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The VPI Claim form serves as an essential document for pet owners seeking to process claims through Veterinary Pet Insurance. Each pet requires a separate claim form, ensuring that all details are accurate and specific to the individual animal. The form comprises several sections, including policyholder information, claim details, invoice submission, and the policyholder's signature. Proper completion of the form is crucial; incomplete submissions can result in delays in processing claims. To facilitate claim approval, pet owners must provide itemized invoices along with the claim form, avoiding any estimates. It highlights the need to check the reasons for the veterinary visit, which may include wellness services or treatment for injury or illness. A clear diagnosis, free of symptoms, must be included, typically corroborated by a veterinarian's records. It is important to submit claims through one designated method, whether it be fax or mail, as multiple submissions can further complicate the process. Additional resources, such as the VPI Policyholder Portal, allow pet owners to track their claims at any time. The guidelines aim to streamline the submission process while providing reassurance that assistance is available at any stage of the claim process.

Vpi Claim Example

CLAIM FORM

Fill out one claim form per pet. Submit itemized, legible invoices.

Incomplete claim submissions may delay claim processing.

1

POLICYHOLDER INFORMATION

 

No. of pages: ____

 

POLICY NUMBER:

ADDRESS:

 

 

CITY:

 

 

 

 

 

PET NAME:

STATE:

ZIP:

 

NAME:

PHONE (H):

PHONE (W):

 

EMAIL:

 

 

 

 

NEW CONTACT INFORMATION? Write your new information here: ___________________________________________________________________

2 CLAIM DETAILS

REASON FOR VISIT (CHECK ALL THAT APPLY):

TREATMENT DATE(S):

 

□ WELLNESS SERVICES

FROM:

/

/

 

□ INJURY OR ILLNESS Write the diagnosis in the box below.

TO:

/

/

WHAT INJURY OR ILLNESS DID YOUR VETERINARIAN DIAGNOSE?

HOSPITAL/CLINIC NAME:

 

A diagnosis is the medical condition treated. Please do not list symptoms. For example, if your pet broke a bone, a symptom might be “limping,” but the diagnosis would be “broken bone.” Your veterinarian can help you with the diagnosis. Include a copy of your pet’s treatment records and lab results for this visit if there is more than one condition being treated, your pet stayed at the hospital overnight or the diagnosis has not been determined. Please do not write “See Attached” or list the services shown on your invoice.

3INVOICE(S) TOTAL

$

You must submit itemized invoices with your claim form.

Do not send estimates.

4POLICYHOLDER SIGNATURE and DATE

X

/

/

By signing this claim form, I confirm that to the best of my knowledge the

information I have provided is true and correct. I authorize my veterinarian to

 

 

 

release medical records and give consent to Veterinary Pet Insurance Company

 

 

 

in California and DVM Insurance Agency in all other states to communicate with

 

 

 

my veterinarian or veterinarian’s staff.

5SUBMIT CLAIM FORM and INVOICE(S)

Please submit your claim by one method only.

VPI CLAIMS DEPARTMENT NOTES ONLY

Duplicate claim submissions will delay claim processing.

FAX

(714) 989-­‐5600

No cover sheet necessary.

 

-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐OR-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐

 

MAIL

VPI Claims Department

 

 

PO Box 2344

 

 

Brea, CA 92822-­‐2344

 

CF-­‐1 (05-­‐12)

©2013 Veterinary Pet Insurance Company

13RET2424

FAX ONLY THE FRONT PAGE OF THIS CLAIM FORM

DO NOT PAPERCLIP OR STAPLE ANYTHING THAT MAY COVER PART OF YOUR CLAIM FORM

The VPI Policyholder Portal gives you 24/7 access to your policy. Log on at my.petinsurance.com.

How to File a Claim

Step 1: Complete your claim form by checking the reason for the visit (wellness services and/or injury or

illness). If your pet was seen for an injury or illness, please write the diagnosis (the name of the injury or

illness your veterinarian diagnosed) in the box provided.

Step 2: Obtain a copy of your itemized invoice(s) and any supporting documents (e.g. medical records,

lab results, etc, if applicable) to send with your claim form.

Step 3: Send your claim and invoice to VPI.

Email: For details on how to email your claim, visit my.petinsurance.com

Fax: 714-­‐989-­‐5600

Mail: VPI Claims Department, P.O. Box 2344, Brea, CA 92822-­‐2344

Check Your Claim Status Online

Log on to the VPI Policyholder portal at my.petinsurance.com and click on “View Claim History.” The status of faxed or mailed claims will be available 72 hours after they are received.

We’re Here to Help

Contact a Customer Service representative toll free at 800-­‐540-­‐2016. Representatives are available Monday–Friday from 5:00 a.m. to 7:00 p.m. and Saturday from 7:00 a.m. to 3:30 p.m. (Pacific time).

Notice to Maryland Applicants: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Form Characteristics

Fact Name Description
Claim Form Submission Individuals must fill out one claim form for each pet. Ensure all invoices are legible and itemized for proper review.
Incomplete Submissions Submitting an incomplete claim may delay the processing time. Take time to verify all information is complete.
Signature Requirement Policyholders must sign the claim form. The signature confirms that the information given is accurate and true.
Diagnosis Information Candidates should write a proper diagnosis instead of symptoms. This can help expedite the claims process.
Submission Methods Claims can be submitted via fax or mail. It's important to choose one method to avoid duplicate submissions.
Claim Status Check Policyholders can check their claim status online 72 hours after submission. Access is through the VPI Policyholder portal.
State Regulations In Maryland, submitting fraudulent claims is a crime. Violators may face fines or imprisonment, in accordance with state law.

Guidelines on Utilizing Vpi Claim

Filling out the VPI Claim form is essential to ensure smooth processing of your claims for your pet’s medical expenses. By carefully following these steps, you can submit your claim efficiently and minimize any potential delays. It's vital to provide all necessary information accurately.

  1. Fill in the Policyholder Information section with your details, including the policy number, your address, pet’s name, and your contact information.
  2. Check the appropriate Claim Details to indicate the reason for your pet's visit. Specify the treatment date and write down the diagnosis in the provided box.
  3. Gather your Invoice(s). Ensure that they are itemized and legible, detailing the total amount to submit with your claim.
  4. Sign and date the form in the Policyholder Signature section, confirming the truthfulness of the information provided.
  5. Submit the claim form and your invoice using one method only: via fax at (714) 989-5600, or mail it to the VPI Claims Department, P.O. Box 2344, Brea, CA 92822-2344.

What You Should Know About This Form

What information is required on the VPI Claim Form?

The VPI Claim Form requires detailed information to process your claim efficiently. You need to fill out your policyholder information, including your name, address, phone number, and email. Each claim form must be completed for one pet only. Additionally, provide the reason for your pet's visit, treatment dates, and the veterinarian’s diagnosis. Ensure you also submit itemized invoices along with your claim form.

How should I submit my VPI Claim Form and invoices?

You can submit your claim either by fax or by mail. If choosing fax, send it to 714-989-5600—no cover sheet is needed. For mail submissions, send your claim and invoices to VPI Claims Department, P.O. Box 2344, Brea, CA 92822-2344. Remember to submit your claim by one method only, as duplicate submissions can delay processing.

What happens if my claim submission is incomplete?

If any part of your submission is incomplete, it may cause delays in processing your claim. It's essential to provide all required information, including legible and itemized invoices. Avoid using phrases like “See Attached” and ensure you have the necessary medical records and lab results included, especially if multiple conditions were treated.

How can I check the status of my claim?

You can easily check your claim status using the VPI Policyholder portal. Simply log on at my.petinsurance.com and click on “View Claim History.” The status of claims that have been faxed or mailed will be available approximately 72 hours after they have been received. If you prefer to speak with someone, contact customer service at 800-540-2016 during business hours.

Common mistakes

When filling out the VPI Claim form, many people make common mistakes that can lead to delays in processing their claims. Understanding these errors can help streamline the process and ensure quicker reimbursement.

One frequent mistake is failing to provide complete policyholder information. Many individuals neglect to fill out every relevant section, such as the policy number or contact information. Leaving out even one detail can complicate identification and processing of the claim.

Another error occurs in the claim details section. People often check the wrong reason for their pet's visit. When a visit was for an injury, but they also check wellness services, it can confuse the processing team. It’s crucial to clearly indicate the primary reason for the visit.

Some claimants mistakenly write symptoms instead of the actual diagnosis in the appropriate box. A veterinarian's diagnosis should always be provided, as symptoms do not give a complete picture. This is a key part of the form, and skipping it can stall processing.

Missing itemized invoices is another common slip-up. Claims submitted without itemized bills can cause delays since the claims department requires this documentation. Sending estimates instead of actual invoices is equally problematic and can lead to rejection of the claim.

Many claimants forget to sign and date the form, or they might sign in a section that is not required. The signature confirms that the information provided is accurate, and without it, the claim may not proceed.

Some might misinterpret submission guidelines, submitting their claim through multiple channels. Whether sending by fax or mail, only one method should be used to avoid duplicate claims and processing delays.

Failing to include additional supporting documents is another common oversight. If your pet received multiple treatments or stayed overnight at a veterinary facility, it’s important to include all relevant medical records and lab results. Omitting these can lead to further inquiries.

Many people also neglect to check their claim status online. They may assume their claim is still being processed without realizing they can track it in real-time. Logging into the VPI Policyholder portal can save time and reduce anxiety about the claim status.

Lastly, some individuals fail to reach out for help when confused about the claims process. Customer service representatives are available to answer questions and clarify any uncertainties. Utilizing this resource can help avoid delays due to misunderstandings.

By being mindful of these common mistakes, you can successfully navigate the VPI Claim form and facilitate a smoother claims process for your pet.

Documents used along the form

When submitting a claim to Veterinary Pet Insurance, several other documents are often required alongside the VPI Claim Form. These documents help ensure a smooth processing of claims and provide necessary information regarding the treatment and expenses incurred. Below is a list of common forms and documents used in conjunction with the VPI Claim Form.

  • Itemized Invoice: This document details the services provided by the veterinarian, including treatment dates, diagnosis, and costs. It must clearly show all charges associated with the visit.
  • Veterinary Treatment Records: A record of the medical treatment your pet received. This may include notes from the veterinarian that explain the diagnosis and any recommendations for follow-up care.
  • Lab Results: Any tests performed, such as blood work or imaging, will have accompanying lab results. These results provide critical evidence of the diagnosis and treatement undertaken.
  • Authorization Form: Sometimes required, this form gives permission for the veterinarian to release your pet's medical records to the insurance company. Inclusion of this document facilitates communication between the parties involved.
  • Previous Claim Documentation: If you are resubmitting a claim or have followed up on a previous claim, include any relevant documentation from past submissions. This helps prevent delays due to missing information.
  • Photos of the Pet: In certain cases, photos of the pet may be required, especially if there is an injury or condition that needs visual documentation for clarity within the claim process.
  • Supplemental Claim Form: This may be necessary if additional information is needed after initial submission. It allows you to elaborate on specific aspects of the treatment or results.

Using the correct forms and documents ensures that claims are handled promptly and efficiently. Make sure to double-check that all required materials are included before submitting to avoid delays in processing.

Similar forms

  • Insurance Claim Form: Similar to the VPI Claim form, an insurance claim form for other types of insurance requires detailed personal information, policy number, and the reason for the claim. Each type of insurance often requires similar documentation, like itemized invoices and relevant records.

  • Medical Claim Form: Much like the VPI form, medical claims require the patient's personal details, a description of the medical service, and itemized billing. Documentation supporting the claims, such as medical records, is often needed.

  • Auto Accident Report: Similar to the VPI Claim form, an auto accident report asks for policyholder information, details about the incident, and requires documentation of damages. An itemized invoice for repairs may also accompany the claim.

  • Homeowners Insurance Claim Form: Like the VPI Claim form, this document collects personal details, the nature of the claim, and requires accompanying invoices for any repairs or replacements. Each form emphasizes accurate and complete submissions to avoid delays.

  • Disability Claim Application: This document also resembles the VPI Claim form in that it requires personal and policy information, a reason for the claim, and supporting medical documentation confirming the disability.

  • Workers' Compensation Claim Form: This form is similar as it requires the claimant’s details, specifics of the injury, and supporting evidence. Just as with the VPI form, including all necessary documents is crucial for timely processing.

  • Travel Insurance Claim Form: Similar information format can be seen in travel insurance claims, which ask for personal information, the reason for the claim, and receipts or invoices related to the claim, similar to the VPI requirements.

Dos and Don'ts

When filling out the VPI Claim form, there are important guidelines to follow in order to ensure a smooth and timely submission. Below is a list that outlines both what you should do and what you should avoid.

  • Fill out one claim form per pet. This helps to streamline the process and reduces confusion.
  • Ensure all information is complete and legible. Incomplete forms can lead to delays.
  • Check the reason for the visit. Mark all applicable options to provide accurate details for your claim.
  • Include an itemized invoice. Submit only detailed invoices, as estimates are not accepted.
  • Sign and date the form. Your signature confirms the truthfulness of the information provided.
  • Do not submit duplicate claims. Duplicate submissions will result in processing delays.
  • Do not write “See Attached.” Always provide complete information in the provided sections.
  • Avoid sending stapled or paper-clipped pages. This can obscure critical information on your claim form.
  • Do not forget to include supporting documents. Attach treatment records or lab results when necessary.
  • Avoid using vague or general terms. Specify the diagnosis rather than describing symptoms.

By adhering to these do's and don'ts, you can help ensure that your claims process goes as smoothly as possible.

Misconceptions

There are several misconceptions surrounding the VPI Claim form that can lead to confusion or mistakes during the submission process. Understanding the facts can help ensure a smoother claims experience.

  • Completing the claim form is optional if submitting supporting documents. Many believe that they can skip filling out the form if they include supporting documents like invoices and treatment records. However, the claim form must be completed and submitted alongside any other paperwork to process the claim effectively.
  • All invoices, even estimates, are accepted. Some people think they can submit any type of invoice. In reality, only itemized invoices are acceptable. Estimates will not be processed.
  • You can submit multiple claims for one pet on a single form. It is a common belief that you can combine claims for different visits or conditions on one form. Each claim form must be filled out separately for each visit or condition to ensure proper processing.
  • Claim submissions can be made via any method of your choice. It's a misconception that you can choose any method to submit your claim. Each claim must be submitted by one method only—either fax, mail, or email—not multiple methods simultaneously.

This information should clarify some of the common misunderstandings about the VPI Claim form process. Properly following the guidelines can aid in a more efficient claim process and avoid unnecessary delays.

Key takeaways

When filling out and using the VPI Claim form, there are several important aspects to consider to ensure timely and accurate processing of your claim.

  • One claim form per pet: Each pet requires a separate claim form. Do not crowd multiple pets onto one form.
  • Itemized invoices are necessary: Submissions must include clear and itemized invoices. Incomplete submissions could lead to delays.
  • Diagnosis must be specific: Include the exact diagnosis provided by your veterinarian. Avoid listing symptoms or vague descriptions.
  • Submit via one method only: Whether you choose to fax or mail your claim, stick to one method. This helps avoid confusion and processing delays.
  • Check your submission: Double-check that all required fields on the claim form are completed, including your contact information and signature.
  • Track your claim status: Use the VPI Policyholder portal to monitor your claim status. It typically updates within 72 hours of receipt.

By following these guidelines, you can help facilitate a smoother claims process and ensure that all necessary information is submitted correctly.