PTZ Insurance Agency, Ltd.

I definitely do NOT recommend this insurance company for insuring your pet. The free month of insurance we received is not worth the horrible customer service received. Every time I would call in I would be on hold for at least 20 minutes. On top of that, their claims can take up to 60 days. Word of caution, they use most if not all of it. Maybe because the policy states you have 90 days from treatment date to file. If you do not provide all the information you need to you to on the first try you will more than likely be denied the claim.

We apologize for the customer’s disappointment with their recent claims experience.


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Please be advised, on two separate occasions the customer submitted invoice [redacted] for $31.46 & invoice #[redacted] for $316.51. Unfortunately, on both occasions, the Claim Forms was cut off and the appropriate medical records were not submitted.  We spoke to the customer on May 6th, 2016 and advised of the missing documentation and requirements for a complete 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 13th, 2016 we confirmed for the customer receipt of a complete claim form, medical records and invoice [redacted] for $31.46, invoice #[redacted] for $66.34, invoice [redacted] for $10.25, invoice #[redacted] for $12.88.
 
On July 20, 2016 we were able to respond to the customer’s claim for Pancreatitis prescription diet; however, the majority of the claimed amount went to satisfy the customer’s $100.00 annual deductible.  The customer will receive reimbursement in the amount of $12.58 via direct deposit.
 
[redacted]   
Customer Solutions Manager
[redacted]

We have reviewed the customer’s policy, and the latest information provided to the customer regarding their policy premiums has been verified as correct.  On November 1, 2106 the customer called us and cancelled her pet insurance policy.  At that time, the customer requested a backdated cancellation to allow for a refund of premiums for the entire billing cycle. Unfortunately, our cancellation policy does not allow us to backdate refunds for a period in which the pet had coverage. The customer’s final premium was collected on October 23rd, 2016 with the cycle ending on November 22, 2016. Based on the customer’s Terms and Conditions, coverage continued until the end of the current billing cycle (November 22).
We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.
[redacted]   
Customer Solutions Specialist [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.
Sincerely,
[redacted]

Initial Business Response /* (1000, 5, 2015/03/28) */
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 condition being claimed for is unavailable for coverage as it is not a...

named peril under the eligible illnesses/accidents covered by the Gift of Insurance. Please note the Gift Policy offers coverage for the following 9 named perils; Foreign Body Ingestion Removal, Bone Fractures, Motor Vehicle Accident, Defined Poison Ingestion, Lacerations, Insect Bites/Stings, Ear Illnesses, Eye Illnesses, Flea Allergy Dermatitis, and the following 7 Infectious Diseases: Intestinal Parasites, Urinary Tract Infections, Upper Respiratory Infections, Mange/Mite/Ringworm Infections, Parvovirus/Feline Panleukopenia, Heartworm Disease, and Tick Borne Disease. Secondly, the condition being claimed for is pre-existing to the core policy effective date and therefore unavailable for coverage.
Initial Consumer Rebuttal /* (3000, 7, 2015/03/31) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Insurance companies are crooks whether it's for humans, pets, autos, etc etc etc. I will have to live with this decision but hope they do not cheat future customers like they cheated me. I have also notified the [redacted] of the United States on this company's practices.

We apologize for the customer’s disappointment with their recent claim experience.  In June 2016 the customer submitted a complete claim form and for invoices for treatment on 03/30/16, 03/31/16, 04/04/16, and 06/02/16. Medical records were not included in the claim submission....

 As per the customer’s selected policy terms and conditions: Section 8 - HOW TO CLAIMIncomplete Claims and/or failure to disclose the complete medical history for your pet may result in the denial of your claim An incomplete claim notice was sent to the customer on June 28th notifying them that the claim had been cancelled due to missing medical records.  The customer’s claims were not resubmitted until August 7, 2016, more than 90 days after the date of treatment.  As per the customer’s selected policy terms and conditions: Section 8 - HOW TO CLAIMAll claims for an active Policy must be submitted within 90 days of Treatment being given, unless state or provincial law provides for a shorter or longer period. The customers claim was processed on October 12, 2016 and invoices for treatment on 03/30/16, 03/31/16, and 04/04/16 were declined for late notification.  As a gesture of good faith we have allowed a reassessment for the invoices dated 03/30/16, 03/31/16, and 04/04/16. The claim was processed on December 16, 2016 and the customer will be reimbursed $828.26 via check.  [redacted]         Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s recent claim experience.


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Management has reviewed the claim, and we have reassessed the customer’s claim for their pet’s Fractured Tooth as this was a trauma related condition. Reimbursement in the amount of $434.64 has been made for this portion of the claim via direct deposit.
 
Unfortunately, we were unable to provide coverage for the portion of the customer’s claim for Dental Cleaning, as the 24Petwatch Classic policy does not provide dental coverage. As per the customer’s selected policy terms and conditions:
 
Section 6 – EXCLUSIONS
20. Dental and orthodontic health care, Dental Treatment, Dental
procedures and/or Dental diseases including but not limited
to Treatment of the teeth and gums, dental caries (cavities),
gingivitis, periodontitis, retained deciduous teeth, malocclusion,
periodontal disease, root canals, caps, crowns, or abscessed
teeth, unless otherwise specifically covered by Our Dental Fees
Endorsement, and coverage is in force under that Dental Fees
Endorsement.
 
As a matter of priority, insurance customers are not guaranteed coverage over the phone.
 
Lukasz [redacted]
Manager, Customer Solutions
T: [redacted]
E: lukasz.[redacted]@pethealthinc.com

Initial Business Response /* (1000, 9, 2014/07/03) */
We apologize for the delay in responding to the consumers' complaint.
Regarding the infected toe, it was presented to us as the condition being claim was Osteomyelitis which is a musculoskeletal condition which is not a named peril...

under the QuickCare for Indoor Cats policy. The Consumer had contacted our Company directly appealing our decision regarding the declination of the claim.
Management has reviewed the claims and medical history on file for [redacted] Based on this review, we have reassessed (as Onychomycosis) this claim in the amount payable of $1292.08. A more detailed breakdown of the claim will be found on thhe Explanation of Benfift letter accompanying the reimbursement.
Reimbursement would have left our office on June 19th or the next business day. Please note that this is coming from our Head Office in [redacted] as such please allow for additional delivery time for receipt.

We apologize for the customer’s experience.Upon adoption, the customer was provided a complimentary
[redacted] Insurance policy through the adoption facility, which had an effective
date of September 6, 2015.The [redacted] Insurance policy is meant to assist owners
should their...

pet develop specific shelter related illnesses after adoption. The
perils (or conditions) that are available for coverage under this policy
include:Foreign Body Ingestion Removal by Endoscopy or LaparotomyUpper Respiratory Tract InfectionUrinary Tract Infection (including FLUTD)Defined Poison IngestionIntestinal ParasitesEye IllnessMotor Vehicle AccidentHeartworm DiseaseEar IllnessMange/Mites/RingwormParvovirus/Feline PanleukopeniaFlea Allergy DermatitisTick Borne DiseasesInsect Bites/StingsLacerationsBone FracturesThis policy provides up to $750.00 of coverage for the
[redacted] named above.On September 9, 2015 the customer phoned our insurance
sales team to purchase our 24Petwatch Essential policy. This policy provides up
to $1500.00 of accident and illness coverage per policy term, and is subject to
a 14 days illness waiting period. The effective date of the customer’s
24Petwatch Essential Policy was September 10, 2015. As a result of the
customer’s upgrade from our [redacted] Insurance policy, we provided the customer
with a complimentary First Time Illness supplement which provides up to
$1500.00 of coverage for conditions which are onset during the 24Petwatch
Essential Policy 14 day illness waiting period. The customer was charged $11.35
for the first month’s premium, which continued at a rate of $20.30 per month
thereafter. Unfortunately the customer’s claim for Bloody Diarrhea
was declined as the onset date of the illness was September 7, 2015, therefore
it is pre-existing to the onset of the core insurance policy. This condition
is, also, not a named peril under the [redacted] Insurance policy that came into force on September 6th 2015.[redacted]Manager, Customer Solutions[redacted]

We apologize for the customer’s disappointment with their recent claim experience.


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Please be advised that all claims are processed based on the information made available to us, including information contained within the claim form and medical records.

Management has reviewed the customer’s claims and the original processing of the claims stands.

The claim for [redacted] was approved in the amount of $90.00, however this amount was used to satisfy the portion of the customer’s $100.00 deductible and therefore no reimbursement was made.

As per the customer’s selected policy terms and conditions:
Section 6 – EXCLUSIONS
4. Any treatment related to an excluded procedure, accident and/or illness.
20. Dental and orthodontic health care, Dental Treatment, Dental procedures and/or Dental diseases including but
not limited to Treatment of the teeth and gums, dental caries (cavities), gingivitis, periodontitis, retained
deciduous teeth, malocclusion, periodontal disease, root canals, caps, crowns, or abscessed teeth, unless
otherwise specifically covered by Our Dental Fees Rider, and coverage is in force under that Dental Fees Rider.

As per the customer’s claim form, the veterinarian noted:
“dental disease felt to be possible cause of infection/hepatic enzyme elevation”

Therefore, we are unable to respond to the portion of the customer’s claim for Dental Disease and Elevated Hepatic Enzymes.

At 24PetWatch, we offer a reassessment process which allows customers to provide us with additional information to appeal the processing of their claim. We invite the customer to request a reassessment of their claim by filling out one of our reassessment forms and providing us with additional medical records and a statement from their veterinarian regarding the conditions claimed.

[redacted]
Manager, Customer Solutions
[redacted]

We apologize for the customer’s disappointment with their recent claims experience.   Please be advised that claims are processed based of the information provided at the time of the claim submission.   When reviewing the account it was seen...

that we had not received full medical records fo[redacted] We requested full medical records from May of 2014 to present on July 4th, 2016 from Gulf Animal Hospital.   On July 5th, 2016 we received the additional medical records which showed that original diagnosis of pancreatitis was not related to the diagnosis of Low Grade Lymphoma. With the additional information provided we were able to reassess the customers claim for Lymphoma and move the pancreatitis treatment back under the digestive category. On July 8th, 2016 reimbursement of $2,182.60 was made via check.   [redacted] Customer Solutions Manager [redacted]

We apologize for the customer’s disappointment with their recent service and claims experience. 
Due to an internal error the customer’s claim was closed for missing information.  Once this error was detected, the customer’s claim was re-opened and we are happy to advise that...

their claim was processed on November 23, 2016 and reimbursement of $90.95 was paid via check.We have been in contact with the customer to discuss their concerns and advised when claim was completed and an Explanation of Benefits was provided.
We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.  
[redacted]Sales and Service Supervisor[redacted]

Complaint: [redacted]
I am rejecting this response because: they will not refund my $74.12.  I cancelled the policy yesterday.  I am also filing a complaint with my bank.
Sincerely,
[redacted]

We apologize for the customer’s disappointment with their recent experience filing claims with 24PetWatch.  We received claims for both the customer’s pets; however, we were missing a claim form.  To complete a claim we require the claim form, invoices and medical. Unfortunately,...

missing documents can delay the claim from being processed while we await further information.As per the customer’s selected policy terms and conditions:Section 8 – HOW TO CLAIMCOMPLETING THE CLAIM FORM1. 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.5. Return the completed claim form with all detailed paid invoices and the medical records to Us.We received the customer’s completed claims; claim form, invoice sand medical records through our online customer portal on November 8, 2016.For Kato, the customer’s claim was processed on November 10, 2016 and reimbursement of $250.40 was paid via Direct Deposit.For [redacted], the customer’s claim was processed on November 17, 2016 and reimbursement of $990.20 was paid via Direct Deposit.We sincerely apologize for the customer’s loss.[redacted]       Customer Solutions Specialist[redacted]
[redacted]

Complaint: [redacted]
I am rejecting this response because:This company is stating that my pets illness is pre-existing to my policy but they have people there that can not read and understand the claim forms or the veterinary medical charts. My pets condition was not symptomatic until Nov. 23 and not diagnosed till January 2016. So how is this pre-existing to my policy. The person reviewing my claim form clearly does not know anything about pet medical records. It was clearly stated on Oct 24 by the veterinarian that my pet had a list of symptoms that are covered by their "gift" insurance and my pet was treated for these and only these symptoms, but the claim was denied. They see that I have large amounts of money on the claim forms and they are making up excuses not to cover my claims. I am demanding a complete review of all my claims and veterinary records to prove that the condition my pet has was not diagnosed or treated until after I bought and paid for my pet insurance. 
Sincerely,
[redacted]

Initial Business Response /* (1000, 6, 2014/08/22) */
Contact Name and Title: [redacted] Director
Contact Phone: X-XXX-XXX-XXXX x[redacted]
Contact Email: [redacted]@pethealthinc.com
All fees collected have been refunded and we have contacted the client to resolve the matter.
Initial...

Consumer Rebuttal /* (3000, 8, 2014/08/30) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have to wait and see because their employee [redacted] told me, by phone, that they sent me a refund check, but I have not received it. [redacted] did say it would take awhile because the check originates in [redacted] goes to an office in the U.S., and then to me. I can't consider this closed until I actually get the check and it clears my bank.
Final Consumer Response /* (3000, 11, 2014/09/10) */
I previously advised [redacted] said they were sending a check but I hadn't received it yet. This is an update to let you know I still have not received it. It has been months since I first told them that I did not want their service and to give me a refund. At the time I told them this, they hadn't cashed my check but they then cashed it even though I had informed them I did not want the service.
Final Business Response /* (4000, 16, 2014/09/25) */
We have been in contact with the Consumer and have resolved the refund issue.

We apologize for any misunderstanding with our previous response. As previously advised, any condition that was covered under their previous policy – would continue to be covered and not be considered pre-existing. However, any conditions that were not eligible for coverage under the previous policy would continue to be considered pre-existing.   [redacted] Joint Disease was noted on October 17, 2008 which is prior to his original coverage date of November 1st, 2008.   We have spoken with the customer and verbally reviewed all claims for bothnd [redacted] and are committed to working with the customer to review their account. We will be providing the customer with a claims breakdown for both pets to show conditions that were previously covered.   [redacted] Customer Solutions Manager [redacted]
[redacted]

We apologize for the customer's disappointment with their recent experience with us.

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The customer adopted a pet from one of our shelter/rescue partners and received a complimentary Gift of Insurance policy which is offered exclusively through our partners. They activated their trial policy online where they agreed to be bound by the terms and conditions of the policy. This Gift of Insurance is a ‘Named Peril Policy’ there to assist new pet owners with the most common accidents and illnesses that affect cats and dogs post adoption.
 
The conditions covered under the Gift of Insurance are:
 
Upper Respiratory Tract Infection
Urinary Tract Infection
Internal Parasites
Eye Illness
Heartworm Disease
Ear Illness
Mange/Mites/Ringworm
Parvovirus/Feline Panleukopenia
Flea Allergy Dermatitis
Tick Borne Diseases
Foreign Body Ingestion Removal by Endoscopy or Laparotomy
Defined Poison Ingestion
Motor Vehicle Accident
Insect Bites/Stings
Lacerations
Bone Fractures
 
The goal of the Gift policy is to try and reduce the number of pets being returned to the shelter should they develop a common shelter-related illness or have an accident after adoption.
 
We would like to clarify that our records show that the customer called to speak with one of our team members on November 5, 2015 before visiting the Massachusetts [redacted] Hospital on November 6, 2015. We have reviewed the customer’s inquiry call from November 5 and can confirm that the customer was provided correct and accurate information, including an explanation regarding the named perils covered under the Gift of Insurance, and was not guaranteed coverage during the call.
 
[redacted]
Manager, Customer Solutions
T: [redacted]
E: l[redacted]

After attempts to contact the customer to discuss their concerns and coverage, our Veterinary Advisor reviewed the claims and medical history on file for [redacted]t.  As per the selected policy terms and conditions:
“In the event of any disagreement between the Insured and the Insurer, the matter will be referred to our Veterinary Advisor.” Based on this review, we have reassessed the customer’s claim submitted in the amount of $352.00 under Infectious Disease coverage due to the nature of the treatment provided for the condition.  A portion of the customer’s claim was applied toward the $200 deductible; reimbursement is being paid in the amount of $152.00 via check. We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.     [redacted] Customer Solutions Manager [redacted]

I have been a customer, pet owner, with a policy on my dog since 2014, having signed up when I adopted my pet from the L[redacted] Society in Colorado, July of 2014. I paid just over $40/month, plus a yearly renewal fee of $19.99. Even though I had visits that I could have filed a claim, I basically got lazy and never filed. I kept all my paperwork, and thought I would actually file once for all of them. NOTE: You must submit a claim within 90 days, or they become invalid. Word to the wise.
Last May, our dog had an emergency overnight, 2am wake-up call. We heard her wince and cry out. We searched for her on the bed, as she sleeps with us. We could not find her. I turned on the lights, and found her on her side, on the floor, at the foot if the bed, near an armoire of my wife's. I went to her immediately. She could only lift her head and look at me. I tried to stand her up, but she could not use her legs!! I placed her on the bed gently. We were not sure if she struck her head, broke her neck, or what happened to make her fall off the bed. I searched online for an emergency vet in the area, as we were new to Washington state. I found a vet about 18 miles away that had 24 hour emergency services. We took our dog there, and she actually started to walk again, but was a little "off", and left her in the care of a great staff. We left her for observation for the day. When my wife arrived to pick her up, the vet said she may have had a seizure, and we were to guard her actions for two weeks. We babied her even more than we already had been doing. I added a foot board to the bed to make sure that she never fell off again, either.
I filed my claim the very next day with 2[redacted], as this emergency visit was nearly $700. (that's also when I found out that claims must be made within 90 days, nullifying all of my prior possible claims). This is where my nightmare began with 2[redacted].
I was emailed by them about a week later asking for the actual office visit notes from the vet visit. The veterinarian's office faxed the notes as requested. Another week or so goes by, I am contacted by email again stating they need the past TWO YEARS of our dog's veterinary visits from her veterinarians. Mind you, we moved from Colorado to Washington only weeks before!
I began the tedious task of collecting all the documentation from two different veterinarians she was seen by, at the [redacted] where we adopted her, and at the vet we ultimately started taking her to. She NEVER had anything happen to her that was related to this injury/trauma of falling off the bed and striking her head, or having a seizure. But I got 28 pages of various notes and sent the by fax to 2[redacted] as requested. I use a website "[redacted].com" to upload the pages, as I have no fax machine. I received a confirmation email that the pages were successfully faxed.
I have been stuck in a nightmare loop of emails, phone calls, and letters with regards to this claim. I was told by 2[redacted] they never received ANY of the 28 pages I had faxed, and that the claim was closed. I re-faxed the pages again, this time, 32 pages. 2[redacted] asks me for the fax number from which the fax was sent. What?1 I used a website!!! They need a fax number, as that is how their records are stored and recorded. I had to contact the website and ask about this. They gave me the fax number that is used to send the faxes. I provided it to 2[redacted], they say they have nothing on file from that fax number!! I am fuming at this point! Totally the most unorganized and unprofessional organization or company I have ever had to deal with!!
Different employees at 2[redacted] offer various help and assistance levels with this issue. I went round and round with someone trying to get this straightened out yesterday. I had received an email stating "Thank you for attempting to submit your recent pet insurance claim(s). Unfortunately, we are unable to process your claim at this time for the reasons listed below: 'Missing Claim Form'. To most effectively care for our furry friends, we need all required documents, written legibly, before we are able to process a claim." WHAT?! When I called back, I was told my claim was incomplete because there was no claim form. I explained in great detail that the claim had already been submitted LAST MAY, and that I was attempting to add all the requested information I had been asked for. Apparently, when you fail to meet even ONE SINGLE requirement, your claim is CLOSED, and you need to start FROM SCRATCH Every.Single.Time. !! This was the first person since LAST MAY to tell me this! I was furious! At this point I am ready to just blow the whole thing off, but it is nearly $700 I am trying to claim!
The woman on the phone yesterday told me she would personally attach the previous claim form to the paperwork I have submitted (for the THIRD TIME), and that I should have no further issues with the claim.
Today, I received another email stating "Unfortunately, we are unable to process your claim at this time for the reasons listed below. 'Missing Claim Form'. To most effectively care for our furry friends, we need all required documents, written legibly, before we are able to process a claim."
I called 2[redacted] AGAIN, and had to go through all of this AGAIN with another employee!! At this point, I thoroughly believe this company HAS NO INTENTION of paying this claim. I have had to jump through so many hoops and file again and again and again and make phonecall after phonecall after phonecall for the same claim!
This has been going on for nearly 6 months!! Every time I think it is done and moving forward, I receive another email to the contrary!
I will NEVER recommend this company or its services to ANYONE. I would like to see legal action taken against them. They take months and years of policy payments, and then have no intention of paying.