PTZ Insurance Agency, Ltd.

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]

Initial Business Response /* (1000, 7, 2015/07/07) */
Contact Name and Title: [redacted]
Contact Phone: X-XXX-XXX-XXXX
Contact Email: [redacted]@pethealthinc.com
We apologize for any misunderstanding the customer might have experienced during the purchase of their policy...

online. We take our customers' feedback seriously to ensure we are providing a consistent experience across our online and telephone channels. Our goal is to ensure that our customers have access to accurate and informative information when purchasing policies online or by phone. Policy Terms and Conditions are available on the insurance pages of the 24PetWatch website, as well as presented at the time of check-out when purchasing a policy online. All customers must indicate that they have read and agree to the Terms and Conditions before the purchase is complete. We follow-up with a policy document package after each purchase outlining the coverage purchased, and Terms and Conditions of the policy. In addition to this, our customer service agents are trained to provide ongoing policy education at times we are contacted by our customers. The coverage option chosen by the customer is an accident and illness policy that does not cover preventative care and medications or routine visits. Upon review, in addition to [redacted] being ineligible for coverage under the policy, the customer's claims have also not met the deductible as outlined in the policy terms and conditions.

Please note that as per the customer’s Document of Insurance the $100.00 deductible is applied once per policy year. The 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 satisfied. The invoices that were processed on July 22nd, 2016 were for treatment on June 21st, 2016 and June 28th, 2016, which were the first claims for the customer’s 2016/2017 policy term. The deductible has now been met until the customer’s renewal on May 10th, 2017. [redacted] Customer Solutions Manager [redacted]

We would like to clarify the effective dates of the customer’s policies:   24PetWatch Gift – effective October 15, 2015 24PetWatch ChampionCare – effective November 13, 2015   As the condition being claimed was onset in October 2015, the condition falls under the customer’s 24PetWatch Gift policy, and is pre-existing to the 24PetWatch ChampionCare policy.   Unfortunately, the condition being claimed is not one of the named perils available for coverage under the Gift policy.   On March 25, 2016, our customer service team had emailed the customer a reassessment form. We invite the customer to submit a reassessment request along with a statement from their veterinarian and any addition information available in order to allow us to further review the submitted claims.

We apologize for the customer’s disappointment with their recent claims experience.  Our Chief Veterinary Advisor has reviewed all of the information the customer has provided regarding reassessment of their declined claim. Unfortunately, the declination of this condition stands as...

their selected policy does not cover treatment of the teeth or gums.  We have not received any further information from the customer such as a veterinary statement or diagnosis by histopathology to indicate this condition is anything other than treatment for the teeth and gums. As per the customer’s selected policy terms and conditions:Section 6 – EXCLUSIONSExclusions list what we do not cover and what we will not be liable for.We will not reimburse and pay for any expenses related to:20. Dental and orthodontic health care, Dental Treatment, Dentalprocedures and/or Dental diseases including but not limitedto Treatment of the teeth and gums, dental caries (cavities),gingivitis, periodontitis, retained deciduous teeth, malocclusion,periodontal disease, root canals, caps, crowns, or abscessedteeth, unless otherwise specifically covered by Our Dental FeesEndorsement, and coverage is in force under that Dental FeesEndorsement.We are committed to working with the customer to help them understand the outcome of the reassessment.[redacted]           Customer Solutions Specialist[redacted]

We apologize for the customer’s disappointment with their experience with 24PetWatch.  We have underwritten the customer's policy to avoid any further miscommunications regarding submitting medical history for their pet.The customer has been in contact with our Customer Solutions Specialist...

regarding their concern about claims checks. We would like to assure the customer that we do our best to send out claims reimbursement in a timely manner.  We encourage the customer to take advantage of our Direct Deposit option for claims reimbursements; which will help ensure money is transferred quickly and efficiently.Our Customer Solution Specialist will reach out to the customer once we have an answer to their concern.  We take our customers’ feedback very seriously as we are constantly looking to improve our customer experience.    [redacted] Customer Solutions Specialist[redacted]
[redacted]

We apologize for the customer’s disappointment with their recent claim experience.   On April 26th, 2016 we received a completed claim form, paid invoices and medical records for treatment on April 21st, 2016 and April 26th, 2016. As this was...

the first claim that we had received for [redacted] we do require his full medical records 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 May 24th, 2016 we emailed the customer to request the additional medical records. On May 25th, 2016 the client called and advised that the clinic would be faxing us the required medical records, however no records were received. On May 27th, 2016 the clinic called to advise that they would be sending in medical records. The records received were for the April treatment dates only. Since full medical records were not received, the claim was completed and declined until the full medical history could be obtained.   We contacted the [redacted] Animal Hospital and requested and received full medical records on June 15th, 2016.   The customers claim was reassessed on June 15th, 2016 and reimbursement of $535.31 was made via check.   [redacted] Customer Solutions Manager [redacted]
[redacted]

Complaint: [redacted]
I am rejecting this response because:  Although they've now refunded the money for the cancelled policy which was posted June 8th, 2016 and paid out the claim I want it noted that it wasn't until the media became involved that they willingly paid out the claim.  I am adamant that they not be able to close this claim and continue to have an A+ rating when the only reason they eventually paid out the claim was under the pressure  and scrutiny of the Revdex.com and the advocacy of [redacted] from [redacted]  
 
I honestly believe that they made every effort to delay paying out our claim using stalling tactics pressuring the consumer into either giving up on the claim or in the case of some consumers being unable to support their claim with the paperwork as we did.  Although they still claim that they did not have all the supporting records and documentation in their response and that it wasn't until they called our vet in June that they were able to have the necessary documentation to adjust our claim and eventually pay it out, our vet has a date stamped facsimile showing that they sent the information to 24Hour Pet Watch previously, which demonstrates their dishonesty.  
I question whether just because they've now paid out the claim that they should now be able to retain an A+ rating with the Revdex.com considering the documentation we have in place to support their dishonesty.
Sincerely,
[redacted]

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]

We apologize for the customer’s disappointment with their recent 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.As per the customer’s selected terms and conditions:NOTICE OF CHANGEWe 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 increaseYour renewal premium, or make a change to Your Policy we will mail or fax oremail written notice of our offer to renew 60 days before the effective dateof the change. Notice will be delivered to Your last known contact details onfile.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 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 encourage the customer to reach out to one of our customer service representatives to hear about the options available for downgrading coverage to find a premium that better suits their needs[redacted] Customer Solutions Specialist[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 as a rehash of what their customer service representative stated during my phone conversation. I am sure 24 Pet Watch and their parent offices take customer service seriously as testified by their near uniform 1 (out of 5) star aggregate reviews on the Revdex.com.
Sincerely,
[redacted]

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, 2016. The...

customer was provided with a total refund amount of $59.72.    [redacted] Customer Solutions Manager [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]

The customer’s account was cancelled as of June 7th, 2016 and a refund of $240.39 was issued on June 8th, 2016 to the [redacted] on file. Refunds can take up to 7 to 10 days to show on the customer’s statement of account.   We understand that the client and the clinic both state that full medical records were received prior to June 15th, 2016. Unfortunately, we do not have any record of the full medical history showing treatment in December and January being received in our office prior to June 15th, 2016. We apologize for any frustration that this has caused the customer and we are happy to be able to report that the claim was completed on June 15th, 2016.    [redacted] Customer Solutions Manager [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]

We apologize for the customer’s disappointment with their recent policy renewals.
 
After 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 customers. 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 policies, 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. 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 take our customers’ feedback very seriously as we are constantly looking to improve our product and service offerings.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted].  They have also directly contacted me regarding this matter, and we were able to resolve the issue. 
Thank you so very much for your assistance with this matter.
Sincerely,
[redacted]

I have wasted over 2 hours in two separate phone calls on hold to 24PetWatch XXX-XXX-XXXX! This is ABSOLUTELY UNACCEPTABLE customer service. I have been trying to notify this company my pet is gone and to cancel his pet insurance coverage. There is no mailing address for the company, only a PO box so I cannot send a certified letter. This company should be put out of business. I would hate to think what would happen if I actually had to file a claim or report my pet missing. I am appauled at this horrible service.

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 /* (1000, 5, 2014/02/13) */
Contact Name and Title: [redacted]
Contact Phone: XXXXXXXXXXX XXXX
Contact Email: [redacted].com
[redacted] operates a call center staffed 365 days a year, 7 days a week, and 24 hours a day by trained Lost Pet Recovery...

Specialists, and provides free registration and a complimentary first year of service for any microchip. After the initial complimentary year, clients can choose between a discounted Lifetime Maintenance Plan or, a pay as you go Annual Plan. By choosing either of these options the client can make unlimited changes or updates to their account either online or over the phone.
Final Consumer Response /* (3000, 7, 2014/02/13) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I still think they are scamming people because it wasn't something I needed.
Final Business Response /* (4000, 11, 2014/03/05) */
We have attempted to contact the client to resolve the complaint. A representative can be reached at X-XXX-XXX-XXXX ext. [redacted] or via email at [redacted].com.