Petplan woes

[Willow and J]

I have posted about my frustration with Petplan already, and because there are so many DK members who LOVE Petplan, I am a bit hesitant to bring this up again. But I am puzzled if I am particularly unlucky with Petplan every time I send claims or I am less patient then others? For those who love Petplan and have successfully received reimbursements, I'd like to hear your experience. 

I haven't been able to get reimbursement once during 2+ years of Willow being on the Petplan. That's not my main frustration. But it's about how they communicate and handle cases. Last time when Willow's AD was declined for "pre-existing condition", they did not indicate which diagnosis from the past that contributed to their decision. Did they decide AD was genetic and thus pre-existing, or a diagnosis from XX month in 201X has gotten them thinking this is a pre-existing condition? If it's genetic, then I basically know to not to bother with any allergy related illnesses in the future. Yes, they have a # to call if I have questions, but why do I have to spend more time, when they could just write that information on the letter? Why forcing sick animals' parents to dwell longer on this matter? (BTW, it took them more than a month to investigate and finally sent this useless letter.)

Another example: this time, I've submitted two claims, and they keep saying they did not get one part or the other - they have receipt from this one but not the claims for the other, and when the receipt is sent, they say claims form is not there, and they are doing this for each. So, in total, I've sent 4 faxes and still my claim is "incomplete" on their end.

Before someone remembers and asks, I know claims this time won't be accepted by Petplan since they've already declined a claim for AD in Jan. Long story short, I had to goto another clinic for the same illness because of first AD diagnosis was made without a test and I needed a second exam for Willow. Petplan will no doubt call this "pre-existing" condition again. But why did I do this? I've spent over $1000 so far for Willow's AD test and allergen shots, and I wanted them to look at this one more time. What I didn't foresee was how my experience with Petplan will go down the hill every time I try. This time, they can't even keep track of faxes sent to them.

Also, their email is lengthy and seemingly sympathetic, but these stock letters and emails with cut and pasted paragraphs ask this and that makes me mad. Instead of "if you haven't done so already~", why can't they check what they need and specifically ask for from which clinic from which period? They should have multiple copies of Willow's records from several vets office by now from previous claims. It also seems like each agent deals with case differently, and some agent just gets medical records etc. on their own, but this time, this one asks to provide "everything" without telling me what they have already. By now Willow has gone through two out-of-town clinics and three in-town vets. Do I have to provide everything from all of them? What's the point of sticking to one insurance company if they are not keeping records for individual client!?

I still want to believe that so many on DK can't be wrong and I should stick to Petplan, but I also feel like I could save a lot of my time and energy if I didn't have to deal with them over the years (and getting "$0" so far). One accident / illness might prove I'm wrong and it was all worth it, but meanwhile, should I give this company more money? Or, am I the exceptionally unlucky one?

(Apologies for this long post and for venting!) 

 

[Lucy & AnnaBelle's Mom]

I know you have said you don't want to or why should you have to, but I think it is time you pick up the phone and try and talk with them rather than just being frustrated.  At least that is what I would do.  I can tell you that I've called them several times.  I won't say that I at times have not been frustrated with them, but I've always been able to work things out and if they have declined a payment I have always been able to look right in their contract and see where and why they are declining.  There is a young girl there by the name of lauren that is very helpful.  When I went through Chemo with Sophie I called to find out the best way to process the claims as I knew that the chemo process was 6 months.  It was going to overlap years etc.  They said I could do it however I wanted.  Each Vet visit, monthly, or wait until the end.  I opted to wait until the end and then put everything together all in order as one large claim as I thought it would be simpler.  Well, when they got it they broke it all down into individual claims.  I got the same thing from them you are talking about .... we have this claim but no invoices, this invoice but no claim form etc.  By getting on the phone with Lauren (twice) we finally got it all sorted out.  I obviously wasn't in the best of spirits because I had just lost Sophie, but between the two of us we got it sorted out.  I think that because they are denying things based on preexisting info in your files you need to get a hold of someone there and find out exactly what it is they are talking about and what all it is exactly that they are going to consider pre existing conditions before you continue to pay them.  I would get this all documented in the file.  Problem with changing is the next company is going to consider them pre-existing as well.  You just need to completely understand where they are starting from so you won't be disappointed going forward.  I still think they are a good Pet Insurance Company although I've been looking at Healthy Paws lately as well as a pretty good Company.

[Jane, Guinness and Murphy]

I think this is very sound advice.  I've had a couple of experiences with Pet Plan and they went very well.  The first experience was when Murphy had the Rocky Mountain Spotted Fever.  I thought that everything had been submitted, and then I got a notice that they couldn't process the claim because they had "insufficient" information from the Vet.  I went to the Vet's office and looked at what they faxed and realized that they were at fault...Pet Plan requires full medical records for two years.  My Vet office only sent the records pertaining to this particular illness.  I straightened it out with the Vet, they faxed the rest of the information, and we received reimbursement very quickly from that point.  With my second claim (Guinness's Pancreatitis) I was dealing with both my Vet and the Specialty Hospital.  I went to both places and looked at exactly what they were submitting to the insurance company to be sure that everything was complete.  That claim was handled quickly from that point.  I think you definitely need to call and talk to one of the representatives so they can walk you through what they are denying and why as well as what specific information the require to examine/settle a claim.  I really think once you understand that, you can take charge of what documentation is being submitted, and things should go more smoothly.

[Lucy & AnnaBelle's Mom]

The other thing I have always done is right when I'm at the vet and they sign/initial the form I just ask for a copy of the hand written notes that are in the file and I just send them in right along with my claim.  That way it doesn't get delayed by them having to ask the vet for the records.

[Debb, Lucy & Oscar]

Getting on the phone with a claim processor is a great idea too. I've done that with Embrace a few times and it really, really helps to get things moving along. (After one such phone call I got my reimbursement check within days of it being submitted - I was shocked and amazed!).

[Karen, Jasper and Jackdoodle]

I'm sorry you are going through this. I know they denied Amy's Ollie's AD testing and treatment, saying it was a pre-existing condition because he was treated for a paw infection before she got the insurance, even though nothing was said to her about AD or allergies at that time. 

Let me give you my perspective, maybe it will help. After JD was diagnosed with AD, I decided that there was no point in getting insurance for him, since the allergies would not be covered. That decision has cost me thousands of dollars. No, theallergy treatments would not have been covered, but the $5000 it cost to diagnose his IBD (including a $3000 endoscopy/colonoscopy) and the thousands spent to treat it would have been. His $1600 MRI last fall to diagnose his ruptured disc would have been covered. If he ends up needing back surgery, the insurance would cover that $6000+ bill. 

In other words, "One accident / illness might prove I'm wrong and it was all worth it" is all too true.
I hope that one accident or illness never happens, but you just can't bank on that, especially as a dog gets older. 

I think Sheri's suggestion is a good one. 

Hope Willow does well with her AD treatments. 

[F, Calla & Luca]

You are our cautionary tale, Karen. In the end, insurance is there for major disasters and the rest is just the insurance companies way of making nothing easy

[Debb, Lucy & Oscar]

I don't have Pet Plan insurance (I have Embrace), but in the beginning 3 yrs ago I had similar experiences with parts of the claims not getting to them. It was frustrating and I can sympathize with how you're feeling. Then after about 6-9 months of being on the insurance plan things changed with them and claims were suddenly getting to them in full and I didn't have to follow through with tracking each claim down and calling vets to resend invoices and/or claim forms. I wondered at the time if there was a particular claim adjuster that had left, and maybe that person used shady tactics to stall the processing of claims. I don't know, but its definitely better now. I can't speak to your specific problem with the 'preexisting condition' issue.

What I would do if I were you, is send them the text above that you posted here. Explain to them where you're posting this concern. If they know that you're spreading the word of your dissatisfaction to a large online doodle community they might change how they handle your claims. Just a thought. I know reputation and word-of-mouth is a BIG thing to any company.

[Jane, Rooney & Stuart]

I have one dog Rooney with no insurance and my other one - Stuart  with Petplan.  We never thought to buy insurance for Rooney as he came from a quality breeder - wasn't I foolish - and after the fact we thought it was too late.  When we got Stuart we were much smarter (thanks DK) and as we had no idea of his background got him on Petplan right from the start.  We have had 2 claims for Stuart - his bee sting allergy and epi pen perscription and possible kennel cough.  Both went through the system very quickly.  The first claim we had the vet send in Stuart's entire record - I filled out 1 additional page of the claim form and also a short note detailing what had happened.  The second time I only had to fill out 1 claim form and faxed it with a copy of the vet bill.  I might not always love my deductible or co-pay but they do pay and quickly.  We have had no problems but we follow the submission instructions to the letter (not saying that you haven't).  Please gather your documents - give them a call.

[Amy, Cubbie & Ollie]

on the times that I have filed claims that were approved, they were very prompt with their payment.  I liked them enough to purchase a second plan through them (for Ollie) and even recommended them to my SIL.  I am still frustrated about the pre-existing condition for Ollie, but there isn't much else I can do at this point and switching to another carrier, would mean even more pre-existing conditions.

[Allyson, Peri & Taquito]

I agree - get someone on the phone and you will probably get somewhere.

Sorry you are going through all this! Willow is beautiful by the way.

[Amy, Cubbie & Ollie]

I think that by calling she will only find out what particular incident and date of treatment caused the pre-existing condition but I really doubt that she would get the AD covered at this point. 

[Jane, Guinness and Murphy]

I agree, but hopefully she'll get an explanation.