Why Did Pets Best Insurance Deny Claims for This User?

General Forum
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Pets Best Insurance denied our claims for my dog’s Cushing’s Disease diagnosis, claiming it was pre-existing, which it definitely wasn’t. I need some advice on what to do next :paw_prints: .We signed up for a policy with Pets Best on 2/3/24, and our waiting period ended on 2/17/24.

On 8/6/24, we took our dog to the vet because she was showing some odd behaviors like heavy panting, pacing, and increased thirst. When the vet asked how long I’d noticed these symptoms, I said “about 6 months.”

They ran some blood tests, and the next day, the vet suspected Cushing’s Disease. On 8/14/24, we brought her in for an 8-hour test (the LDST). The following day, we learned it was Cushing’s due to a pituitary gland tumor. After that, the vet started her on medication, and on 9/3/24, she had a follow-up test (the ACTH Stimulation Test) to check her dosage.

Now, the insurance company is saying the claims were denied because they considered it pre-existing based on the vet’s notes from our visit. They wouldn’t tell me exactly what they found in her records. I looked through her records and think they’re relying on a note from the 8/6/24 visit that said, “for 6 months patient has been urinating in the house…”

If you count back 6 months from our first visit, that brings you to 2/6/24, just 11 days before the end of our waiting period. I realize now I should’ve been clearer about when the symptoms really started, which was in April 2024. I was just trying to give a rough estimate. Honestly, I was super stressed during the visit :worried:

This whole denial feels really unfair. The notes don’t reflect what I said accurately. Did Pets Best not consider an 11-day difference? When I got the insurance, I honestly didn’t suspect anything was wrong. All the testing has already cost about $800, and her medication is $194/month for the rest of her life. The insurance would’ve made a huge difference with reimbursement.

Any suggestions or advice? I’m really upset about this.

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Has your vet written or called on your behalf? I’m dealing with a similar denial with Figo right now, and the best advice I’ve received is to have the vet argue that “6 months” was just a rough estimate. They could clarify when the real symptoms started. :stethoscope:

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I just got off the phone with both the pet insurance company and my vet. I received an appeal form from Pets Best, and one option for documentation is a statement from the vet to support my appeal. I’m just waiting for my vet to call back about that letter.

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Unfortunately, this may count as pre-existing based on your own words. It’ll be tough to change anything now that it’s on your dog’s record. You mentioned this was pre-existing to the policy, so it may not work in your favor. :confused:

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You can definitely appeal the decision, but it’s going to be challenging. Your vet is obligated to record what they heard from you, and they can only amend it, not change it completely. They may not be willing to adjust it either.

There’s a significant difference between saying the symptoms began in February and now saying they started in April. The insurance is likely to stick with your initial statement.

I’d also check for other signs in the records. They might argue there were symptoms present before the diagnosis. Insurance companies take dates very seriously and can interpret vague language to their advantage. If no specific date was mentioned, it could be hard to win this, though you never know.

This situation shows how vets often aren’t trained for insurance paperwork. In human healthcare, there are experts who really know how to nail down the timing. Unfortunately, vets don’t usually have that training yet. Pet owners need to be vigilant when making claims. :grimacing:

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image

Picture of the exact verbiage used when they denied our claims.

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That’s really frustrating! I’m so sorry to hear that. Definitely appeal! I tend to use rough estimates too, and it feels like they comb through everything to find a way out. I really hope it gets approved for you! :pray:

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Thanks. I just got the appeal form today. I really should’ve been more precise during my conversation with the vet. Lesson learned for sure.

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Keep us updated, and thanks for sharing your experience! It helps us all learn. :+1:

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You can appeal, but since your own words indicate it was pre-existing, it might be tough. Have a chat with your vet to see if they can help with the appeal.