PTZ Insurance Agency, Ltd.

Complaint: [redacted] I am rejecting this response because: I submitted $969.22 in claims. Less the $300.00 deductible, $669.22. Eighty percent of the is $535.38.I still have not received and EOB, so I don't know why they are only reimbursing me $276.97. Sincerely, [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 $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 $deductible; reimbursement is being paid in the amount of $via checkWe take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings [redacted] Customer Solutions Manager [redacted]

Upon receipt of this inquiry, we carefully reviewed the issues raised by our customer. The policy is a 12 month policy that automatically renews each year. A new policy packet for the upcoming term was provided to the customer, along with notice of a rate increase and... new underwriter for the policy. With a new underwriter, the products were evaluated, which did result in a rate increase to more accurately reflect the value of the coverage. This information was provided in August 2016, more than 60 days in advance of the new term set to begin on October 19, 2016, to provide the customer ample advance notice of the changes and give her an opportunity to contact us with questions or take other actions. Based on the customer’s letter, we reviewed the account. We were not able to locate where she withdrew her previous authorization to bill her payment method on file, nor was there a request to cancel or select a different coverage. With no direction from the customer otherwise, per the notice, the payment method was automatically billed on October 19, 2016 for the new plan period. Finally, the customer referenced a claim that was recently submitted. We reviewed the claim in question and confirmed that it was processed accurately. A large portion was not eligible because it was for wellness treatment which is not covered under the policy terms and another portion was applied to the annual deductible. We will again reach out to the customer to discuss her concerns. [redacted] Customer Solutions Specialist [redacted]

As previously stated, the checklist is presented during the online activation process for the complimentary Gift of Insurance. It is not possible to activate the Gift of Insurance online without first being presented with the checklist and accepting the terms. The Gift of Insurance is not listed on our website as it is not available for purchase. We would be happy to speak with the Policy Holder directly to help clear up any confusion. [redacted] Manager, Customer Solutions [redacted]

Pethealth Incis the administrator of pet insurance products in the United States responding on behalf of The *** *** Insurance Company.We apologize for the customer’s disappointment with their policy for the new policy term We issue policy documents annually for our customers’ days
prior to their anniversary date. On August 2, we issued the policy package to the customer including the new premium for the upcoming policy term.We recently changed underwriters in the United States, and a part of this transition involved undergoing a comprehensive review of our product offerings and a complete market analysisIt was determined, at that time that a rate increase was required to reflect the actual costs and frequency of treatments and illness for all insured petsIn order to allow us to continue offering the insurance products that our customers expect, and to ensure our products’ sustainability, a rate increase was necessary in order to ensure that the premiums charged reflect the indemnity offered by our productsWe are confident that our new premiums better reflect the high level of care and protection our insurance products provide while still being very competitive in the market.Please be advised that we have reviewed the customer’s policy, and the latest information provided to the customer regarding their policy premiums has been verified as correct. Ensuring that our products provide our customers with access to the best possible care for their pets, and enabling them to have peace of mind knowing that they can rely on our products throughout the duration of their pets’ lives is of the utmost importance to us.We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings *** *** Customer Solutions Specialist*** *** ***
***

Initial Business Response /* (4000, 11, 2015/02/23) */
Management has reviewed the claims and medical history on file for ***Based on this review, the original declination of this claim stands
Please be advised that the sales call which took place on Monday, September 22, has
been reviewed by ManagementDuring this call the sales checklist was fully reviewed by the sales agent and included the disclosure of the day waiting period for illness coverageIt should also be noted that the consumer advised that there would not be funds on the credit card until the following day so the sales agent advanced the sale by one day to the 24th of September which the client was okay with
As per the call that occurred on October 9th, at 2:pm (est.) the Agent correctly reviewed the coverage and advised the illness and accident coverageThe Agent also explained the process for a pre-approval if the client wanted to have a guarantee of coverage before treatmentThere was no mention of sudden onset illness or accident
We would like to apologize for the delay in service time as we are currently experiencing higher than claim volumes and are working to rectify this situation so we can continue to offer our clients the best possible customer service
We invite you to provide us with further information and/or documentation that may be relevant to this claimWe will review that information and/or documentation as it may relate to our position regarding coverage of this claim

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

We apologize for this customer’s recent experience
face="Calibri" size="3">The customer’s claim in question was originally declined due to missing information as no diagnosis was provided to us on the claim form submittedWe notified the customer of this in our letter dated September 30, This claim was declined for “non-disclosure” of required information, not as a pre-existing condition
During the reassessment process we were asked to look into a claim declined for being a pre-existing condition, and therefore did not reassess the above claim as the customer had intended
We apologize that this misunderstanding has delayed the processPlease note that we have now reassessed the claim in questionReimbursement in the amount of $has been made with check number ***
*** ***
Manager, Customer Solutions
** *** *** ***
** ***

We apologize for the customer’s disappointment with their recent experience. We issue policy documents annually for our customers days prior to their policy’s renewal date. On June 16, we issued renewal packages to the customer for two pets indicating their current Pet Insurance
Policies, underwritten by Praetorian Insurance Company, will no longer be available and will not be renewedThe documents also indicated the customer must contact us to enroll their pets in newly offered policies by September 29, or the coverage would be terminated.Please note, this is an insurance underwriter change, and not a new insurance company.On July 12, the customer spoke with a sales representative about the package he received. The representative advised the customer that we would have a member of the Customer Care team get in touch to address their questions about the renewal package. Unfortunately, our attempt to contact the customer back on July 12, was unsuccessful.We received no communication back from the customer about their desire to oto the new policies. The customer’s policies cancelled effective September 29, 2016.*** *** Customer Solutions Specialist*** *** ***
***

We apologize for the customer’s disappointment with their recent experience with their claim submission. On February 29, the customer submitted a claim for Tumor on Ear. Upon review of the information provided by the customer and the veterinarian, the claim was declined as
this is not one of the perils available for coverage under the customer’s QuickCare Indoor Cat policy. As per the customer’s selected policy documents: Your QuickCare Indoor Cat policy offers coverage exclusively for the following named perils; Foreign Body Ingestion Removal, Bone Fractures, Defined Poison Ingestion, Feline High-Rise Syndrome, Bite Wounds/Bite Wound Abscesses, Burns, Feline Lower Urinary Tract Disease, Feline Asthma, Diabetes Mellitus, Cancer and Infectious Disease The customer then submitted a reassessment on two separate occasions with a veterinarian statement. Reviews were completed by management in our Claims Department and it was determined the declination stands As per the customer’s Explanation of Benefits for the final reassessment: Please be advised that we are unable to respond to your claim under the illness category of Infectious Disease as we have not received a definitive diagnosis by laboratory report indicating the cause of Scarlet's Infected Sebaceous Cyst to be caused by an infectious agentInfectious Diseases are defined as Any Illness caused by or relating to an infectious agent that affects any or all of the body systemsAs no infectious agent was identified, we are unable to reimburse you treatment expenses under this Illness We are committed to working with the customer to help them understand the outcome of the reassessment. We have attempted to contact the client multiple times and at this time have been unsuccessful in connecting *** *** *** Customer Solutions Manager *** *** *** ***

We apologize for the delay in processing the customer’s claims
face="Calibri" size="3">We have processed the customer’s outstanding claims on file for the following submitted invoices:
***
Invoice *** $Invoice *** $Prescription Slip for Neo/Poly/Dex $Prescription Slip for Neo/Poly/Dex $
***
Prescription Slip for Neo/Poly/Dex $Prescription Slip for Metronidazole $
We have not received the invoices mentioned in point of the customer’s complaint, and we have reached out to the customer to obtain these claim forms and invoices for processing
*** ***
Manager, Customer Solutions
T: *** *** ***
E* ***

We apologize for the customer’s disappointment with their recent policy renewalsAfter a comprehensive review of our product offerings and a market analysis it was determined that a rate increase was required to reflect the actual costs and frequency of treatments and illness for all
insured petsThere are a number of new and innovative veterinary treatments available to pet owners and to ensure we maintain a sustainable insurance product, a rate increase was necessary to reflect treatment options used by our customersWe are confident that our new premiums better reflect the high level of care and protection our insurance products provide while still being very competitive in the marketPlease be advised that we have reviewed the customer’s policies, and the latest information provided to the customer regarding their policy premiums has been verified as correctEnsuring that our products provide our customers with access to the best possible care for their pets, and enabling them to have peace of mind knowing that they can rely on our products throughout the duration of their pets’ lives is of the utmost importance to usIn order to allow us to continue offering the insurance products that our customers expect, and to ensure our products’ sustainability, a rate increase was necessary in order to ensure that the premiums charged reflect the indemnity offered by our products
We do offer a wide range of products and different levels of deductible. Our staff can discuss with the customer that by lowering the coverage level or changing deductibles, we can look at a monthly premium they are more comfortable with
We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.
*** *** ***
Customer Solutions Manager *** *** *** ***

Please be advised that this is a duplicate complaint, and will be responded to through the Indiana DOIWe consider this case closed*** ***
Manager, Customer Solutions
** *** *** ***
** ***

We apologize for the customer’s disappointment with their recent claims experienceThe clients original claim submissions for *** were incomplete as they were missing medical recordsAs per the customers selected policy terms and conditions: Section 8: How to
Claim A Complete Claim must be submitted for processingA Complete Claim consists of the; Claim Form filled out and signed Itemized paid invoices 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, we received a complete claim, including claim form, invoice*** and medical records for *** The claim was completed on May 31st and reimbursement of $was made via checkOn June 8th, we contacted the customer and obtained invoice *** for $as well as a completed claim form and attached medical records for SamanthaWe are pleased to advise that we have completed the outstanding claim for *** on June 9th, and reimbursement of $was made via check. We have spoken with the policy holder and they were pleased with the outcome*** *** Customer Solutions Manager *** *** ***
***

We apologize for the customer’s disappointment with their recent policy renewalsAfter a comprehensive review of our product offerings and a market analysis it was determined that a rate increase was required to reflect the actual costs and frequency of treatments and illness for all insured pets
There are a number of new and innovative veterinary treatments available to pet owners and to ensure we maintain a sustainable insurance product, a rate increase was necessary to reflect treatment options used by our customersWe are confident that our new premiums better reflect the high level of care and protection our insurance products provide while still being very competitive in the marketPlease be advised that we have reviewed the customer’s policies, and the latest information provided to the customer regarding their policy premiums has been verified as correctEnsuring that our products provide our customers with access to the best possible care for their pets, and enabling them to have peace of mind knowing that they can rely on our products throughout the duration of their pets’ lives is of the utmost importance to usIn order to allow us to continue offering the insurance products that our customers expect, and to ensure our products’ sustainability, a rate increase was necessary in order to ensure that the premiums charged reflect the indemnity offered by our productsWe do offer a wide range of products and different levels of deductible. Our staff can discuss with the customer that by lowering the coverage level or changing deductibles, we can look at a monthly premium they are more comfortable withWe take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings. *** *** *** Customer Solutions Manager *** *** *** ***

I bought this health Insurance for my Great Dane as he was getting up there in age and if something happened I wanted to be protected and I knew I could not come up with a lot of money if something happened so I thought I was good getting Insurance well I was wrongOn the cover page they sent with the policy it said we are dedicated to the health and welfare and look forward to providing quality protection and peace of mindI got neither my dog got heart failure about months after I got Insurance in a month it cost almost 4,dollars trying to keep him a live longerI thought ok if insurance pays in about to weeks I will be ok I got everything they need I was told it would take days for when it posted then told only about more weeks then told about a month and a half well because of the bull crap they give you I had to but him down I didn't get the chance to say lets keep going I had no money and I am still waiting this is wrong there was no peace of mind and they were not dedicated to his health or they would pay back sooner they said there was nothing holding it up they are just not paying so why do we get insurance if they are not there to help us and we have to fight to get our money backThe time frame on this company is way to long other company"s pay out in a week to we should not have to wait that long to get paid back

All these customer reviews are exactly what I am going through Everyone's review put together is the same as minesWhy is this "company " still doing services?! What is Revdex.com doing to help consumers like myself to not fall into there SCAM?!

We apologize for the customer’s disappointment with their recent claim experience
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Management has reviewed the claim, and the customer’s claim for Urinary Tract Infection was reassessed as payable in the amount of $on January 27, Reimbursement has been made to the customer with check * ***
Unfortunately, we were unable to provide coverage for *** treatments related to Pain, secondary to Ovariohysterectomy, including *** *** provided November 7, for prevention of incisional licking and *** Chewable mg prescribed for post-operative pain management, as this condition is secondary to an excluded procedure. In addition, we were unable to provide coverage for *** Pre Paid Fecal Test performed on November 7, as this is considered a preventative and elective procedure
As per the customer’s selected policy terms and conditions:
EXCLUSIONS-
Preventative and elective treatments/ surgeries including but not restricted to vaccinations, cosmetic treatment/surgery, spaying (including for pregnancy), neutering (including crypt orchid neuters), or any treatment /surgery relating to breeding or pregnancyClaims arising from, or as a result of, any excluded procedure, accident or illness condition
*** ***
Manager, Customer Solutions
T: *** *** ***
E* ***

We apologize for the customer’s disappointment with their recent claims experience On June 22, we received a claim form, invoice and medical records to be processed. Section of the claim form, filled out by the treating veterinarian, indicates the claim was for “weight loss &
feline resorption lesion #407”. The claim was processed based on this information and was approved and applied toward the customer’s annual deductible for their illness coverage.On November 1, the exam and bloodwork were reassessed as wellness based on the medical records provided and the customer will be reimbursed $via check.We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings *** *** Customer Solutions Specialist*** *** ***

We apologize for this customer’s recent experience. The customer’s claim in question was originally declined due to missing information as no diagnosis was provided to us on the claim form submittedWe notified the customer of this in our letter dated September 30, This claim was
declined for “non-disclosure” of required information, not as a pre-existing condition During the reassessment process we were asked to look into a claim declined for being a pre-existing condition, and therefore did not reassess the above claim as the customer had intended We apologize that this misunderstanding has delayed the processPlease note that we have now reassessed the claim in questionReimbursement in the amount of $has been made with check number *** *** ***Manager, Customer Solutions** *** *** *** ***