PTZ Insurance Agency, Ltd.

Please note that as per the customer’s Document of Insurance the $deductible is applied once per policy yearThe customer’s policy term renews on May 10th each year and any claims made after that date will be applied towards the deductible until it has been satisfiedThe invoices that were processed on July 22nd, were for treatment on June 21st, and June 28th, 2016, which were the first claims for the customer’s 2016/policy term
The deductible has now been met until the customer’s renewal on May 10th,
*** *** ***
Customer Solutions Manager *** *** ***
***

We apologize for the customer’s disappointment with their recent claims experience Upon initial submission of the customer’s claim, we did not receive complete medical records. In order to process a claim, we require a complete submission, which includes the claim form, invoice and
medical records Multiple attempts were made to contact the clinics for the medical records necessary. When we received the medical records we requested a reassessment on behalf of the customer.The customer’s claim was reassessed on March 27, and reimbursement of $was paid via Direct Deposit. The final Explanation of Benefits letter has been emailed to the client for their records.We encourage the customer to reach out to one of our Customer Solutions Specialists for any questions. We are committed to working with the customer to help them understand the outcome of their reassessment *** *** Customer Solutions Specialist*** *** ***
***

Complaint: ***
I am rejecting this response because: Is this where I am supposed to reply? This complaint is not resolved! I have since had to send yet another reassessment request, along with a letter from my vet which he had already sent them. I would be happy to share this with you. It has become only more clear that *** has made every effort to contort my cat's records to make it appear to be a new incident My vet has been clear that every single visits been related to one single cancer diagnosis and treatment Thank you, *** ***

We apologize for the customer’s disappointment in their recent claim experienceWe would like to clarify our mailed claim processIn order to ensure that we can better serve our US customers we offer a US mailing address which allows us to ensure that our customers have the option to submit
physical documentation to us using a domestic addressThe mail received at our PO Box is automatically forwarded to our office where the documentation is processed by our administrative teamUnfortunately, due to this process once a trackable package is delivered to our PO Box, further tracking information will not be updated with ***The customers claims for wellness were received on May 12th, and applicable reimbursement in the amount of $was made via direct deposit*** *** *** Customer Solutions Manager *** *** ***
***

We appreciate Ms*** circumstance and concernsIn no way did we endeavor to leave clients feeling abandoned or mislead; we took great care in our communications to be as transparent as possible about the status of our product offering in the state of Florida.Despite our best efforts, we did not have approval from the Florida Department of Insurance to offer a product at the time of the client’s policy expiration.Our customer experience is paramountWe endeavor to discuss the client’s coverage options with her directly but all exchanges regarding this matter have been limited to this forumWe called the client on January 23, and February 6, with no successIn spite of leaving messages, with a direct point of contact, we have not received a return call from the clientWe would appreciate the opportunity to discuss the client’s concerns in greater detail and hope to be able to offer a satisfactory resolution for all*** *** Customer Solutions Specialist*** *** ***
***

Complaint: ***
I am rejecting this response because:of all the same reasons which remain unresolved specifically misrepresentation of of conditions covered in laymans terms on website vs fineprint of insurance formNow as a result of this misfortune and the cost of the vet over 900$ I have to resort to returning to the humane society to inform them of the non payment and see if they can assist me in any way shape of formI am really disappointed in the way hour pet insurance conducts "business" and feel no person should have to go through this much of a process to have a claim paidThis is ridiculous
Sincerely,
*** * ***

We apologize for any confusion regarding the claims notification processThe customer’s claim was submitted multiple times and, on our end, each submission needs to be responded toAs a result, the customer will have received declined claims letters for the duplicate submissions The claim was completed on June 9th, and reimbursement of $was made to the customerOn June 22nd, we spoke with the customer and confirmed that they have received their reimbursement *** *** *** Customer Solutions Manager ###-###-#### elizabeth***@pethealthinc.com

We apologize for the customer’s experience.Upon adoption, the customer was provided a complimentary
*** ** Insurance policy through the adoption facility, which had an effective
date of September 6, 2015.The *** ** Insurance policy is meant to assist owners
should their pet develop specific
shelter related illnesses after adoptionThe
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 $of coverage for the
*** named above.On September 9, the customer phoned our insurance
sales team to purchase our 24Petwatch Essential policyThis policy provides up
to $of accident and illness coverage per policy term, and is subject to
a days illness waiting periodThe effective date of the customer’s
24Petwatch Essential Policy was September 10, As a result of the
customer’s upgrade from our *** ** Insurance policy, we provided the customer
with a complimentary First Time Illness supplement which provides up to
$of coverage for conditions which are onset during the 24Petwatch
Essential Policy day illness waiting periodThe customer was charged $
for the first month’s premium, which continued at a rate of $per month
thereafterUnfortunately 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 policyThis condition
is, also, not a named peril under the *** ** Insurance policy that came into force on September 6th 2015.*** ***Manager, Customer Solutions** *** *** *** ***

My dog had been with this absolutely HORRIBLE company since we adopted him at months He was a Great Dane We had never let the policy lapse, but every year, on it's renewal date, we got a slight increase in the cost of the policy
My dog began slipping in his back legs in January of this year The vet told us it was just that he was getting older, so slick floors were going to be tougher for him We put rugs down to prevent this
In March, the policy renewed Again, it never lapsed coverage, it just automatically renewedOver the July 4th weekend, my dog hesitated to climb the stairs to our room The next day, he yelped when he got off the couch We took him to the emergency vet (as the regular vet was closed due to the holiday) They did X-rays and blood work They told us he might have slipped a disc or he might have cancer
I sent in the claim for the almost $bill They first claimed that they had never received the information the vet faxed over Told me that I had to have the phone number for the fax that the information was sent from! What? Anyway, I sent it again They finally got it the 3rd time, after I had my vet send it through both fax AND email
Waited the days, and got an email that the claim had been finalized I got NOTHING They said that because my dog had had slippage in January, and the policy renewed in March, it was considered a new policy and therefore, a PRE-EXISTING CONDITION!!
I was completely shocked! The lady on the phone even tried to say that I had been neglectful by not taking my dog in in January when it first started I DID take him in The vet didn't think anything of it
I can not believe that each year, when the policy automatically renews, anything that happened before that date is then considered a pre-existing condition! No matter that I've had a consistent policy with them for years!
This company is absolutely HORRIFIC, and I don't every recommend anyone going through them

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 want to apologize for the customer’s recent experience, as well as offer our condolences for the loss of their pet We have reached out to the client and made the appropriate correction of cancelling their policy effective May 12, The customer was provided with a total refund amount
of $59.72. *** *** Customer Solutions Manager *** *** ***
***

Initial Business Response /* (1000, 7, 2014/03/31) */
A member of management has spoken to the consumer and was able to address her concerns; including her claim reimbursement which was couriered to the consumerWe are in the process of hiring additional Adjusters & Agents to help mitigate
the claim/call volumeFeedback was provided to appropriate team regarding technical issues with our callback feature and is currently being investigated with the vendor
Kindest regards,
*** *** RIBO
Quality Assurance Analyst
Initial Consumer Rebuttal /* (3000, 9, 2014/03/31) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The only reason they responded to me is because I had to call several times about this
Why was NO ONE calling me to let me know what was going on and/or why it was taking exceptionally long to handle?
I finally received the payment, but it took me three calls (and spending countless cell minutes on hold)That is unacceptable to me
The customer service is severly lacking

I am a veterinarian I have tried to submit a claim with pet watch insurance for the last days Each time they send an email confirmation saying that the email is received Then we receive an email from "live agent" saying the claim is not received They say perhaps the email is too large and the attachment can only be

Complaint: ***
I am rejecting this response because: I am happy that they're being proactive in fixing the problem; however, I have yet to receive a checkI will accept a response made by PetHealth/ PetWatch when I receive the check they claim to have mailed out on July 8,
Sincerely,
*** *** ***

We apologize for the customer’s difficulty in contacting our customer service team
size="3">
Unfortunately, at this time, we have not received a claim submission from this policy holderWe have contacted the customer via email to ensure that we are able to quickly resolve this issue and begin processing their claim
Lukasz ***
Manager, Customer Solutions
T: *** ext***
E: lukasz.***@pethealthinc.com

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 the customer’s disappointment with their recent claim experienceAs this was the customer’s first claim with 24PetWatch, we require *** complete medical records in order to move forward with processingAs per the customer’s 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) At this time we have only been provided with medical records from March 5th, to May 25th, and are unable to re-assess the claim at this timeWe have made several attempts to obtain these medical records from the client and are committed to working with the customer to assist in reviewing the claim once we have received the requested medical records from June to March *** *** Customer Solutions Manager *** *** ***
***

We apologize for the customer's disappointment with their recent experience with us 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 partnersThey activated their trial policy
online where they agreed to be bound by the terms and conditions of the policyThis 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, before visiting the Massachusetts *** *** Hospital on November 6, We have reviewed the customer’s inquiry call from November 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 *** *** Manager, Customer Solutions T: *** *** *** E: l***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meThanks to *** my Credit Card has been credited and mt Pet tags re-ordered.
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because: They have not responded to the complaint through Indiana DOIWhich is why I have filed the duplicate complaint
Sincerely,
*** ***