VPI Claim Form PDF Details

Navigating the process of filing a claim for pet insurance can often feel daunting for policyholders, but understanding the basics of the VPI Claim Form can significantly streamline the experience. This form is designed for policyholders to report expenses incurred from their pet's veterinary visits, whether for routine wellness checks or for treatment due to illness or injury. It stipulates that a separate claim form must be completed for each pet, accompanied by itemized and clear invoices to avoid any delay in the processing of the claim. The form is segmented into sections covering policyholder information, claim details including the reason for the visit and specific diagnosis from the veterinarian, as well as invoice details. Additionally, it emphasizes the importance of the policyholder’s signature to validate the information provided as accurate. The process for submitting the claim and associated invoices is outlined clearly, offering options for fax, mail, or online submissions to accommodate different preferences. Moreover, it provides guidance on how policyholders can check the status of their claim online and assures them of support through customer service channels, underlining the company's commitment to assist its clients. This form not only functions as a bridge facilitating the communication between policyholders and the insurance company but also underscores the importance of transparency and accuracy in submitting veterinary expenses for reimbursement.

QuestionAnswer
Form Name Vpi Claim Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names vpi pet insurance claim form pdf, nationwide pet insurance claim form, vpi pet insurance claim forms, vpi pet insurance claim 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: ___________________________________________________________________

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.

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 healthy paws pet insurance claim form 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:

vpi pet insurance claim form empty spaces to complete

Complete the INVOICES TOTAL, POLICYHOLDER SIGNATURE and DATE, You must submit itemized invoices, By signing this claim form I, SUBMIT CLAIM FORM and INVOICES, FAX No cover sheet necessary OR, and VPI CLAIMS DEPARTMENT NOTES ONLY space using the information requested by the system.

step 2 to filling out vpi pet insurance claim form

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