• Report: #765091

Complaint Review: Petfirst Healthcare

  • Submitted: Sun, August 14, 2011
  • Updated: Wed, January 18, 2012

  • Reported By: Unhappy — Swarthmore Pennsylvania United States of America
Petfirst Healthcare
Internet United States of America

Petfirst Healthcare Multiple refusals and extensive red tape, Internet

*Consumer Comment: Petfirst insurance has been great for us!

*Consumer Comment: Not upfront with policy

*UPDATE Employee: PetFirst Response

*Consumer Comment: Wouldn't it be better

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In January 2011 my daughter adopted a dog from the SPCA.  I purchased Petfirst health insurance coverage for her.  Since that time, Since the dog had health issues, I have submitted multiple claims, and gotten very few payments on them.  The usual routine is to a submit a claim, have the claim denied (unless it is for inexpensive routine care), and I then have to submit medical records. Then the claim is denied for various hokey reasons.  

The forms have to be filled out correctly with a stamp and signature of the vet plus the stamp of the clinic.  This in itself is a real pain as you have to remember to bring the claim for with you.  If you forget a claim form, you have to contact the vet and beg them to fill out one for you, something which they don't do correctly most of the time.

Once I get the claim in, it is usually denied, and I then have to contact the clinic and have them send the dogs complete medical records.  I submitted one for Lyme Disease treatment and was told that Lyme disease is preventable and so it wasn't covered.

I urge owners to avoid Petfirst and find another pet health insurance that is a reputable company.

This report was posted on Ripoff Report on 08/14/2011 03:35 PM and is a permanent record located here: http://www.ripoffreport.com/r/Petfirst-Healthcare/internet/Petfirst-Healthcare-Multiple-refusals-and-extensive-red-tape-Internet-765091. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Consumer Comment

Petfirst insurance has been great for us!

AUTHOR: BeagleMom - ()

I want to state that of all the pet insurances that I have researched, and also used in the past, Petfirst is by far the best one I have ever paid for.

I have 3 personal dogs, 3 cats, and 2 foster dogs, and I have covered every animal in my home at one time or another. I always add a "rescue policy" for any new animals coming in....it gives immediate coverage at midnight the day I sign up for accident and illness with 100% reimbursement after a $50 deductible. I have never had a problem getting any claims paid.

I use the insurance for what it is intended...accidents and unavoidable illness. Two of my dogs got into a snake nest and both needed to go to vet at the same time. I do have to pay upfront, but I received money back on both claims.

My oldest dog was hit by a car, and went to emergency room at 530am. I have care credit to cover the initial charge, but when I saw the estimate, I knew I had enough to cover the fees. Since he required surgery, I actually received the full $1000 back because they counted the $50 deductible and additional 10% from the additional medical expenses incurred, and also received additional money for an ear infection and antibiotics which fell under the illness portion. I only wish that I had a higher coverage amount, but never anticipated an accident with such a large expense.

I had the peace of mind to know my dog could be treated...didn't have to consider euthanasia due to lack of funds, and I received reimbursement about 2 weeks after I submitted the claim.

I have referred many friends and all the rescue folks to this insurance. While it doesn't cover pre-existing or preventable illnesses, I think it is worth every penny to know that when they are sick or injured, I can afford to have them covered for the majority of things that may occur.

My 3 personal dogs share a policy for $43/mo and have $2000 of coverage. I use low cost vaccine clinics to keep them current on shots and Heartworm meds and flea prevention, and I have only had one claim completely denied and knew that it may be rejected due to possible pre-existing/congenital defect on one of my adopted dogs.

No other insurance has come close to covering the basics for such an affordable cost. (roughly $14/mo for single policy, and $43 for the the 3 together...and I only have $50 deductible with 100% coverage for rescues $1000 total, and 90% for the others $2000 total) I have chosen to keep them at the minimum levels and set additional money aside in case of additional expenses. I just like knowing that I don't have to worry about having the money to pay for their care.

To date I have filed 7 claims on 5 different animals and was paid for all but 1 (which didn't cover the corrective surgery, but did cover the infection and antibiotics for a partial reimbursement.)

I highly recommend this insurance, especially to someone rescuing a new dog that you don't have any medical history of, or a new puppy who is most likely to occur accidents or illness in their first year just by nature. It is only $5 plus tax for the first month and coverage starts immediately, and you get a full copy of the policy including inclusions and exclusions within 24-48 hrs of signing up.

The only negative I have is that you can't reach a customer service person on the weekends, so if you plan on adopting on a weekend, add the potential dog before picking them up so that they are immediately covered when you take them home.

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#2 Consumer Comment

Not upfront with policy

AUTHOR: Tim - (United States of America)

Hi, I just adopted a dog at the local shelter. At that time, there was an offer of pet insurance with this company at an intro price of $5 for first mo. 14.95 thereafter.
So I go to the website to review the policy first...No policy terms stated??
I call the toll free # and with much frustration I am told in salesman speak that I cannot review the policy until I actually send money first! WTF? Anyway I ask to speak to a supervisor and am told that they are on lunch.
One last note:Customer service person was about to hang up on me before I could find out the details.
Based on this experience, I will NOT be buying insurance from this company.
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#3 UPDATE Employee

PetFirst Response

AUTHOR: PetFirst Healthcare - (United States of America)

Were sorry that your experience with us has not been satisfactory. We would be glad to talk with you further to discuss your claims and what we could have done differently, or even just to explain the process in further detail so that your claims experience meets your expectations.

Insurance contracts, claim payments, and all the associated administrative functions of pet insurance are regulated by the states in which policyholders live. Even though we consider our pets part of our family, they are actually defined by the states as personal property and are subject to the states laws regarding property insurance. The way we handle claims is regulated by your state Department of Insurance and they impose some specific requirements on us. For instance, all the coverage and exclusion language in your policy must be filed and approved with the Department of Insurance prior to our issuance of any policies. The Department reviews the language of the policy to make sure its readable, that there isnt any intentionally confusing or misleading language and that all the terms comply with state law. As a company we are then required follow the exact terms and conditions approved by the state or risk state sanctions. This means if the policy says certain items are included, or specifically excluded, we must follow the exact intent of the policy.

Also with claim payments the Department requires, by statute, that we complete a thorough investigation before we approve or deny claims. In order to meet that legal requirement, we must obtain a complete medical history on each pet to make sure that we have enough information to make a determination on what is covered and what isnt under the state approved terms of the policy. Failure to investigate a claim by requiring full medical records would be unfair to our policyholders and a violation of state law. We realize that the claims submission process seems like a lot of hoops to jump through; however it is a necessary process to ensure we have the information to fairly evaluate your claim. This includes looking at pre-existing conditions, preventable conditions, or any other items that are excluded under the state approved policy.

Finally, regarding your claims that have been denied; insurance, whether its coverage for our furry family members or your auto and home insurance is intended as a tool to mitigate loss. Insurance policies arent intended to cover every possible scenario of loss, which is why they have deductibles, co-payments, and excluded areas of coverage. Its a balance of trying to provide good comprehensive coverage at a reasonable cost. The cost of your policy is simply a function of a claims cost. If any policy (pet, auto, home) covered every conceivable loss scenario, none of us would be able to afford the premium for the coverage. Our policies provide an effective balance between the most common conditions and an affordable monthly or annual premium. We would recommend review of the policy terms and conditions in order to ensure there are no surprises the next time your pet requires treatment.

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#4 Consumer Comment

Wouldn't it be better

AUTHOR: mr rik - (USA)

to just put money in a savings acct instead of paying the HIGH premiums for WORTHLESS insurance?

No hoops to jump through either.

Oh yeah, the "spca" is usually a scam too.
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