Reviews

Review Details

• Review fromPaula R

  Date: 08/05/2024

  1 star

  Paula R

  Date: 08/05/2024

  Prudent Pet (pet health insurance) denied a legitimate claim, repeated their denial despite my twice pointing out that the reason for their denial was illogical and inconsistent with my dogs clinical history, and then reversed their decision after I mentioned that I did not appreciate companies making profits because they know most people wont appeal erroneous claims decisions and that I had previously reported another insurance company to the Insurance Commission for a similar business practice. In the process of reversing their decision, they revealed that they had all along had the information that demonstrated that their initial denial was erroneous. They had claimed that because my dog had shaken her head on an earlier occasion months before, that that was a clinical sign that meant her current hematomasomething she had never had beforewas an excluded condition because head shaking "could" be a sign of a hematoma. Horses have four legs; that does not mean that all creatures with four legs are horses. Her previous head shaking was due to foxtail; had nothing to do with hematoma. They discovered this upon closer examination (of vet records they already had) after I implied that I would report them. Icing on the cake, they tried to blame me for not initially communicating that information even though I had repeatedly pointed out that the dog had never had a hematoma before. I requested either a reversal of their decision or a refund of all policy premiums paid to date; they chose to reverse their decision. In choosing to reverse, they avoided paying out anything because of the deductible and co-insurance, but in doing so, gave me what I really wanted, i.e. they demonstrated that they had the correct information all along and had made an erroneous decision that they defended until threatened.
  

  Prudent Pet Insurance Agency, LLC

  Date: 08/26/2024

  We genuinely regret this policy holder had a negative experience with Prudent Pet as we strive for superior service, value, and claim processing accuracy for each and every policy holder. Claims are processed in accordance with our policy terms as outlined by our underwriter ******. In cases where the policy holder disagrees with the claim determination, the policy holder has the option to appeal the determination and submit additional medical records that support the appeal. We are happy to work all appeal requests to ensure all parties are heard and any misinformation is clarified. While this policy holder did not request an appeal, our Claims Adjuster took it upon themselves to escalate the communication from the policy holder to our Claims Manager for review, as is standard operating procedure for Prudent Pet when a policy holder is unhappy with the explanation of a claim determination. Because the pets medical records confirmed the pet had previous hematomas due to ear infections, it was reasonable for our Claim Adjuster to deny this claim as pre-existing. However, once the claim was escalated to our Claims Manager, they investigated further, which is also standard operating procedure. They re-reviewed records and then reached out to the veterinarian who confirmed the reason for the ear shaking was due to a foreign body in the ear that was not discovered until two visits after the initial claim date of service. This allowed us to reverse our claim determination and pay this claim in accordance with our policy terms as it was not linked to a pre-existing condition. We followed all service and claim processing procedures as well as complied with all requests from this policy holder. While we are disappointed this policy holder views that our decision was erroneous intentionally, we did process the claim correctly based on the information we had been provided and only reversed our claim determination after confirming additional information with the veterinarian. We thank this policy holder for the opportunity to insure her beloved furry family member, and hope she finds other insurance protection for her pet even though she was unhappy with Prudent Pet.