# A bad experience with Petplan insurance



## Loop Hole (Mar 15, 2016)

I just had two claims denied by Petplan based on language in their policy that defines preexisting condition as any pre-coverage treatment for the same illness. Mine was infected ears five years between occurrences. Hardly a condition that preexists in the strict meaning of preexist.
In my opinion such a broad definition of preexisting seriously limits the coverage available for a dog insured other than as a very young puppy. Not easy to find this language in the policy because it is buried in the preexisting exclusion paragraph and not delineated as anything as broad as previously treated conditions.

I wonder if anyone else has run in to this with Petplan.


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## Thomas D (Jan 27, 2003)

How did your vet write it up? Did your vet know you were going to submit it?


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## ErinsEdge (Feb 14, 2003)

How much money was it for and how much was your deductible? It can't be for much. If ear treatment was in the records, they would turn it down. I wouldn't even turn something small like that in. There are pet insurance programs that cover everything by adding a Wellness plan but you will pay for them and for an average dog it isn't worth it. I have pet insurance for the big stuff.


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## Thomas D (Jan 27, 2003)

Funny OP posts one time to complain and then disappears.


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## Loop Hole (Mar 15, 2016)

Thomas D said:


> How did your vet write it up? Did your vet know you were going to submit it?


She billed for detecting and treating the ears about $100 and $400 for ex-rays to diagnose an anterior crutiate tear, the repair of which will be just over $5,000 when rehab is complete. I emailed the claim and the carrier contacted the vet for the dog's life history. Both claims were denied with the same "pre-existing" form letter without signature. I have resubmitted and will sue if denied the crutiate treatment. I might make it a class action and discovery how many other rejections in Colorado were based on similar incidents.


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## Loop Hole (Mar 15, 2016)

I have the Gold coverage. I think it is an annual $200 and then 80/20, although I remain O for 1 as I cancelled the policy the day the ludicrous pre-existing definition was called to my attention, that ruled out coverage on the ears and the patantly false finding as to the knee.


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## Loop Hole (Mar 15, 2016)

I sent in the single bill and Petplan turned it into two claims and denied both with the same form letters.


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## Justin Allen (Sep 29, 2009)

How long have you had your policy?


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## ErinsEdge (Feb 14, 2003)

The policy must be in effect for 6 months before a ccl can be claimed. If you had the vet examine the dog in the first 30 days of covereage and and say no evidence of ccl damage or patella damage and note it in the chart, then it is effective immediately. Of course they separated the ear treatment because it wouldn't be paid because your deductible hasn't been met and it is a different claim. If the ccl was before the 6 months then that's why it was denied. If not, have your vet resubmit it by itself. The other knee would be covered after a year after the first repair. Most of the time I get policies for ccl coverage and if I can't find it I phone and ask if its covered.

See V Exclusions g-j

If you cancelled the policy now you are SOL with any other insurance company taking the policy without an exclusion of both legs.


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## sandysylvester (Apr 13, 2015)

This is the 2nd person I see with such a low cost for the insurance. Why am I getting a 35 a month quote from Petplan or is it because I am in NJ? I was looking to cover a 10 month old pup, but at that price I may as well stash the cash in an emergency fund for him...


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## ErinsEdge (Feb 14, 2003)

sandysylvester said:


> This is the 2nd person I see with such a low cost for the insurance. Why am I getting a 35 a month quote from Petplan or is it because I am in NJ? I was looking to cover a 10 month old pup, but at that price I may as well stash the cash in an emergency fund for him...


It goes by Zip Code. My property is 20 feet from a different zip code and it is much cheaper.


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## Loop Hole (Mar 15, 2016)

The coverage is $200 deductible. My four dog premium was almost $600 quarterly and I have had it over six months. Not having any coverage is kind of like having Petplan from my viewpoint.


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## sandysylvester (Apr 13, 2015)

^^^^ But that is what I mean. Does a zip code make a dog more likely to need to put in claims for injuries? Stuff like that annoys me.


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## ErinsEdge (Feb 14, 2003)

sandysylvester said:


> ^^^^ But that is what I mean. Does a zip code make a dog more likely to need to put in claims for injuries? Stuff like that annoys me.


Of course not but the regular insurance companies are the ones that underwrite it so it is based on the tables where care is higher or lower. Metropolitan city is higher than out in the country.


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## JusticeDog (Jul 3, 2003)

Loop Hole said:


> She billed for detecting and treating the ears about $100 and $400 for ex-rays to diagnose an anterior crutiate tear, the repair of which will be just over $5,000 when rehab is complete. I emailed the claim and the carrier contacted the vet for the dog's life history. Both claims were denied with the same "pre-existing" form letter without signature. I have resubmitted and will sue if denied the crutiate treatment. I might make it a class action and discovery how many other rejections in Colorado were based on similar incidents.



First, send an email to PetPlan's head vet. He was helpful in getting one of my claims paid. If that does not work, 
File let a complaint with your state's department of insurance. They have to answer with specifics then. Be sure you quote the policy and use your records as exhibits. If you need assist, let me know.


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## Loop Hole (Mar 15, 2016)

test111111111


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## Loop Hole (Mar 15, 2016)

UPDATE I did contact the state and am in hopes of receiving some relief based on deceptive disclosures. Yesterday I received three letters from PetPlan reviewing my re-submission or appeal of the denials. All three remain denied. What amazed me is the extent of the research evidenced in the rejection letters. There ar 18 pages to these three letters. The crew at PetPlan was provide two pages of vet records (all my vet gave me). The letters contained information form many other vets, apparently identified, contacted, and records were provided all without my knowledge or permission. I have learned three things from this. One, PetPlan is hugely staffed to investigate and deny claims. Two, why would I want to be involved with and insurance company that is so adversarial? The 11 page denial letter on the ear infection had to cost more in man hours than the $44 ear wash. And three, nobody should insure an older model dog with this company. It just is not likely that a common malady will be covered. Take the advice of my friend Ted, insure a seven week old with a letter from your vet asserting perfect health. This costs a life time of premiums, but at least you are paying for health insurance not investigators.


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