This company is the WORST!!! They will do anything to get out of paying claims. When presented with medical records they will dismiss anything that is not in their favor to get out of paying. When you call customer service the only information they can provide you is the notes that are sent back to you with your explanation of benefits. I had to file an appeal twice to have them actually look over the medical records and now they are have sent the vet a question where there’s not really a good way to answer so that they can find some way to get out of paying.
Summary of events:
Claim submitted 10/21/19
Claim denied 11/1/19 REASON: D11 Policy per-incident limit or lifetime limit has been reached
No further explanation or documentation provided to me. I called and they said that the vet thought that the 2 incidents were related. (His previous bout of pneumonia and the most recent one) the hospital did not follow up with my vet which had taken x-rays showing that he no longer has pneumonia between the 2 incidents. So I filed an appeal.
Appeal filed 11/4/19
Appeal denied 11/19/19 REASON: D11 Policy per-incident limit or lifetime limit has been reached
No further explanation or documentation provided to me. I called and they said that the vet thought that the 2 incidents were related. (His previous bout of pneumonia and the most recent one) the hospital did not follow up with my vet which had taken x-rays showing that he no longer has pneumonia.
NO THAT IS NOT A TYPO THE SAME EXACT EXPLANATION OF BENEFITS WAS SENT TO ME WITH A DIFFERENT DATE.
I sent them my dogs medical records yet again for a second appeal because when I called customer care yet again they gave me the same reason. I wanted to know why the medical records were not reviewed or why there was no further explanation provided. They said you can file another claim.
2nd Appeal filed 11/14/19
More information requested from the vet: According to Winston’s medical history, he has been treated On three separate occasions for bronchopneumonia. Bring the medical records from your hospital, it indicated that Winston presented on 9/19/19 and 10/20/19 for vomiting, which developed into secondary aspiration pneumonia. The medical records from Hutto veterinary clinic stated that the recheck radiographs performed on 10/3/19 revealed no radiographic evidence of bronchopneumonia.
While we understand that the recheck radiographs on 10/3/19 revealed normal radiographs, in your professional opinion’s, has an underlying ideology and or cost for the vomiting a 9/19 and 10/20 been determined?
Currently waiting to see what the insurance comes back with this time. This is 2 separate bouts of Pneumonia and I have medical records and x-rays to prove it. However the insurance company is still trying to find a way to get out of paying it.
My dog was diagnosed with brachycephalic syndrome Which if you are not aware refers to the combination of elongated soft palate, stenotic nares, and everted laryngeal saccules. While he did have surgery on his everted laryngeal saccules and stenotic nares he also had a repair of his secondary cleft palate which is not a part of the brachycephalic syndrome. However my explanations of benefits states: my hereditary plus was added 2 days too late. I get it. My loss however part of the surgery unrelated to the “diagnosis” made 2 days prior was addressed with surgery and the whole denial was based on the diagnosis of brachycephalic syndrome.
I have spent numerous hours filing appeals and speaking with employees trying to resolved this. This company is the absolute worst. If you love your pet stay FAR FAR away!!! I am baffled that the AKC allows their name to be used with this company.