change in Underwriting Company and change to the customer’s policy.  The documents indicated the customer had to take action by January 27, 2017 in order to avoid a lapse in coverage for their pet’s coverage.   The customer spoke to our Customer Care agent on December 22, 2016 regarding the increase in premium for Maple and decided at that time to lower the level of coverage and increase their annual deductible. During that call the customer did not actively inquire as to making changes or opting in for coverage for [redacted].  On February 16, 2017 the customer reached out to us as she had received the cancellation confirmation letter for [redacted].   We reached out to the customer on February 24, 2017 to discuss a resolution that will enable [redacted] to have continuous coverage; however, at this time we have not been able to speak to the customer.   We are committed to working with the customer to satisfy her concerns and encourage the customer to reach out to one of our Customer Solutions Specialist to hear about the options available for the opt-in coverage available.   [redacted]    Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s disappointment in their recent claim experience. Upon the customer’s upgrade on June 1st, 2015 for [redacted] from QuickCare Gold to 24PetWatch Super the customer was advised that any condition that was covered under their QuickCare Gold policy would continue to be...

covered under their upgraded policy and would not be considered pre-existing. Previously excluded conditions would continue to not be eligible for coverage as these are considered pre-existing. As per the customer’s medical records for [redacted] from [redacted] Veterinary Hospital on October 17, 2008: Hip radiographs -DJD of left stifle As per the customer selected policy terms and conditions: Section 5 – COVERAGE RESTRICTIONS PRE-EXISTING MEDICAL CONDITIONS We do not cover: 2. Any ILLNESS Medical Condition or Illness complication directly resulting from a Condition that manifested, first occurred, displayed signs and/or symptoms , was noted, treated, diagnosed or has been known by You and/or Your Veterinarian prior to the Coverage Effective Date of the Policy and/or during Your Policy’s ILLNESS Coverage Waiting Period. In all cases, this includes any Associated Condition or complication directly resulting from a condition that manifested, first occurred, displayed signs and/or symptoms , was noted, treated, diagnosed or has been known by You and/or Your Veterinarian prior to the Coverage Effective Date of the Policy or in respect of illness medical conditions during the Illness Waiting Period. Therefore the condition of Degenerative Joint Disease is pre-existing to the customer’s original policy start date of November 1st, 2008 and remains permanently excluded from coverage. Upon review of the account no past claims for Zack’s Arthritis have been payable. All eligible claims for Jake have been reimbursed to the policy limits. As the policy has been administered and claim processed in accordance with the customers selected policies terms and conditions, a refund of any premiums is not available. [redacted] Customer Solutions Manager [redacted]
[redacted]

My vet chipped my dog with 24PetWatch, and nowhere in the information was the requirement to pay an annual fee or a lifetime fee. My first dog was chipped and there was no fee. I just received an email saying "you are up for renewal." I am rechipping my dog with another company. They are scammers. They have multiple addresses and phone numbers but are based in Ontario Canada.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:
I spent over an hour on the phone and was never told the police would cancel.  I was under the impression that my policy would remain in affect under the new underwriting . I have no issue with resigning for a new policy , but now to be declined overage because of patient age,. When he was covered since being a puppy is unacceptable . Again , at the least I need the company to allow me to reinstitute an insurance policy , for illness and accident. Josh 
Sincerely,
[redacted]

We apologize for the customer’s disappointment with their recent claims experience. To clarify, on April 1st, 2016 we had received a completed claim form and medical records with no associated invoices. On April 12th, 2016 we had received 2 claim forms, dated March 25th, 2016 and April 9th, 2016,...

with no associated invoices or medical records.  On April 21st, 2016 we reached out to the customer via email advising that we were missing the associated invoices necessary to continue the claim process. On May 6th, 2016 we received invoice [redacted] invoice [redacted] and invoice [redacted] totaling $1673.93. Unfortunately, there was no claim form or medical records submitted by the client with this submission.  On May 18th, 2016 we reached out to the customer via email advising that we were missing the associated claim form and medical records necessary to continue the claim process. Unfortunately, the information received was not sufficient to process and complete the claims at that time. As per the customer’s selected policy Terms and Conditions: Section 8 – HOW TO CLAIM COMPLETING THE CLAIM FORM 1. Complete the sections on the claim form indicated to be completed by You. 2. Ask Your Veterinarian to complete the sections indicated to be completed by the Veterinarian. Be sure the Veterinarian has signed the Veterinarian Declaration and used the clinic stamp. 3. You sign the customer declaration. 4. Collect the detailed paid invoices and Your Pet’s medical records.                                         ...⇄ As a customer service gesture, we have brought all information provided together for the client to allow claims processing.  The customer’s claim was process on May 31st, 2016 and reimbursement of $178.32 will be made via direct deposit.  An explanation of benefits has been sent to the customer to explain the breakdown of the claim.  [redacted] Customer Solutions Manager [redacted]
[redacted]

We apologize for the customer’s recent experience with 24PetWatch.On September 1, 2013 policy [redacted] was put into effect with 24PetWatch Extra coverage.  This policy was effective until July 31, 2014 when the customer contacted 24PetWatch to make a change in coverage.  On August 1,...

2014 policy [redacted] was put into effect with 24PetWatch Classic coverage. We received an Ownership Transfer request to transfer coverage to the customer’s brother, [redacted]  It appears during the Ownership Transfer process policy [redacted] was created, however; policy [redacted] was not cancelled, causing payments under both policies to be collected.  This matter was rectified on July 30, 2016 when we refunded $242.38 to the customer, [redacted]  Upon further investigation into [redacted] concerns, it appears there was an error that caused an overlap of coverage between her policy and the new policy from August 1, 2014 to August 1, 2015.  We have rectified this as well and refund her $237.74 via Direct Deposit.  Once again we would like to apologize for any inconvenience this matter may have caused either party.  [redacted] Customer Solutions Manager [redacted]
[redacted]

Initial Business Response /* (4000, 10, 2015/02/26) */
We are in receipt of the consumers request for further review of their pet's claim. Management has reviewed the claims and medical history on file and recently obtained additional information. Based on this review we have reassessed...

the previously declined amounts as payable.
We would like to apologize for the delay in service time as we are currently experiencing higher than normal claim volumes and are working to rectify this situation so we can continue to offer our clients the best possible customer service.

Please be advised that this is a duplicate complaint, and will be responded to through the Indiana DOI.We consider this case closed.[redacted]Manager, Customer Solutions[redacted]

Complaint: [redacted]
I am rejecting this response because:
How can you send a letter from last November 2015 to tell me there will be changes in 2016 and expect people to remember?  I am sure I am not the only one that is in angry mode and wants their money back.  This is unacceptable...
Sincerely,
[redacted]

On May 4, 2017 a reassessment of the deductibles in question was completed.  On May 5, 2017 a reimbursement check was issued to the customer in the amount of $742.40.  We have emailed the Explanation of Benefits for this reassessment to the customer for their records.We are committed to working with the customer to help them understand the outcome of their reassessment and encourage the customer to reach out to one of our Customer Solutions Specialist directly with any further questions or concerns.  Jennifer Traversa    Customer Solutions Specialist[redacted]

Complaint: [redacted]
I am rejecting this response because:The proposed new policy is significantly more expensive than the one I had signed for 11 years ago. I have had no insurance claims during this time frame and as soon as my pet aged and began suffering health problems they have switched to a 
way more expensive coverage. I demand full refund of the premiums I have made for all these years.Sincerely,
[redacted]

[redacted]
I am rejecting this response because: My credit card ending in [redacted] is still in active dispute according to [redacted] Card.  Only a conditional credit has been put on the account until it is resolved.  [redacted] Card still has not heard from 24PetWatch according to them. 
Sincerely,
[redacted]

We apologize for the customer’s disappointment with their recent claims experience.   Please be advised, the customer originally submitted a completed claim form and part invoices for treatment from February 16 to 27, 2016. Unfortunately, the customer's claim was missing a portion of an...

invoice and the necessary medical records, therefore we were unable to process the customer's claim.    As per the customer’s selected policy terms and conditions: Section 8 – HOW TO CLAIM COMPLETING THE CLAIM FORM 1. Complete the sections on the claim form indicated to be completed by You. 2. Ask Your Veterinarian to complete the sections indicated to be completed by the Veterinarian. Be sure the Veterinarian has signed the Veterinarian Declaration and used the clinic stamp. 3. You sign the customer declaration. 4. Collect the detailed paid invoices and Your Pet’s medical records.   On July 14, 2016 the customer contacted 24PetWatch and was notified of the necessary information needed to process their claim.  The customer submitted a complete claim form, invoices and medical records.   On July 20, 2016 we were able to respond to the customer's claims for Gastroenteritis.  The customer will receive reimbursement in the amount of $500 via check [redacted].  We have now reimbursed the customer for the Maximum Benefit available under their First Time Illness Coverage.   [redacted] Customer Solutions Manager [redacted]
[redacted]

We apologize for the customer’s disappointment with their recent claims experience. The clients original claim submissions for [redacted] were incomplete as they were missing medical records. As per the customers selected policy terms and conditions: Section 8: How to Claim A Complete Claim must...

be submitted for processing. A Complete Claim consists of the; 1. Claim Form filled out and signed 2. Itemized paid invoices 3. Medical records pertaining to the condition and for the time period twelve (12) months prior to the Treatment Date (date of loss) On May 9th, 2016 we received a complete claim, including claim form, invoice[redacted] and medical records for [redacted] The claim was completed on May 31st and reimbursement of $50.40 was made via check. On June 8th, 2016 we contacted the customer and obtained invoice [redacted] for $63.00 as well as a completed claim form and attached medical records for Samantha. We are pleased to advise that we have completed the outstanding claim for [redacted] on June 9th, 2016 and reimbursement of $113.57 was made via check.  We have spoken with the policy holder and they were pleased with the outcome. [redacted] Customer Solutions Manager [redacted]
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Thank you for assisting me in getting my claims paid.
Sincerely,
[redacted]