Tierrasanta Veterinary Hospital

Review: This complaint involves our dog, [redacted]. Briefly after welcoming her home, my wife had our pet insurance activated thru her medical insurance at Scripps Healthcare in San Diego. Our policy has been active since 11/9/2012. After having our insurance policy active, [redacted] was treated at the Tierrasanta Veterinary Hospital several times. My wife provided all the necessary insurance information to our vet (Tierrasanta Veterinary Hospital, Dr [redacted]) a few days after 11/9/2012. Actually, the insurance paperwork was given to them twice (once in November and once in December). Dr [redacted]'s office staff told us that all claims would be submitted directly to the insurance company. [redacted]'s treatment total between 11/9/12 and 12/17/12 was $1,096.61, which was covered by us out of pocket in anticipation of a future reimbursement by the insurance company.A few weeks ago, after having received no money from the insurance provider, we received a claim rejection letter from them stating that the reimbursement is denied due to Dr [redacted] and her staff not submitting the claim to the insurance company on time. There's a 90 day deadline for all claims. We heard from the insurance company that these claims were sent 112 days after the last treatment date. I have been in contact with California Department of Insurance verifying that the 90 day deadline is an industry standard. We have tried to reach Dr [redacted] several times but she refuses to speak with us. Her office staff has simply told us that the doctor thinks this is not a medical issue, thus, she doesn't have anything further to say. But the same office people have told us several times that this was their mistake and one of their employees even offered to pay this money to us out of her own pocket!? We simply said thank you but no thanks as this is something no individual employee should do but rather Dr [redacted] as the business responsible. The insurance company, again, refuses to pay according to their underwriting guidelines.Desired Settlement: First of all, it's our opinion that we should not be the ones paying the price of this mess. We have an insurance policy for Lola and my wife has done everything she possibly could to provide all the necessary paperwork to Dr [redacted] and her staff. It's unacceptable that we are stuck between these two entities and forced to pay the price of Dr [redacted]'s / her staff's mistakes. We are asking this money to be reimbursed to us immediately by the Tierrasanta Veterinary Hospital / Dr [redacted].

Business

Response:

Tierrasanta Veterinary Hospital

10799 Tlerrasanta Blvd., San Diego. CA 92124

888-282-8118

Complaint Information

Customer Information: Complaint# [redacted]

[redacted] Daytime Phone: [redacted]

[redacted] Evening Phone: [redacted]

[redacted] E-mail: [redacted]

Complaint Involves:

Billing or Collection Issues

Customer's Statement of the Problem;

Our client, the [redacted]'s and their pat, [redacted], held an outside contract with a pet Insurance

comp.any, namely PetFirst Healthcare. The Insurance company did not reimburse them for

medical services performed and so the [redacted]'s came after Tierrasanta Veterinary Hospital

to pay them. The [redacted]'s felt that Tlerrasanta Veterinary Hospital was somehow at fault for

them not getting reimbursed. As we will show below, this was a very frustrating issue for the

entire staff of Tierrasanta Veterinary Hospital as well as the [redacted]'s

Titrrasanta Veterinary Hospital's response to the complaint .

First ,·let Is be said that this is a very frustrating situation to see come across the desk of RevDex.com having it on Tierrasanta Veterinary Hospital instead of PetFirst Healthcare

Insurance. It is a case where our clients, the [redacted]'s loved us, the staff, and the doctor and

how they were treated and appreciated the medicine we provided to their pet Lola and they

had no complaints as to the veterinary medicine at all. This is the premise we start with as It

is Important as this fs our business In a nutshell to perform medicine and surgery on pets. We

are not in the business of billing or being affiliated with any insurance companies. Our client,

the [redacted]'s, In fact were so happy with our medicine and surgery, they wrote a 5 star review

for us. They never had any issues with any of the things we do business wise to supply Lola

with only the best we had to offer medically and surgically.

The premise of their complaint unfortunately stems from their frustration with not

understanding a policy they had signed up with on an outside company, namely PetFirst

Healthcare. We also were not even familiar with this company and had never heard of them

until the [redacted]'s. We have no ties, no contract, no knowledge of this company and their

policies and quite frankly know nothing of them. They are not the company we recommend to

all our clients if they want outside pet Insurance. For the [redacted]'s and often others too

unfortunatly, they expect a pet's Insurance to run the same as our human counterpart and in

fact they are totally different. We as veterinarians do not sign up to be a Nprovlder'' to any

insur~nce and therefore do not rely upon billing and collections and reimbursements as

huma·n physicians do. We Instead are a cash based business and directly receive payment

from pur clients. The [redacted]'s were always given written estimates of treatment plans,

signed for them and paid us directly. Again we do not "bill out" to Insurance companies. The

[redacted]'s willing paid their bills to us for [redacted]'s treatment at the time of services over the

period we saw her. We also find clients often do not read their policies and therefore fall to do

what they need to get reimbursed (see the copy of PetFirst Health care website: How it works

section). The client was

to "take the pet to the veterinarian. The veterinarian gives you a bill and you pay it. You (the

client owner) goes to the website and downloads and fills out the claim form and submits by

tlmailllfatnaH." As a courtesy we help our clients accumulate the invoices they might need

and lielp them thru the process. We however cannot be expected to know the nuisances and

timing of each policy and simply help where we can and do not charge anything extra to do

so. We have a delegated one employee, a care specialist to help clients with Insurance forms

.................she period of 10/12/12 thru early January 2013. At no time during that

period did they ever voice any concerns to us regarding Lola's treatments and in fact seemed

very happy. On 3/18/13, one of our care specialists that helps handle and guide clients with

their outside Insurance received a form from Mrs. [redacted] from her outside Insurance

company, PetFirst Health care. The care specialist caught that Mrs. [redacted] had not even

signed the form (which the form olearly states must happen in order to process) and she

called the client, went above and beyond her service to client and had her return to sign the

form. She would not have been able to help process and mail this form without the signature

and she caught it for the client. The owner was called and finally came in to sign the form or

drop off a signed for to us and we mailed the form on 4/3/13.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[Seeing a response from Tierrasanta Veterinary Hospital that is missing the whole point is not only frustrating but unethical. This whole complaint has never been about pet care so covering those points at great length is only muddying the waters further. Also, the Tierrasanta Veterinary Hospital's response is full of inaccuracies and lies and comes over a year after the whole incident took place. My wife submitted all the paperwork to the hospital and confirmed with the font desk person who said she would handle the claim on our behalf twice. These points have been mentioned in the past and I will not go over them again. However, I will spend my time correcting the lies that the hospital rep has started. First of all, the people we spoke with (believe the same person mentioned in hospital's response) admitted to us on the phone several times that this was their mistake and they should have submitted the claim paperwork on our behalf. Plain and simple. Their mistake admitted by the person who handles the matters with insurance companies. What's even more strange is that we were never able to talk to the person in charge/doctor directly. She simply refused to deal with us and told her front desk lady to speak with us (same person who admitted this being their mistake). Due to this late and inaccurate response by the business, I will now spend the next year writing accurate reviews about their way of doing business and make sure no other customer has to go thru this same bs with them]

Regards,

Business

Response:

Complaint Information

Customer Information;

[redacted] Daytime Phone: [redacted]

[redacted] Evening Phone: [redacted]

[redacted] E-mail: [redacted]

The details of this matter are ae follows:

Complaint involves:

Billing or Collection Issues

Customer's Statement of the problem:

Our client, the [redacted]'s and their pet, Lola, held an outside contract with,a pet Insurance company,

namely PetFirst Healthcare. The Insurance company did not reimburse them for medical services

performed and so the [redacted]'s came after Tlerrasanta Veterinary Hospital to pay them. The

[redacted]'s felt that Tierrasanta Veterinary Hospital was somehow at fault for them not getting

reimbursed. As we will show below, this was a very frustrating issue for the entire staff of Tierrasanta

Veterinary Hospital as well as the [redacted]'s

Tierruanta Veterinarv Hotpltal's response to the complaint

First let is be said that this is a very frustrating situation to see come across the desk of RevDex.com having it on Tierrasanta Veterinary Hospital Instead of PetFirst Healthcare

Insurance. It is a case where our clients, the [redacted]'s loved us, the staff, and the doctor and how

they were treated and appreciated the medicine we provided to their pet Lola and they had not

complaints as to the veterinary medicine at all. This Is the premise we start with as it Is Important as

this Is our business In a nutshell to perform medicine and surgery on pets. We are not in the

business of billing or being affiliated with any insurance companies. Our client, the [redacted]'s, in fact

were so happy with our medicine and surgery, they wrote a 5 star review for us. They never had any

issues with any of the things we do business wise to supply Lola with only the best we had to offer

medically and surgically.

The premise of their complaint unfortunately stems from their frustration with not understanding a

policy they had signed up with on outside company, namely PetFirst Healthcare. We also were not

even familiar with this company and had never heard of them until the [redacted]'s. We have no ties,

no contract, no knowledge of this company and their policies and quite frankly know nothing of them.

They are not the company we recommend to all our clients If they want outside pet Insurance. For

the [redacted]'s and often others too unfortunately, they expect a pet's insurance to run the same as

our human counterpart and In fact they are totally different. We as veterinarians do not sign up to be

a "provider" to any insurance and therefore do not rely upon billing and collections and

reimbursements as human physicians do. We instead are a cash based business and directly

receive payment from out clients. The [redacted]'s were always given written estimates of treatment

plans, signed for them and paid us directly. Again we do not "bill out'' to insurance companies. The

[redacted]'s willing paid their bills to us for Lola's treatment at the time of services over the period we

saw her. We also find clients often do not read their policies and therefore fail to do what they need

to get,reimbursed (see the copy of PetFirst Healthcare website: How It works section). The client was

to "take the pet to the veterinarian. The veterinarian gives you a bill and you pay it. You (the client

owner) goes to the website and downloads and fills out the claim form and submits by email, fax or

thru the mail." As a courtesy we help our clients accumulate the Invoices they might need and help

them)hru the process. We however cannot be expected to know the nuisances and timing of each

policy and simply help where we can and do not charge anything extra to do so. We have a

delegated one employee, a care specialist to help clients with insurance forms and copies of Invoices.

We treated Lola from the period of 10/12/12 thru early January 2013. At no time during that period

did they ever voice any concerns to us regarding Lola's treatments and in fact seemed very happy.

On 3/18/13, one of our care specialists that helps handle and guide clients with their outside

insurance received a form from Mrs. [redacted] from her outside Insurance company, PetFirst

Healthcare. The care specialist caught that Mrs. [redacted] had not even signed the form (which the

form clearly states must happen In order to process) and she called the client, went above and

beyond her service to client and had her return to sign the form. She would not have been able to

help process and mall this form without the signature and she caught it for the client. The owner was

called on 3/1912013 and finally came in to sign the form or drop off a signed for to us on 4/2/2013.

This was the first form we show In Lola's file and we did speak with the care specialist In charge who

also remembered this being the first form she knew of for Lola. [redacted]'s last veterinary services were

on December 17,2012 and we did not see her again medically. On March 18, 2013, she was

dropped off for a grooming and at that time left the form for us. By then, it was already beyond the

90day period Mr [redacted] discusses. If Lola's treatments were completed on December 17,2012 and

the clients did not hear from the Insurance company, why did they not call the Insurance to Inquire or

place· any call to us during the time from December 18, thru March 18, 2013? If they had done so. to

either, I am sure this could have been avoided. They were In fact In for grooming on January 21,

20131 and nothing had been mentioned regarding the insurance even at that time. If we had any

indication at all during that December thru March tlmeframe that they had trouble with their Insurance

we might have been able to help. They never called during that time at all to ask for help or Inquire.

Attached is a copy of the Insurance form we received from the [redacted]'s not signed and also what

the responsibility is for the client from Petflrst Healthcare's own website.

Message from Tierrasanta Veterinary Hospital

As soon as we became aware of the [redacted]'s situation In April, we placed him In contact with the

hospital manager who handles these issues not the doctor. The doctor and the manager spoke many

times trying to find a solution that would work for both the [redacted]'s and Tierrasanta Veterinary

Hospital. What the client wanted was for Tierrasanta Veterinary Hospital to pay for medical services

that Dr Luke and Tierrasanta Veterinary Hospital had provided for their dog Lola. This was deemed

an unreasonable request when the client had always been happy with the medicine and service. The

hospital manager and Mr. [redacted] spoke over 20 times trying to resolve ,this issue. She also

contacted PetFirst Healthcare as well as Dr. Luke personally speaking wlih the Insurance company

on their behalf several times. We literally tried that hard! While we could not feel comfortable

supplying Mr [redacted] with his demand, we did offer to Mr. [redacted] free grooming ($45) and free

heartworm/flea product (trifexis) that would cost him over $250.00 and would have matched what they

were out from the insurance company. We worked with our outside drug representatives to sponsor

this and PetFirst Healthcare agreed to reimburse for the product even though they were getting free

product from us to try to help the client. This would have totaled over $350.00, but the owner would

not accept. At some point, we just have to say enough is enough and did we try our hardest? We

can honestly answer that yes indeed we did especially in light of the fact that this was not our fault to

begin with. Simple follow up and phone calls on the owners part would have avoided this and

ultimately was their responsibility as the owner of the Insurance In the first place. We did want to

keep Mr [redacted] happy, but it seemed that nothing we offered, did, or any amount of effort on our

part was going to work.

Unfortunately, the first time we were aware of the problem was when [redacted]'s received the

explanation of benefits from PetFirst Healthcare which was beyond the allotted time to get

reimbursement from their pet Insurance.

I took my dog to Tierrasanta Veterinary Hospital (the one near Haagan.) During my visit I was left waiting for over 2.5 hours. I strongly felt that Dr. Luke was making sales on me, and not considering treating my dog, but adding additional unnecessary costs to my bill. She even pressured me by saying I would have to sign a form stating that I was "going against doctors orders" (a form which they never brought) and the worst part was when I got home I found that they didn't include two of the medications I had paid for. I called the next day to ask for the medications at which time I was told that since I left, the price of the medication had gone up and to receive the medicines (that I already had a receipt for) I would have to pay an additional $88 dollars for it. After four days, 7-8 phone calls, and arguing I finally got the medication. Worst customer service experience I have ever had. Not to mention the office was filthy. I HIGHLY DISCOURAGE ANYONE FROM TAKING THEIR PETS HERE.