PTZ Insurance Agency, Ltd.

Complaint: [redacted]
I am rejecting this response because: 
It’s really a shame that I had to file a complaint with the Revdex.com to get 24 PetWatch aka Pet Health, Inc. to fulfill their contractual obligation and stop the stalling on paying the claims.  They stated that the 4/22/16 claim was for $316.51. That amount included her wellness visit. Since they had a representative trick me into a plan that does not cover wellness in 2015, by saying it would be half the price and a better plan that included her prescription food, I included a cover sheet that stated I was only asking for the dog food to be paid in the amount of $66.76; a 8.5 lb. bag of dry food and a case of can food. I have never had a problem until just this April.   They told me they didn’t get Coco Channel’s medical records on 5/6/16, which isn’t the case because I started scanning the paperwork and attaching it to an email to their claims department. That way I could be sure they got every page. (They started disconnecting their existing fax lines making it harder to use fax.) Their representative was the one who submitted the claim again on 5/6/16.  They paid half of the $66.76 minus my deductible, which was $14.12 on 5/20/16. The case of can food for $31.46 was denied again. I called once more and was told to fill out a Request for Reassessment Form. The claim was submitted again on 6/14/16, for the $31.46, not $316.51 as they stated. They have done everything possible to delay or reject claims for food. They know other pet insurance companies cannot insure my dog now that she has been diagnosed with mild pancreatitis and a representative has told me that on the phone. They know they have me over a barrel. I simply can’t change companies now. I am not the only one experiencing this kind of treatment.  The Internet is full of similar experiences and complaints. Pet Health, Inc., only started to pay the claims since I filed the complaint. That too is a common thread here. Other people have had to file complaints with the Revdex.com or their state insurance commissioner to get their claims paid. It’s very sad because they were once a great company.
Sincerely,
[redacted]

We sent the customer renewal documents indicating we required action by September 30, 2016 for the pets’ coverage or the coverage would not continue.  We received no communication from the customer about these offers.  Our policies are available for pets’ age 8 weeks to 10 years; unfortunately we are unable to set up comprehensive coverage for pets older than 10 years.  We can only offer an accident only policy.  [redacted] Customer Solutions Specialist[redacted]

We apologize for the customer’s disappointment with their recent experience. 
We issue policy documents annually for our customers 60 days prior to their policy’s renewal date.  On June 16, 2016 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 renewed. The documents also indicated the customer must contact us to enroll their pets in newly offered policies by September 29, 2016 or the coverage would be terminated.Please note, this is an insurance underwriter change, and not a new insurance company.On July 12, 2016 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, 2016 was unsuccessful.We received no communication back from the customer about their desire to opt-in to the new policies.  The customer’s policies cancelled effective September 29, 2016.[redacted] Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s disappointment and frustration in their recent experience with 24PetWatch. On February 15, 2018 the customer purchased a microchip identification tag and was advised the time frame for receipt was 4 to 6 weeks.  Unfortunately, due to an internal error the order...

was delayed. As the customer has yet to receive the tag, he has been communicating with our contact center and we are in the process of resolving this matter. We have attempted to reach out to him however have not yet been successful in reaching him to discuss the resolution further. We encourage the customer to contact our office at [redacted] to speak with one of our Customer Solutions Specialists in order to resolve the matter. We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.   [redacted]             Customer Solutions Specialist [redacted]@pethealthinc.com Tell us why here...

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


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The customer’s claim form and invoices were originally received on February 8, 2016. On February 18, 2016, we received the required medical records to complete the claim submission. 
 
As per the customer’s selected policy terms and conditions:
 
Section 8 – HOW TO CLAIM
We will be able to reimburse on Your payable claim:
- If the claim form is correct and complete.
- When we have all the information needed to support the claim including detailed paid invoices and supporting medical records.
- When we are sure that the claim is valid.
 
We will write to You with our decision within 60 days after submission of a completed claim form and supporting documentation, unless state or provincial law provides for a shorter period.
 
The customer’s claim was processed on April 7, 2016, and reimbursement in the amount of $3,574.08 was made via direct deposit.
 
[redacted]
Manager, Customer Solutions
T: [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.
Sincerely,
[redacted]

Initial Business Response /* (1000, 5, 2015/08/31) */
Contact Name and Title: Lukasz [redacted]
Contact Phone: [redacted]
Contact Email: [redacted]@pethealthinc.com
We apologize for the delay in processing the customer's claims, and for the customer service issues the customer...

had experienced.
The customer's claims were processed on August 27, 2015 after we received a confirmation of payment for the invoices submitted from Eastside Dog and Cat Hospital on that same day.
A summary of the customer's policies is below:
24Petwatch Gift of Insurance
Effective date: April 27, 2015 - May 26, 2015
24Petwatch Essential Policy
Effective date: July 2, 2015 - Present
We were able to respond to the customer's claim for Intestinal Parasite Infestation with an onset date of April 27, 2015 as this is a named peril under the 24Petwatch Gift of Insurance Policy. Check #29432 in the amount of $117.85 was cut on August 27, 2015 and mailed to the customer along with the claim outcome letter dated August 27, 2015.
We were unable to response to the customer's claim for Dietary Indiscretion, Interdigital Dermatitis and Gastroenteritis. The condition of Dietary Indiscretion with an onset date of July 10, 2015 falls within the 14 day waiting period of the 24Petwatch Essential Policy. The condition of Interdigital Dermatitis with an onset date of June 29, 2015, is pre existing to the customer's 24Petwatch Essential Policy. The condition of Gastroenteritis with an onset date of April 27, 2015 is not a named peril of the 24Petwatch Gift of Insurance policy.
Regards,
Lukasz [redacted]
Manager, Customer Solutions
Tel: [redacted] ext 5398
Email: [redacted]@pethealthinc.com

We apologize for the customer’s disappointment with their recent claim experience.   The customer’s original claim submission was incomplete as it was missing medical records. An email advising of this was sent to the customer on April 5th, 2016.   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 June 12th, 2016 we received a completed claim form, invoice #[redacted] totaling $646.56 and updated medical records.   The customers claim was processed on June 13th, 2016 and reimbursement of $309.97 was made via check.   [redacted] Customer Solutions Manager [redacted]
[redacted]

Upon enrollment online the customer was prompted to review the policy’s terms and conditions where they would have been notified our renewals are automatic.On October 20, 2016 a renew package was issued to the customer more than 60 days’ notice of the policy renewal on January 29, 2017.On February 8, 2017 a full refund of the term’s premium, $172.80 was processed.  The customer should see this refund in approx. 5-7 business days, depending on the financial institution.[redacted] Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s disappointment with their recent claims experience.   On May 20th, 2016 we received a completed claim form, invoice # [redacted] for $1711.94 and records from the referral vet for [redacted] visit on May 11th, 2016 in which...

she received treatment. As this was for an illness and was the first claim that we had received for him, we do require his full medical records from [redacted] regular vet in order to be able to process the submitted claim.   As per the customer’s selected policy Terms and Conditions: Section 8 – HOW TO CLAIM Your Pet’s complete medical history/records are required to process Your claim.   On June 22nd, 2016 we requested the medical records from [redacted] regular vet at [redacted] On June 24th, 2016 we followed up with [redacted] Clinic and was advised that medical records could not be sent to us until Dr. [redacted] was in the office on Monday June 27th, 2016.   We are committed to working with the customer to help finalize her reassessment once medical records for EttaFay are received.   [redacted] Customer Solutions Manager [redacted]
[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]

Initial Business Response /* (1000, 9, 2014/08/14) */
After speaking with the Consumer on 7/22/2014 the declined claim was submitted for reassessment. Management has reviewed the claim(s) and medical history on file as well as contacted the clinic(s) [redacted] attended. Based on this...

review, we have reassessed this claim in the amount payable of $639.20. Reimbursement is enroute if not already received.
Coverage is subject to the Terms and Conditions of the consumers specific Policy including any previous amounts claimed, any pending claims submitted, any applicable co-payment and deductible. The Consumer is advised to refer to their policy documents, which includes their Document of Insurance, your Policy Specific Product Chart and Policy Terms and Conditions for further details.
Claim for Hernia, Inguinal
Treatment Start Date: 04/21/2014
Treatment End Date: 04/21/2014
Total Claim Submitted $899.00
Total Uninsurable Amount $0.00
Deductible $100.00
Co-Payment $159.80
Total Amount Payable $639.20

We apologize for the customer’s disappointment with their recent renewal and premium.We are currently in the process of transitioning underwriters for our pet insurance business in the United States.  In preparation for this transition we completed a comprehensive review of our product...

offerings and a complete market analysis. Upon completion, it was determined that a rate increase was required in order to allow us to continue offering the insurance coverage our customers have come to expect and to ensure our product’s sustainability.  Premiums reflect the indemnity offered by our products. We are confident that our rates under the [redacted] Insurance Company premiums are competitive for the level of coverage provided by our insurance plans. We are working with our customers to provide options to reduce their monthly premium such as deductible change or change in coverage.  We encourage the customer to reach out to our Customer Service Department to review options available. [redacted]    Customer Solutions Specialist[redacted]
[redacted]24PetWatch®  Pet Insurance Programs are underwritten in the United States by [redacted] Insurance Company and administered by PTZ Insurance Agency, Ltd.  24PetWatch®, 24PetWatch & Design and related words and logos are trademarks and the property of PTZ Insurance Agency Ltd. a wholly owned subsidiary of Pethealth Inc.

We apologize for the customer’s disappointment with their recent service and claims experience.  At the time of the customer’s original claim submission in December 2016, the claim form listed two conditions being claimed for; “Right thoracic limb lameness” and “Tracheal collapse”.  The...

medical records made note of these two conditions as well; this is why there were two deductibles applied.As per the customer’s selected policy documents; Coverage Chart:                Deductible                Per Illness Condition: $100Upon receiving a statement from the customer’s veterinarian indicating the tracheal collapse was not addressed at the time of the visit in question, we have reassessed the second deductible applied.  The customer will receive reimbursement from this reassessment via check.  We have emailed an Explanation of Benefits to the customer for this reassessment.We recently underwent an underwriter change in the United States that resulted in some of our products not being available moving forward. We were committed to ensuring all pets were able to continue receiving coverage, so we found the most similar insurance policy available and offered to switch them without repercussion of pre-existing conditions. We were obligated, however, to have these customers agree to change their coverage, or have their policy lapse. A package was issued to the customer on January 10, 2017 requiring them to contact us by April 6, 2017 to let us know if they wished to continue coverage.  This package explained that effective April 7, 2017 we are offering the customer a new policy to be underwritten by The [redacted] Insurance Company, as their current policy was no longer available. This was not a decision based on the age of a pet or the claims history, but the unavailability of a product moving forward. We apologize that our representatives did not address the renewal when the customer called about their claim during the renewal period.  We have made an exception to re-open the offer previously provided for the customer’s renewal policy.  We will be contacting the customer to finalize their policy change.We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.[redacted] Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s disappointment with their recent service and claims experience.  We have been unable to locate the customer’s account with the information provided in their complaint.  We made multiple attempts to contact the customer with the phone number provided and have...

left numerous messages.  To date we have not heard back from the customer to provide further account details.  We encourage the customer to contact us so we can assist them with their concerns.[redacted] Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer's claim experience.
The customer had adopted a pet from one of our animal welfare partners and received a complimentary Gift of Insurance policy which is offered exclusively through our partners. The customer did not purchase one of our core insurance policies, as...

advertised on our website, and no money was collected from them. The Gift of Insurance policy is not available for purchase, and is not advertised online. This policy is there to assist with a specific list of shelter related illnesses that a pet can develop after adoption. The conditions covered under the Gift of Insurance include:
Upper Respiratory Tract Infection
Urinary Tract Infection
Internal Parasites
Eye Illness
Heartworm Disease
Ear Illness
Mange/Mites/Ringworm
Parovirus/Feline Panleukopenia
Flea Allergy Dermatitis
Tick Borne Diseases
This list of conditions appears within the customer's document of insurance. Unfortunately, Gastroenteritis is not a named peril under this policy.
By working with our animal welfare partners to provide new owners with this free policy, our mutual goal is to try and reduce the number of pets being returned to the shelter should they develop these common shelter related illnesses after adoption.
[redacted]
Manager, Customer Solutions
[redacted]
[redacted]

We apologize for the customer’s disappointment in their recent claim experience. We would like to clarify our mailed claim process. In 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 address. The mail received at our PO Box is automatically forwarded to our office where the documentation is processed by our administrative team. Unfortunately, due to this process once a trackable package is delivered to our PO Box, further tracking information will not be updated with [redacted]. The customers claims for wellness were received on May 12th, 2016 and applicable reimbursement in the amount of $163.20 was made via direct deposit. [redacted] Customer Solutions Manager [redacted]

PTZ Insurance Agency is the administrator of pet insurance products in the United States responding on behalf of North River Insurance Company and Praetorian Insurance Company.   We apologize for the customer’s disappointment with their recent service and claims experience.    We...

issue policy documents annually for our customers’ renewals 60 days prior to their renewal date.  On August 2, 2016 we issued a renewal package to the customer including the new premium for the upcoming policy term, effective October 11, 2016.   As per the customer’s selected terms and conditions:   Section 9 – Our Service to You NOTICE OF CHANGE We reserve the right to make any changes to the Policy upon notice, including but not limited to Rates, Premiums, Fees, Coverage, Exclusions, Maximum Benefit Amounts, Deductibles, and/or Co-payment. If we increase Your renewal premium, or make a change to Your Policy we will mail or fax or email written notice of our offer to renew 60 days before the effective date of the change. Notice will be delivered to Your last known contact details on file.   This premium increase was larger than our previous increases. 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 analysis. It 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 pets. In 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 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 knowing that they can rely on our products throughout the duration of their pets’ lives is of the utmost importance to us.   The claims referenced in the complaint are subject to the policy underwritten by Praetorian Insurance Company.   A claim received from the customer on September 6, 2016 was completed on October 27, 2016 and the customer was reimbursed $0.88 via check.  A large portion of this claim was declined as the customer’s selected policy, 24PetWatch Champion, does not offer coverage for Preventative Care or Routine treatments.  A portion of the claim was also applied to satisfy the $100 annual deductible.    Section 6 – EXCLUSIONS We will not reimburse and pay for any expenses related to: 9. Preventative Care and Routine Treatment intended for the maintenance of good health of Your Pet. This includes but is not limited to Vaccinations (including Vaccine Titers), prophylactic medications (such as heartworm, lice, internal parasites and fleas), spaying (including for false pregnancy or pyometra), neutering (including cryptorchid neuters), and anal gland expressions, unless otherwise specifically covered by Our Wellness Endorsement and coverage is in force under that Wellness Endorsement.   A claim received from the customer on September 8, 2016 was completed on October 31, 2016 and the customer was reimbursed $81.26 via check.    We take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.  We are also committed to working with the customer to help them understand the outcome of their claims.   [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.

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]