Slow pay and eager to blame pre-existing conditions

2
Out of 10

I've been a customer of Pets Best for over 10 years and have insured eight cats with them over those years. In the beginning, they were easy to work with. I'd submit a claim via mail (that's how long ago we started with them) and would receive the agreed upon reimbursement within the SLA.

As time went on, though, there was a shift. Unless a claim was for an insignificant amount or easily denied, it would take longer and longer to process. I would receive emails apologizing for the delay, claiming a heavier than normal work load. But this would only occur when I submitted a claim for more than a token amount (say, less than $200).

This review has been a long time coming. I kept hoping that was I was experincing was a fluke or a one-off. That doesn't seem to be the case.

In the span of a few weeks, I have an example of each of the reasons I am not happy with their current level of service.

We have a two-year old cat named Yelena. When we adopted her, we knew she had food allergies. So, when we signed her up for Pets Best, we listed food allergies as a pre-existing condition. I fully expected anything that came up with Yelena's health that dealt with food allergies would not be covered. That makes perfect and complete sense. We knew going in she had food allergies, so we wouldn't expect Pets Best to cover it. She's also apparently accident prone.

On August 23 the bit her tongue so we took her to the vet. On the 25th, she had to have sutures because the laceration was not healing. I submitted the claim on the 26th. On the 30th the claim was set to pending vet records. I talked to my vet on the 31st and they confirmed they sent the requested records. The claim remained unchanged in Pets Best's system. I contacted them via their portal around Sep 6 about the vet records. They confirmed they had the vet records.

It wasn't until the 17th of September that they finally completed the claim. They did submit the agreed upon amount for reimbursement.

Then, late on September 7th, Yelena started vomiting. By the next morning, she was leaking blood from her rectum so we ran her to the vet. She went through a battery of tests and was prescribed several medications. Yelena didn't eat over the weekend, which we expected because of all the vomiting. However, when she wasn't eating by Tuesday we were increasingly nervous. We took her in to the vet on Thursday (they're closed Wednesdays). They performed a barium series and other diagnostics. She began eating on Friday the 14th and has begun making a slow recovery. Our vet said that she most likely had a severe bacterial infection. She suspected Clostridium sp.

I was submitting the claims for these procedures as we went, but based on my recent experience wasn't expecting an explanation of benefits for a month. However, they turned this one around fast. They denied everything claiming it was tied to her pre-existing food allergy.

Yes, food allergies affect the gut. But , so do other things. Our vet did not think this was related to food allergies, instead it was a bacterial infection.

Did you find this review helpful?
Injury/illness

Gastritis/vomiting

Enteritis/diarrhea

laceration
Claim Amount
$500 - $1000
Breed

Mixed Breed

Age of Pet
1 - 8

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Posted: 10/02/2018
By: isis

Hi Chad, we understand your concern for coverage. Based on the medical records, the claimed condition was present prior to the policy start date. Our records show every other eligible claim has been processed and paid out. We show you have initiated a first level appeal. Please let us know if you have other questions or concerns. Have a good day!