Vpi Claim Form PDF Details

If you are a business owner, you know that insurance is an important part of protecting your business. However, when it comes time to make a claim, the process can be confusing and overwhelming. The VPI Claim Form is designed to make the process easier for you. In this blog post, we will provide an overview of the VPI Claim Form and explain how to submit a claim. We will also discuss the benefits of using the VPI Claim Form and provide tips for completing the form.

You'll find info about the type of form you would like to complete in the table. It will tell you just how long it takes to complete vpi claim form, what fields you need to fill in and some other specific details.

QuestionAnswer
Form NameVpi Claim Form
Form Length2 pages
Fillable?Yes
Fillable fields25
Avg. time to fill out5 min 34 sec
Other namesvpi pet insurance claim form pdf, print nationwide pet insurance claim form, vpi pet insurance claim forms, vpi form

Form Preview 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: ___________________________________________________________________

2CLAIM DETAILS

REASON FOR VISIT (CHECK ALL THAT APPLY):

WELLNESS SERVICES

INJURY OR ILLNESS Write the diagnosis in the box below.

WHAT INJURY OR ILLNESS DID YOUR VETERINARIAN DIAGNOSE?

TREATMENT DATE(S):

FROM: / /

TO:/ /

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.

How to Edit Vpi Claim Form Online for Free

We were making our PDF editor having the concept of making it as quick to use as possible. This is why the actual procedure of filling in the vsp claim forms will undoubtedly be easy perform the next steps:

Step 1: Click on the "Get Form Here" button.

Step 2: You're now on the form editing page. You may edit, add content, highlight selected words or phrases, insert crosses or checks, and include images.

These particular segments will compose the PDF form that you'll be creating:

print nationwide pet insurance claim form empty spaces to complete

Complete the POLICYHOLDER, SIGNATURE, and, DATE PO, Box, Brea, CA CF, Veterinary, Pet, Insurance, Company, RET and VP, I, CLAIMS, DEPARTMENT, NOTES, ONLY space using the information requested by the system.

step 2 to filling out print nationwide pet insurance claim form

Step 3: Select the button "Done". Your PDF file may be exported. It is possible to download it to your device or email it.

Step 4: Produce copies of the document. This is going to prevent possible concerns. We cannot look at or distribute your details, therefore be assured it will be secure.

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