BBB Accredited Business since

Embrace Pet Insurance

Additional Locations

Phone: (440) 386-2406 View Additional Phone Numbers 4530 Richmond Rd, Cleveland, OH 44128 http://www.embracepetinsurance.com



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Description

Pet Health Insurance plans for veterinary bills for cats and dogs across the United States.


BBB Accreditation

A BBB Accredited Business since

BBB has determined that Embrace Pet Insurance meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB accreditation does not mean that the business' products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business' product quality or competency in performing services.


Reason for Rating

BBB rating is based on 13 factors. Get the details about the factors considered.

Factors that affect the rating for Embrace Pet Insurance include:

  • Length of time business has been operating
  • Complaint volume filed with BBB for business of this size
  • Response to 16 complaint(s) filed against business
  • Resolution of complaint(s) filed against business


Customer Complaints Summary Read complaint details

16 complaints closed with BBB in last 3 years | 7 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 2
Billing/Collection Issues 3
Delivery Issues 1
Guarantee/Warranty Issues 0
Problems with Product/Service 10
Total Closed Complaints 16

Customer Reviews Summary Read customer reviews

7 Customer Reviews on Embrace Pet Insurance
Customer Experience Total Customer Reviews
Positive Experience 1
Neutral Experience 0
Negative Experience 6
Total Customer Reviews 7

Additional Information

BBB file opened: September 12, 2006 Business started: 07/01/2003 in OH Business incorporated 10/20/2004 in OH
Licensing, Bonding or Registration

This business is in an industry that may require professional licensing, bonding or registration. BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

These agencies may include:

Ohio Department of Insurance
50 W. Town Street; Third Floor - Suite 300, Columbus OH 43215
http://www.insurance.ohio.gov
Phone Number: 614-644-2658
Fax Number: 614-644-3743

Type of Entity

Limited Liability Company (LLC)

Business Management
Mr. Christopher Hagesfeld, Contact Center Manager
Contact Information
Customer Contact: Mr. Christopher Hagesfeld, Contact Center Manager
Business Category

Pet Health Plans

Products & Services

Embrace Pet Insurance offers the following product(s): Health insurance plans for cats and dogs, Wellness plans for cats and dogs

Method(s) of Payment
Visa, Mastercard, American Express, direct deposit from your bank account
Refund and Exchange Policy
You can cancel your policy at any time. We have a 30 day money back guarantee assuming you have not made a claim during that time. Afterwards, we refund you the proportion of your paid premium that has not been used.
Alternate Business Names
Cleverland Holdings, LLC
Licensing

According to the company, the following are agency license numbers for the Embrace Pet Insurance Agency across the US as of September 26, 2011. You should check with your State's licensing agency to confirm
State License Number
Alabama 447130
Alaska 84718  
Arizona  873020  
Arkansas  362743  
California  OG89328  
Colorado  277029
Connecticut  2267003  
District of Columbia  2838043  
Delaware  1108332  
Florida  L066508  
Georgia  153583  
Hawaii  363205  
Idaho  338500  
Illinois  n/a
Indiana  502474  
Iowa  1002047149  
Kansas  204939968-000  
Kentucky  723377  
Louisiana  417164  
Maine  AGN175227  
Maryland  NPF 100036089  
Massachusetts  1885310  
Michigan  0080006  
Minnesota  40195910  
Mississippi  15015053  
Missouri  AG8021919  
Montana  725802  
Nebraska  YR391040  
Nevada  503864  
New Hampshire  2065156  
New Jersey  1078287  
New Mexico  100006394  
New York  PC-1157550  
North Carolina  1000079850  
North Dakota  2000000604  
Ohio  34499  
Oklahoma  10011557  
Oregon  817699  
Pennsylvania  571222  
Rhode Island  n/a
South Carolina  175571  
South Dakota  10011644  
Tennessee  n/a
Texas  1616889  
Utah  339453  
Vermont  n/a
Virginia  127942  
Washington  758997  
West Virginia  6884  
Wisconsin  n/a
Wyoming  196159  


Customer Review Rating plus BBB Rating Summary

Embrace Pet Insurance has received 0 out of 5 stars based on 0 Customer Reviews and a BBB Rating of A+.

BBB Customer Review Rating plus BBB Rating Overview

Additional Locations

  • 4530 Richmond Rd

    Cleveland, OH 44128

  • PO Box 22188

    Beachwood, OH 44122

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BBB Customer Review Rating plus BBB Rating Overview


BBB Customer Reviews Rating represents the customers opinions of the business. The Customer Review Rating is based on the number of positive, neutral and negative customer reviews posted that are calculated to produce a score.

Customer Review Experience Value
Positive Review 5 points per review
Neutral Review 3 points per review
Negative Review 1 point per review

BBB letter grades represent the BBB's opinion of the business. The BBB grade is based on BBB file information about the business. In some cases, a business' grade may be lowered if the BBB does not have sufficient information about the business despite BBB requests for that information from the business.
Details

BBB Letter Grade Scale

BBB Rating Value
A+ 5
A 4.66
A- 4.33
B+ 4
B 3.66
B- 3.33
C+ 3
C 2.66
C- 2.33
D+ 2
D 1.66
D- 1.33
F 1
NR -----
Star Rating scale

  Average Score
5 stars 5.00
4.5 stars 4.50-4.99
4 stars 4.00-4.49
3.5 stars 3.50-3.99
3 stars 3.00-3.49
2.5 stars 2.50-2.99
2 stars 2.00-2.49
1.5 stars 1.50-1.99
1 star 0-1.49

BBB Customer Review Rating plus BBB Rating is not a guarantee of a business' reliability or performance, and BBB recommends that consumers consider a business' BBB Rating and Customer Review Rating in addition to all other available information about the business. If the BBB Rating is NR then only Customer Reviews are used for the Star Rating.

Complaint Detail(s)

9/6/2016 Problems with Product/Service
5/27/2016 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: This insurance company repeatedly finds any excuse to never pay a claim. The latest excuse is we cannot file a claim more than 60 days after the date of our policy renewal. The policy renewal has nothing to do with filing a claim. Prior to renewal, this wouldn't have been a problem but they would have denied us for another reason. Burying this obscure clause in small print seems unethical.

Desired Settlement: I would like to see this company honor the contract and pay our claims.

Business Response:

Dear BBB,

I am happy to address these topics to help clarify this situation.

Our current policy terms and conditions state:

PART VIII – HOW TO FILE A CLAIM

1. a. All Claims must be submitted and received by us within sixty (60) calendar days after the next policy renewal date after the date of the claim’s veterinary Allowable Charges. You must send us a Claim form that has been properly completed. We will then write to you with our decision.

This clause is not ‘buried’ anywhere, it is written plainly in the terms and conditions document. It is also noted on our website:

Unfortunately, Mr. *******’s claims were not submitted within the allowable time frame. This is not an ethical issue. It is simply Embrace complying with the terms and conditions we are bound by.

I understand Mr. ******* is not pleased with his prior claim coverage either. *****’s prior claims were all either related to a pre-existing condition or were submitted within a waiting period. We were not able to provide coverage on those occasions, however, all of the prior pre-existing conditions listed for ***** were temporary and have now expired. I fully expect any claims submitted within the proper timeframe for conditions/procedures we cover in general to be covered. I hope this gives Mr. ******* some solace.

Please let me know if you have further questions.

Jenna M****, RVT

Claims Manager

Tell us why here...

Business Response:

Dear BBB and Mr. *******,

I cannot see how following our terms and conditions could be seen as unethical. We state this requirement in many places so our policy holders know there is a deadline. It would be unethical if we were trying to hide the deadline, but aren't trying to hide it, we are advertising it! Any company out there would do the same thing. We have to close our books of business from term to term with our underwriter, so we have to set a date for claims to be submitted by. This is the underwriter's rule and we have to follow it. Sometimes, as in this circumstance, it creates a bad experience for the policy holder, and while we would like to avoid this, the vast majority of claims are submitted within the required time frame.

I looked at the claims in question and all of them would have been covered had they been submitted in a timely fashion.

Please let me know if you have any questions.

Jenna M****, RVT

Claims Manager

Embrace Pet Insurance

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

To say all of our claims would have been paid if filed timely is insulting and wrong. This company will find any excuse to deny or delay claims or otherwise confuse their paying customers so that claims are never paid. I have attached a document with a sampling of the correspondence we have received from Embrace. Each time they require further, burdensome information that is not necessary or find an excuse why the claim cannot be paid.

They cannot deny they are unethical.

Regards,

******* *******
 

5/20/2016 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: Embrace has a nice and stealthy "auto renew option" in their contracts. When you catch them, rather than refund the entire premium, they withhold the "prorated" portion between the renewal date and the date you get the credit card statement. Further, the email they claim they sent regarding the auto renewal option was not sent to me, the person responsible for the credit card charge.

Desired Settlement: Embrace should refund my premium, in full, for the last 2 years. I received no notifications of either renewal (which is shady in its own right).

Business Response: Darcy L****** <djl@embracepetinsurance.com>
2:41 PM

to me 
Dear *******,
 
Here is Embrace Pet Insurance’s response to complaint #********:
 
Embrace automatically renews policies each year, and we let Pet Parents know by sending them an e-mail about their upcoming renewal 60-90 days before the renewal date.  We sent these e-mails to Mr. ***** at the e-mail address he entered when he purchased the policy online:  tinamarienorris@gmail.com .   If this was not the correct address, we were never informed by Mr. *****, and we were never provided with an alternate address.  The e-mails were sent on the following dates:  11/26/13, 11/26/14, and 11/23/15.  We also follow up on the day of the renewal each year with an e-mail that includes the updated policy documents.  This e-mail was sent to Mr. ***** on 12/30 of each year that he held a policy.  Below is a copy of the renewal e-mail that is sent:
 
Hello *****,

I hope everything is going well. I am writing to let you know that your Embrace Pet Insurance will automatically renew on 12/31/2013. Annual premium for the new policy term will be $?330.54. Learn more about premium changes at renewal.

I've attached a summary of your coverage, so please take a moment to review. Please review the terms and conditions. There have been no changes to the terms this year.
The Healthy Pet Deductible (not available in WA) is now in place! If your pets do not exceed their annual accident and illness deductible during this policy term, you will receive an automatic $50 reduction in their deductible for the next policy term.
If we do not hear from you, we will automatically renew your policy on 12/31/2013 using the payment method on file. If you need to update your billing information, please give us a call at 800-511-9172, M-F 8:30am-8pm Sat 9am-1pm ET.
 
We appreciate your continued business, and look forward to continuing to “Embrace” you and your pet. Please don’t hesitate to let us know if you have any further questions or concerns about the renewal. 

Warm regards,
Embrace Customer Care Team 
EmbracePetInsurance.com
Connect with us on Facebook & Twitter
 
Additionally, by signing up with a policy a policy holder agrees to electronic delivery of policy documents including the automatic renewal notices. The following is the pertinent excerpt from the terms and conditions:
 
PART VII - OTHER TERMS AND CONDITIONS
16. Electronic Delivery By accepting the terms of this insurance as evidenced by the payment of premiums, you agree that this policy, any endorsements and any notices shall be delivered to you by electronic mail via the Internet.
 
We also define our cancellation reimbursement policy in our terms and conditions: 
 
PART VII - OTHER TERMS AND CONDITIONS
3. Cancellation Refund Upon cancellation, you may be entitled to a premium refund. If you provide us written notice of cancellation within thirty (30) days of the Original Start Date and you have made no Claim, we will refund the premium you paid us and the policy will be canceled. If you have made a Claim within thirty (30) days of the effective date, the premiums paid for or allocable to the first month of Coverage become fully earned upon the submittal of the Claim, and you will only receive a refund for any premiums paid for periods beyond the first month. After the first thirty (30) days of the policy period, we will compute any refund due on a daily pro-rata basis.
 
Since Mr. ***** had active coverage from 12/31/12 to 2/2/16, we would not be able to issue a full refund as it is past the 30 day  money back guarantee.  
 
We have done everything in good faith and according to our policy terms and conditions. Mr. ***** was provided a copy of the terms and conditions at the start of the policy and at every renewal.
 
Please feel free to contact me with any further questions,
 
darcy l******
contact center manager
(800) 511-9172 x133

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

I am a small business owner myself (I own 7 restaurants with a partner) and the idea that a business needs to make money is one with which I am very familiar.  That being said, to do so ethically and legally is also important.  This business has put in place an auto renewal policy that is meant to "trap" the consumer...period.  Were they a purveyor of informercials of some similar sort of snake oil, it would be expected.  They are not.  They are an insurance company and they should hold themselves to a much higher standard.  Their lack of concern or regard for their customers is "impressive" to say the least. The fact they have yet to reach out to me directly to even apologize is stunning.

Here are all the facts they aren't telling you:

(1) the auto renewal notice was not sent to me.  They used the email address of my girlfriend (which they apparently acquired from the vet).  So I received no notification. I intend to file a small claims court claim against them in Chicago as a next step.  I would strongly encourage them to review their files and confirm what I just stated - because it is true.

(2) while this is not directly relevant to my case since they sent the renewal to someone who was not the person with whom they contracted, you should know that the language is buried in the contract and is meant to "catch" people.  I would think this would bother you as the BBB. 

(3) The customer service rep I spoke to prior to the manager was clearly not surprised by my complaint and it was obvious this is a common issue and they had a script to follow.  If I am correct, why do they continue the practice? Presumably it is very profitable.

I would encourage their in-house counsel to contact me at 312-560-2762 if they want to discuss any of the above.  I told the manager I was disturbed by their business practices and that I would contest the charge with **** (which I have already won for the stub portion of 2016) and that I would file a BBB complaint. I followed through on both of these because I'm very upset.  I'm now telling them I will file a small claims court complaint in Chicago regarding the 2015 premium unless they do the ethical thing.  I'm an attorney and it will cost me nothing.  If they won't choose to act legally and ethically on their own, I will help them along the way.

Regards,

***** ***** 

3/25/2016 Delivery Issues | Read Complaint Details
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Additional Notes

Complaint: I purchased a policy from Embrace for my dog, *****, right around the time that I adopted him in late Summer of 2015. I wanted to make sure that my dog would be covered in the event of medical problems. So I bought a policy and paid Embrace in full for about $600 for a year of coverage. At some point in my very first vet appointment with ***** (or any dog, ever, as ***** is my first), I mentioned, in response to the Vet asking at the end of the appointment whether or not there was anything else at all I was curious about, that sometimes, in the morning, Ed would lick his paws a little bit. In the vet's notes from this visit she says, "Discussed licking of front feet - could be normal, could be fleas, could be allergies..." A few months later, Ed came down with an ear infection. I incurred some expenses from vet visits and prescriptions. I submitted my very first claim to Embrace shortly thereafter and was denied due to a pre-existing dermatological condition. Naturally, I was quite surprised given that my dog, whom is only about one and a half years old has never been diagnosed with any sort of dermatological issue, let alone any prior ear infections or any problems at all. On consulting Embrace about the matter, I was informed of the following: "per the terms and conditions of [my] policy a pre-existing condition is not always something that is diagnosed." Apparently mentioning that my dog licked his front paws in the morning sometimes, without any sort of diagnosis from the vet or anything beyond the fact that I simply said, "sometimes my dog licks his paws in the mornings", was all that was required for Embrace to assess a pre-existing dermatological condition and exclude coverage for anything at all they could tie to that phantom dermatological condition including an ear infection.

Desired Settlement: Embrace has offered a pro rata refund for the remaining ~5 months left on my policy. I don't believe that this is sufficient. I want a FULL REFUND for my entire premium of about $600. I paid this amount in full and in advance in good faith that Embrace would treat me fairly. They have not. They have provided absolutely no value to me whatsoever; instead they've been unhelpful and totally unwilling to work with me to resolve this matter. I have no idea what I would pay them anything for after the experience I've had.

Business Response:

Dear BBB,

I am happy to explain further what has occurred in regards to Mr. *****’s policy. At the first medical exam for Mr. *****’s pet, *****, the notes state “Owner presented pet with no health concerns other than some itching primarily on the front feet in the mornings.” This statement implies the issue is a concern and therefore an abnormality. The notes also state: “Discussed licking of front feet- could be normal, cloud be fleas, could be allergies- recommend a Benadryl dose in the AM when licking is the worse and if helps likely due to allergies.” Since the veterinarian was not able to diagnose this issue as either normal or a clinical sign related to allergies, and she recommended a treatment for it, Benadryl, we have to list it as a pre-existing condition, per our policy terms and conditions. The following are the pertinent excerpts:

Part I – Definitions

28. Pre-existing  Condition(s)  means: a. a Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for your  Pet(s) and any related conditions; or b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and  any related conditions.  Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.

13. Dermatological Condition means an Illness related to your Pet’s skin and is deemed to include ear infections and skin lumps from skin irritation or infection, such as interdigital cysts from pododermatitis, but not conjunctivitis or parasitic infestations.

Part IV – Exclusions

1. i. If your Pet showed Clinical Signs of any Dermatological Condition prior to the end of the Waiting Period, your Pet must be free of any Dermatological Conditions for twelve (12) consecutive months before any Dermatological Conditions may be covered again.

***** had an undiagnosed clinical sign of foot licking, and the veterinarian stated it could be due to allergies. A few months later, ***** had an ear infection. Ear infections are defined by the policy as a dermatological condition because they are often related to allergies. Under the exclusions section, part 1. i. we are not able to cover any dermatological condition if any dermatological condition was noted as a pre-existing condition or undiagnosed clinical sign.

We have an appeals process where we are able to review any additional information the veterinarian is able to provide and take it into consideration. Mr. ***** was offered the opportunity to appeal the decision, but we have not yet received any appeal documentation. Mr. ***** has since cancelled his policy, this means he has 60 days from the date of cancellation to submit any veterinary appeal information for this issue.

In regards to Mr. *****’s desired settlement of a full refund of his policy refund, I am unable to grant this request. We refunded him the unused portion of his policy as the policy terms and conditions state:

              Part VII – Other Terms and Conditions

3. (…)After the first thirty (30) days of the policy period, we will compute any refund due on a daily pro-rata basis.

I am happy to address any other information or points of fact for this complaint as needed.

Jenna M****, RVT

Claims Manager

Embrace Pet Insurance

Consumer Response:

Dear BBB,

I absolutely reject the business's response on this matter; however, I do appreciate your assistance in mediating.

I will forward them a copy of a letter from my vet which clarifies that the dog in question has no "dermatological condition".  Additionally, I have absolutely not received any sort of a refund, pro rata or otherwise from this company.

Furthermore, I'll note for the record that my girlfriend and I volunteer on the weekends for a dog shelter with about 110 dogs in their care on premises and about another 30 fostered at various volunteer residences whilst waiting for their forever home.  I will be making it my mission to share with any volunteer, pet owner, or potential pet adopter (whom I work with frequently) my extremely negative experience with Embrace.  I will recommend that anybody seeking fair treatment steer very clear of Embrace.

Thanks again for your assistance in this matter and have a great weekend,

***** *****

Business Response:

Our records show Mr. ***** cancelled his policy on 2/18/16. He received a pro-rated refund of $246.02. If he has not yet received these funds he should check with his bank. The refund was processed the same day.

We also have not received any appeal letter or information to clarify the pre-policy dermatological issues from Mr. *****'s veterinarians. We are unable to appeal the conditions without this information.

We are unable to make exceptions in the policy terms and conditions due to the threat of not recommending us to adopters and kennel personnel. The policy terms and conditions are there to protect the company and the consumer. We stick to the policy, in this case and all others. While it is his right to express his opinion and displeasure, it's not something I want to happen, however, I cannot be expected to bend the rules or disregard the terms and conditions because he disagrees with what his veterinarian wrote in the pet's medical history.

Please let me know if you have other concerns about this complaint

jenna m****, rvt

claims manager

(800) 511-9172

Embrace Pet Insurance

3/17/2016 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I have a pet insurance policy on my dog. He tore his CCL and had to have surgery. EPI states that they will make a determination on all claims within 15 working days. I filed a claim at the end of January when my dog was diagnosed, all required medical records were sent to EPI but they did not make a determination on the claim. I told them at least 3 times that they had received all medical records. Finally, 2 weeks after my dog had to have surgery they told me that they needed medical records from a Vet that my dog had never been to. They were told this. Claims were initially filed on or about January 28th, 2016. On March 2nd, 2016 they told us that they were denying the claim. The denial of the claim is in dispute as well. By not keeping good faith and performing their diligence since they had in their possession all medical records that the policy states they require in order to make a determination, and by them not contacting me (not once did they ever attempt to call me via phone) they violated the terms of the policy. In the wording of the policy it states that any diagnosed condition prior to the policy would be pre-existing. My dog was having brain seizures and we took him to the vet in February of 2015. This visit was 99% dealing with his brain seizures. When that was taken care of the vet asked if there was anything else. We said he started limping on his left leg the day before after we saw him step on a stick or ice (the ground was snow covered). The Vet looked at it and said that's probably what he did, she checked his leg for any damage (such as a torn CCL) and said he looked fine and that if he didn't stop in a week or two to let her know. His paw was fine the next day, and on his next visit nothing was noticed about any limp. In all subsequent Vet visits, he was examined and nothing was wrong with his left paw (EPI says this makes it his leg). In January 2016 he tore his right hind CCL. They denied this claim because his left paw constituted a bi-lateral issue. His Vet who performed his surgery said that this was not the case and this had no effect on his right CCL tear.

Desired Settlement: I expect EPI to pay the claim filed for my dog. This claim would include a payment of 80% of all Vet bills minus the required $500 deductible.

Business Response:

Regarding: Complaint ********

Mr. *****  submitted a pre-certification for surgery for his pet ********* on January 28th, 2016.  When reviewing the medical history to process this claim, it was noted that Mr. ***** was referred to a another veterinarian, ******** ********, for a 2nd opinion. Embrace contacted ******** ******** to collect *********’s medical history and confirmed that ********* had not visited ******** ******** on 2/22/16. The claim processing time starts after we have confirmed we have all medical history for the year prior to the start of the policy through the end of the waiting period, so the processing time was under 15 business days.

 

The 15 day process time is as estimate and is not guaranteed by Embrace. The large majority of claims are processed well under 15 business days, but first time claims are sometimes delayed as we collect medical history.

 

The claims were not covered because there was a note in *********’s records on 2/21/15 stating “Left back paw, is limping on and off, licking and chewing, whines on occasion…LR (left rear) WNL (within normal limits).” Since there was no other information or definitive diagnosis in this case of limping we are unable to cover any lameness related issues for the next 12 months in either rear limb. The policy terms and condition state:

 

Part 1 – Definitions

26. Pre-existing Condition(s) means: a. a Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for your Pet(s) and any related conditions; or b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions.

Undiagnosed conditions with the same Clinical Signs as those in (a) or (b) above are also considered pre-existing.

 

Please contact me with any other questions regarding this case.

 

Chris H********

Embrace Pet Insurance

12/26/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Embrace Pet Insurance is a FRAUD. My dog had a harmless bump on his back a year and half ago-The Vet said it was no problem, just bumps older dogs get and my last Cocker had many just like it. Fast forward to December 2015, My dog Angel has a serious cyst/mass that needed surgery. It never crossed my mind that Embrace Pet Insurance, which I have had over a year, would not cover it since they are more than happy to take my 35 bucks a month. The surgery was done and all the lab work turned out to be fine (after a scare)-then Embrace said THEY REFUSED TO COVER THE SURGERY BECAUSE MY DOG HAS A PREVIOUS CONDITION. I had no idea what they were talking about so I called Embrace, and they said that harmless bump on his back a year and a half ago was a "previous condition" and made the surgery for the serious foot mass moot-uninsured. Of course the the bump on the BACK had nothing to do with a mass on the foot-but Embrace didn't care and refused the claim. They WILL CHEAT YOU TOO-PLEASE BEWARE!! My old Vet, by the way, called Embrace and explained that the harmless bump had nothing to do with any others masses/cysts-THEY IGNORED MY VET AND SAID TOUGH. HORRIBLE COMPANY-TOTAL WASTE OF MONEY.

Business Response:

Bear BBB,

I am happy to explain Embrace Pet Insurance’s decision to not cover this mass claim. Our policy terms and conditions specify any undiagnosed mass present before the start of the policy will create an exclusion of coverage for all other masses. The following is an excerpt for the policy:

    Part IV - Exclusions:
    e. If a Pet has been treated for undiagnosed masses prior to the end of the Waiting Period, any mass, or condition where a mass is a Clinical Sign, is not covered, including     those caused by cancer. If the cause of the mass that occurred prior to the end of the Waiting Period can be diagnostically narrowed down via cytology, un-related conditions     may be covered.

The situation is this case is the same as what is stated in this policy exclusion. There was a mass noted before the start of the policy. It was never tested or definitely diagnosed, therefore according to the policy, no other masses can be covered.

Ms. ******** can certainly appeal the outcome of this claim, but we would need more definitive information to do so. Her veterinarian saying it is a “harmless mass” is not enough information. An actual diagnosis, as the policy states (via cytology) such as sebaceous cyst, lipoma, or mast cell tumor would be needed to narrow down the exclusion and see if it is related to the current issue. Without this diagnosis we are unable to cover the claim.

If further information is needed by the BBB or Ms. ********, I would be happy to help.

***** *****,
Claims Manager,
Embrace Pet Insurance

11/27/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Embrace Pet Insurance refuses to pay for multiple claims made for my dog, Belle, indicating that a UTI is a "pre-existing condition. However....the dog did not have a UTI for one year PRIOR to the year for which the claims are being made.

Desired Settlement: I want Embrace Pet Insurance to pay 90% of the claims that were made for my dog for 2014-2015 that are beyond the $1000 deductible as indicated in my pet insurance policy.

Business Response:

Hello ******** and BBB,

I can understand your disappointment in the outcome of these claims, but the fact is Belle has not been free of urinary tract infections for a full 12 months as the policy requires for coverage.


The first visit we have for Bella was on 10/3/2013 which noted that Belle was urinating often and she was treated for a urinary tract infection. This visit was prior the start of Belle’s policy which was 10/4/2013 which makes it a pre-existing condition. This pre-existing condition started out as temporary and for all temporary conditions, the exclusion is for 1 year  and would then have expired on 10/3/2014  as long as Belle would remain free of any related conditions and/or clinical signs of urinary tract infections.

Unfortunately, Belle did not remain free of urinary tract infections for a full year. The medical notes indicate on 9/8/2014 that Bella was seen for hematuria (blood in the urine) and inappropriate urination (which are clinical signs of a UTI) and the diagnosis for this visit was an antibiotic resistant infection/ predisposition to UTI’s. Because Belle did not go a full year without having urinary issues, the exclusion is then extended another year from the most recent occurrence (9/28/14) making the expiration of the pre-existing condition 9/28/2015.

The medical history again indicated on 1/5/2015 that Belle was having blood in her urine, was straining  to urinate, and had urinary crystals (another clinical sign of UTI's). Belle was again treated for a urinary tract infection. This extended the exclusion another year making the expiration 1/5/2016.

On April 15, 2015, Belle was again seen for a urinary tract infection and in the medical notes the veterinarian stated that Belle has "chronic urinary tract infections." Because the UTI's were noted as chronic before the temporary exclusion expired this exclusion was made permanent as any chronic conditions that began before the start of the policy are excluded from coverage for the life of the policy.

I hope this helps to understand the pre-existing condition for Belle. If you are unsatisfied with the medical history review or claims outcomes, you can appeal the pre-existing conditions. To do so you would need a letter from your veterinarian (which can be in the form of an email) stating why the urinary tract infections should not be a pre-existing condition, or that they did clear up for a full 12 months at some point and the records they have sent us are incorrect. This information can then be emailed to claims@embracepetinsurance.com or faxed to 1-800-238-1042.


Best Regards,


***** *****, RVT

Claims Manager

Embrace Pet Insurance

6/24/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: I began corresponding with Embrace representatives 7/2014. I purchased a policy & was told to follow up with my vet. I took my dog in August 2014 to the vet, which I informed Embrace via email. I had a Wellness Sr Dog exam in August 2014. I faxed the invoice & prescriptions that were given on that visit -to Embrace. Embrace reimbursed me. The invoice also had the correct vet's address on the invoice (so records could be requested if necessary). I also emailed Embrace staff in July my dog was scheduled for this visit. Last month, I refilled the rx that were (originally given in August). I sent the invoice in March. Yesterday, I received an email that my Dog's diagnoses from the August exam are pre-existing. This comes after they requested the records from the Wellness exam- they already reimbursed me for. Records from August were not requested until March - when they received the rx invoice (no office exam). I feel like 7 months after an exam is an inappropriate time to decide diagnoses from August- are preexisting. They were not preexisting. And as a customer, I would not have paid 7 months of a policy- had I known they would not cover invoices I want paid. Embrace should have requested records when they knew I had the visit in August, not March. You were noticed by email about this exam and by invoice. I would have appreciated the email about preexisting after a review of my records in August, not April 2015. I am requesting the amount I paid in coverage for 7 months, as I would have cancelled my policy after her Wellness exam (August 2014)-- had I known what they found on that exam is considered preexisting. I am not okay with an insurance company making this decision after I pay- when notes should have already been reviewed (August). Embrace can reimburse me for the 7 months of insurance I paid for, instead of the cost of the rx invoice sent in March. I only used it at my exam in August bc my dog is fine... And I want my policy cancelled ASAP. Please let me know if you need a copy of my email from 7/2014.

Desired Settlement: I want Embrace to reimburse me for 7 months of coverage, as I would have cancelled in August had they reviewed my records at the time of service instead of April. Amount is $252.84

Business Response:

Dear BBB Representative,

I am happy to try and clarify our procedures for you and for Ms. *****.

On 7/28/15 Ms. ***** let us know ******* had been seen by VCA ** ****** in the past. We requested records from VCA ** ****** on 8/20/14 which was a few days after the 14 day policy waiting period. This is our standard procedure so we make sure we get all of the needed notes with one request instead of having to go back and request them again in case a pet had an exam during the 14 day waiting period.

We received records for a date range of 5/2/12 through 8/11/14, though the last exam was done on 5/2/12. Since there was no exam in the 12 months before the policy start these records did not fufill the exam requirement. Ms. ***** knew ******* needed an exam and it was done at a different hospital. VCA ******** **** Animal Hospital did the exam on 8/12/14. A claim for that wellness exam was submitted and we covered it in full under her wellness policy. We did not request the records from ******** **** at that time. Usually, unless we know at the very start of the policy which vets have examined a pet we do not request medical history until before the first illness claim. We did not know about ******** **** at the very start of the policy.

Alternatively, we may request all of the records, if and only if, the pet parent requests a medical history review for their pet. This can be requested at any time and is a service we do free of charge. The pet parents are informed of the availability of this service upon signing up for the policy. This is the only time we will request all records and review them before an illness claim has been submitted. We simply cannot review all records we receive at the time we receive them. We do it only when we need to. Sometimes we never need to review or request the records if we do not get claims for a certain amount of time. Additionally, when we do receive records, we send pet parents an email letting them know records came in and we would be putting them on file in anticipation of any claims. At no time do we imply we will be reviewing the records at the time of receipt unless a history review has been requested. I do not see any record Ms. ***** requested a medical history review, so we did not look at the records.

When the first illness claim for her pet, *******, came in we requested, received, and reviewed the notes from VCA ******** ****. At that time we became aware of several conditions that would be excluded from coverage and we pre-emptively sent a medical history review email (even though it was not requested) since we wanted Ms. ***** to be informed of what would not be covered and for how long it would not be covered.

The policy states any issues noted in the 12 months before the policy start (or on the first exam after the policy starts if there are no exams in the pet’s 12 month past, such as in this case) they will be pre-existing conditions and cannot be covered by the policy. The issues Ms. ***** is stating are not pre-existing are things that were noted on that first exam on 8/12/14. This makes them pre-existing conditions.

I am unable to acquiesce to Ms. *****’s request for a full refund as her pet was (and still is) covered under the insurance for any non-pre-existing illnesses or accidents. A pet parent is able to cancel the policy at any time, and Ms. ***** can do this by calling into our customer care center. We will be able to offer a prorated refund for the month, as we would for any policy holder.

Please feel free to contact me with any further questions or concerns on this complaint.

***** ****** ***

claims manager

Embrace Pet Insurance

(800) 511-9172

Consumer Response: Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

Embrace customer service was notified about the appointment I had for ****** for her medical review. I told a representative via email, so that records could be reviewed, see attached copy. The response from Embrace (to BBB) states, "we did not know about The ******** **** Hospital." This is not true, as the address is on the invoice- embrace paid for -- dated 8/2014. Embrace had the address at that time & was told via my email about the appointment. 


I did not send an illness claim; I sent an invoice for a medication refill- given on the 8/2014 exam. 

Again, I would not have paid 7 months of coverage (which I have not used ) dated 9/2014-3/2015 --had I known Embrace considered ******* to have pre-existing conditions. 

I want my money reimbursed for these months.

Attached photo is a copy of where I notified Embrace about my Dog's visit. Again, the invoice was sent with ******** **** vca's address (so you could have requested records & notified me of "pre existing" before I paid the 7 months. My pic I am attaching is in response to an Embrace representative asking for medical history. 

Regards,

*** *****




 

Business Response:

I am happy to further explain and address Ms. *****’s response statements.

Her first statement is untrue as she has truncated my sentence. My prior response states, “We did not know about ******** **** at the very start of the policy.” This is a factual statement. The picture of the email Ms. ***** has provided states she was taking her pet in for a senior exam, but it does not tell us where the exam was to be. Also, the email pictured was a full 30 days after she started the policy. So there was no way for us to know at the start of the policy what clinic to request records from. As I stated previously, we only do this request at the very start of the policy and from clinics we have been notified of.

A medication refill is an illness claim. There are two parts to our policies. Wellness or routine care reimbursement for things like vaccinations and spay or neuter procedures etc. The other part is the accident and illness insurance. A prescription medication refill falls under this portion of the coverage.

As stated previously, I am unable to provide a refund for the prior months of insurance. Each policy holder is given ample opportunity to request a medical history review at the start of the policy if they fear their pet may have any pre-existing conditions that would affect their decision to continue coverage. We often are able to complete this review within the first 30 days so a pet parent can cancel the policy within the 30 day money back guarantee period. Ms. ***** did not request a review at any point and as such I am unable to refund her for the period her pet was insured.

Please feel free to contact me with any further questions or concerns on this complaint.

***** ****** ***

claims manager

(800) 511-9172

Consumer Response: Hi,

I received an email requesting a copy of my policy. I am requesting this tonight via email to Embrace. I never formally got a copy. I signed up for the wellness policy and added rx coverage. I will send a copy as soon as they send me one. 
I am attaching a few more photos of email correspondence for clarification. 
7/28/14 I received an email thanking me for purchasing a policy. 7/29/14 I responded to clinics my dog had been seen at. 7/30/14 I received an email stating ******* must be examined and documented by a vet. This email says, "we'll be asking for *******'s health history in a few weeks." 7/31 I request clarification- if I needed to schedule 2 exams (for wellness and additional) to start my policy. 7/31 response from embrace says I do not need an appointment for wellness (no mention of anything else needed for my dog).
The next response was 8/20/14 requesting history, which I replied about the Sr dog exam. 
The email from 7/31/14 says Embrace would be requesting records in weeks (not 7 months later). I was under the impression my claims would be paid, as I was not notified by Embrace about any questionable diagnoses (until last month). I would not have paid 7 months of coverage had I been notified ******* had what they say is "preexisting."  I want these 7 months of coverage reimbursed to me. 
As also mentioned in previous correspondence, Embrace did indeed have ******** **** VCA address & phone number on a faxed invoice. Had they (the vet) been contacted (like I was told 7/31)- "we will request history in a few weeks" Embrace could have notified me of any changes or denials to my plan. It would have also likely kept me a customer. 
I will send a copy of my policy once I receive it from Embrace.
Thank you,
*** *****

3/30/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I purchased Pet Insurance for two of my dogs. C**** who was a 7 month old at the time started limping, so we decided to bring him into the vet. They X-rayed him and sent his X-Rays out to be read. They said it appeared he had OCD in one shoulder. (which wasn't even the shoulder he was being seem for) and they referred us onto a specialist at ** State Veterinary Hospital. C**** was seen at my vets office prior to this appointment but never for limping or being lame. He had just started limping. It is not uncommon for puppy's/dogs to play with other dogs on a DAILY basis and then limp for a day or so from pulling a muscle. Soft tissue injuries are common and all my dogs from time to time end up limping after playing, but with rest they are usually better the next day or two. So who is to say that anything can be related. We decided to bring C**** into the Vet to be check after he started limping for about a week and it didn't get better with rest. The Vet also said in his medical opinion this was NOT pre-existing as C**** showed no signs prior. They are trying to deem this a pre-existing condition. If he was seen at my vets prior then I could see how that would be considered pre-existing or if we had his one shoulder done and then he later developed it in the other shoulder but when you have a puppy and an estimated guess as to how long and why a dog is limping there is no real evidence of actually how long and why unless he was seen by the doctor prior and it was a documented office visit. When they asked how long he was limping, I said just this month, meaning January, so I am not sure how they would deem that pre-existing if his waiting period was up on January 1, 2015 and we were seen January 15, 2015. I think because of the amount if the claim they are trying their hardest to find anyway possible to NOT pay the medical claim. This was NOT a preexisting condition. C**** started limping right before we took him into S********* (my vet). He always had good wellness and vet visits with NO sign of lameness or limping. I do not know where they got that information from. I took him to the vet as soon as he started having problems. I never brought him in to my vet for limping or lameness prior he was a healthy boy, so how can they say this was preexisting when it had just developed. I talked to my vet and he said , C**** never had any lameness issues prior. He was never treated for lameness or limping and he was recently seen not long before that. Don’t you think if he was limping or lame they would have noticed it and noted my file. He has always been a healthy boy.

Desired Settlement: I feel that this medical claim for C**** should be paid by EMBRACE.

Business Response:

I am happy to address the situation concerning C****’s lameness claims for BBB review.

Ms. ******’s policy started on 7/1/14, and included a 6 month orthopedic waiting period that expired on 1/1/15. This waiting period can be reduced to 14 days with completion of an orthopedic exam by a veterinarian after the purchase of the policy. This is exam is optional and we do not have records of this exam on file for C**** so his waiting period stood to expire on 1/1/15.

We are only able to make decisions for coverage on what information we are provided with from the veterinarian. In this case, the medical records for the first visit for lameness on 1/15/15 state “Presented for lameness of RF (right front) leg. Duration > 1 month.” This puts the onset of the lameness into the orthopedic waiting period since that waiting period did not end until 1/1/15. The policy terms and conditions state any abnormal signs noted by the pet parent or veterinarian within the defined waiting periods will create exclusions of coverage in the policy. The following is an excerpt from the policy terms and conditions:

28. Pre-existing Condition(s) means: a. a Chronic Condition observed by you (the policy holder) or your Veterinary Provider prior to the end of the Waiting Period for your Pet(s) and any related conditions; or b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions.  Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.

Ms. ****** did appeal the claims, however, the appeal information from Dr. B****** confirmed the onset of the clinical signs of the lameness were approximately one month and the appeal was not successful. The letter from Dr. B****** did also state the condition is not pre-existing since he had not previously diagnosed it, but as our terms and conditions state, that is not needed for a condition to be pre-existing. A pre-existing condition as defined by the policy is any condition showing signs during a waiting period or before the start of the policy.

Additionally, for the appeal our senior claims adjuster reviewed all of the notes from ** State. We did not have those notes prior to the appeal. Those notes also have the duration of the lameness as one month, putting the onset in the orthopedic waiting period.

Unfortunately, due to the above evidence and the policy restrictions, I am unable to acquiesce to the stated desired settlement to cover the lameness condition for C****.

***** *****

Claims Manager

Embrace Pet Insurance

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

This is an assumption made by EMBRACE. I  never told my VET that he was lame for over a month. He had just started limping for about a week before I brought him in to the point of no relief with rest. I would never let my pet go for a month liming without seeking medical attention. He has other issues as a pup, one with his tail and lump on back foot that made him limp from time to time but it WAS NOT because of his shoulder. They are trying to find an excuse not to pay this claim. My Vet even sent a letter that this was not pre-existing in his medical opinion. If C**** had any prior history of limping it would have been noted in his medical history during prior Vet appointments and Wellness visits. They need to pay this claim as they are denying this on an assumption.

He is my dog and I know this was NOT pre-existing!
Regards,

******* ******




 

Business Response:

Hello again BBB and Ms. ******,

 

I am happy to keep explaining this situation until Ms. ****** is more satisfied.

 

We are not permitted to assume an onset date of an illnesses and, as such, we did not assume anything in this case. As I have noted in my prior responses the medical notes from 1/15/15 stated and I quote “Presented for lameness of RF (right front) leg. Duration > 1 month.” Also, the veterinarian’s appeal letter noted and I quote, “During my exam I asked the owner the duration of condition, the owner stated it was approximately 1 month”. Therefore, no assumptions were made. We took the onset of this lameness directly from the two written sources we were provided with. Both sources agree the onset of this lameness was before the completion of the policy orthopedic waiting period.

 

I understand Ms. ****** is not happy with the result of her claim and appeal, however, I believe I have addressed all of the points she has brought up in this and my previous responses.

 

Please let me know if there is any other information you need from Embrace.

 

***** *****

Claims Manager

Embrace Pet Insurance

3/16/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: While shopping for pet healthcare insurance, I found Embrace. All information displayed claimed their coverage will cover anything short of an apocalypse. Under "What We Cover", it claims they cover genetic conditions. This was a major selling point for me as the dog I was insuring is a Puggle - which tend to suffer frequently from genetic issues - and because her sire had recently been diagnosed with a severe allergic condition. Prior to purchasing the policy, my dog had not experienced any dermatological conditions short of some itching. Nothing severe but, since I have a wellness plan through ******** allowing free routine vet visits, I would take her in for anything remotely out of the ordinary. The cause of her itching was never diagnosed and several potential causes were simultaneously treated including allergies. Roughly one month after purchasing the policy, my dog began to experience severe itching, skin lesions, and a widespread yeast infection - conditions unlike any she'd experienced before, but similar to those her sire had experienced. She was then diagnosed as most likely having allergies (although not pinpointed) and her symptoms have not fully gone away since - only diminished. I'd submitted her bills for these beginning around August of 2014. Embrace sat on these claims until late December and, in early January, decided that her unrelated itchiness prior in the year invalidated any future dermatological conditions, labeled the claims as "preexisting" and dismissed all open claims despite the fact that her condition was not preexisting by any stretch of the imagination. Embrace stated that they would reopen the claims if my vet were to write to them with a reason why they should not be found as preexisting, and she did, but the claims never reopened.

Desired Settlement: I'm asking that Embrace either reopens and makes payment on my claims, or refunds all monthly payments since August 2014. Had I known they would not make good on their word, I would not have given them my business.

Business Response:

I am happy to address Mr. ********’s concerns and explain the details on why his pet ***’s claims were not covered.

To begin, we do cover genetic conditions (and all other conditions) as long as there are no signs of them before the start of the policy. If there is a clinical sign of an issue before the start of the policy, it is considered a pre-existing condition. This is true of all pet insurance companies.

*** had a visit on 4/24/14 where her vet described her to have pruritus (itching), a severe ear infection, and yeast dermatitis in skin folds and on her chin. On 5/28/14 she was noted to be licking her feet which can be a sign of itchy feet and allergies. The policy was purchased on 7/14/14, and the policy 14 day waiting period was complete on 7/29/14. On 8/8/14 *** was seen for an ear infection, skin fold dermatitis and was ultimately diagnosed with atopy.  

Our policy terms and conditions concerning this issue are as follows:

Part I- Definitions

15. Dermatological Condition means an Illness related to your Pet’s skin and is deemed to include ear infections and skin lumps but not conjunctivitis or parasitic infestations.

Part I- Exclusions

1.            i. If your pet showed clinical signs of any dermatological condition prior to the end of the waiting period, your pet must be free of any dermatological conditions for twelve (12) consecutive months before any dermatological conditions may be covered again.

The exclusion section of the terms and conditions above specifies any dermatological condition noted before the start of the policy creates an exclusion for any dermatological condition unless the pet can be free of dermatological conditions for a full 12 months. This did not happen in ***’s case. She had dermatological issues in April, again in May, and was diagnosed with allergies/ atopy in August.

We did receive a letter from Mr. ********’s veterinarian on 2/19/15 and it is in the process of being setup, however, I do not expect the appeal will be successful in overturning ***’s claims in light of the clinical signs of dermatological issues seen before the start of the policy.  

As for the desired settlement, if Mr. ******** would like to cancel his policy we can offer him a prorated refund for the unused portion of this month’s premiums as we would for any pet parent wishing to cancel his policy. I am sorry I cannot offer more, but we have upheld the policy terms and conditions as stated.

Mr. ******** should feel free to call us with any questions, concerns, or if he would like to cancel his policy.

I hope this addresses the complaint in its entirety and feel free to contact me directly with any issues.

Best regards,

***** *****, RVT

Claims Manager,

Embrace Pet Insurance

Consumer Response: Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

I've personally concluded that her foot-licking was a reaction to chemical treatments on the grass at the apartments where I had lived at the time. Since moving, I have noticed no licking of the feet at all. Despite his excessive treatment for allergic conditions, my dog's sire licks his feet excessively due to a developing benign tumor on his foot. Given the genetics, it's possible she may have been gradually developing one unseen as well. There are many possible explanations for her conditions at the time of that visit, and allergies were discussed as a possible concern in the future during the visit, but it was in no way conclusively determined at that time. The cause of her yeast infection in April, 2014 was inconclusive and may have been due to inadequate drying after bathing. After some changes in her grooming, her symptoms went away and were not seen again. What she experienced in August was dramatically different from what she had experienced in April, with widespread hair loss and lesions across her neck and face. THIS was determined to be an allergic reaction. There was no conclusive determination prior to the policy that she was experiencing any allergic reactions. I DID know prior to the policy that she could potentially develop these in the very near future based on her sire's recent diagnoses and treatment (he had hair loss and lesions covering his entire body.) It is because of the genetic connection creating a concern of potential need that I sought coverage. There was no need prior to coverage. By rejecting my claims, considering my financial status, the rate at which her sire's condition progressed, and the fact that no other insurance would cover her claims now that she's definitively experienced allergic symptoms, Embrace is dooming her to a miserable existence for the remainder of her lifespan. Punishing the consumer for being hyper-vigilant of his pet's health prior to coverage is a VERY poor legacy for a pet insurer. 


Regards,

**** ********

1/31/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I purchased pet insurance for my dog ******** from Embrace Pet Insurance. The policy went into effect 7/19/14. They made it clear there was a 14-day waiting period for accident/illness, and 6-month for orthopedic conditions. They received all requested documentation from my vet, and other than that I was not told of any limitations on the coverage. Their website also does not mention any other waiting periods of any kind. I submitted 2 claims in error because the dates of service were prior to the start of my policy. One of these was for an infected incision from spaying surgery, and one was listed as Dermatitis, which was due to an unkonwn allergic reaction on the bottom of her paws. These 2 claims were understandably denied since I wasn't covered yet. Subsequent to that, I submitted a claim for $38 for a parasite test, which Embrace paid. Later on I submitted 3 claims totalling $341.13 for 9/12-9/13, with 9/26 follow-up, claim # ***********, ***********, ***********. These were for a skin irritation caused by shampoo, and an ear infection resulting from water getting in the dog's ear, both from a bath at a grooming facility. These claims were denied as a pre-existing condition. I followed up with a letter from the vet stating that these conditions were completely unrelated to the prior allergic reaction, and therefore not pre-existing. This generated an appeal with additional claim # ***********. This appeal was also denied on the grounds that dermatitis was noted prior to onset of the policy, creating a 12-month waiting period for any dermatological conditions. First, an ear infection is not dermatological. Second, i was given no notification of such a waiting period. Third, the vet specifically documented the complete lack of any relation of the conditions the claims were submited for to the pre-policy dermatitis. Therefore, I feel these claims should absolutely be paid. My gut tells me at this point that Embrace is guilty of insurance fraud, and will only pay the smallest of claims that they absolutely can't find any justification to deny.

Desired Settlement: My desired settlement is one of two things - refund all premiums paid less the $38 claim they paid me ($222-$38 = $184), or pay the claims in the amount of $341.13 as submitted.

Business Response:

Dear BBB,

I am happy to address Mr. ********’s concerns and explain the details on why the claims and appeal were not covered. It is certainly not in order to be fraudulent or “find any justification to deny”, as Mr. ******** has stated.

The issue in this case is not one of an additional, hidden waiting period, but one of a pre-existing condition. Our policy states no dermatological conditions can be covered if any dermatological conditions were noted before the start of the policy until dermatological conditions have been clear for 12 months. The following excerpts are from the policy terms and conditions:

Part I- Definitions

15. Dermatological Condition means an Illness related to your Pet’s skin and is deemed to include ear infections and skin lumps but not conjunctivitis or parasitic infestations.

Part I- Exclusions

1.    i. If your pet showed clinical signs of any dermatological condition prior to the end of the waiting period, your pet must be free of any dermatological conditions for twelve (12) consecutive months before any dermatological conditions may be covered again.

 

********’s owner has already stipulated that a dermatological condition did occur before the start of the policy, meaning we are unable to cover any dermatological conditions until ******** has been free of other dermatological conditions for 12 months.

I will address Mr. ********‘s concerns in order.

“First, an ear infection is not dermatological.” The inside of the ears are covered in a layer of dermis and most vets will agree they are often affected like other exposed parts of the skin. We include ear infections in our definition of dermatological specifically to clear up any confusion on how we treat the ears.

“Second, i was given no notification of such a waiting period.”  As I have already explained above it is not really a waiting period, but an exclusion due to a pre-existing condition. Upon signup for this policy, on 8/5/14 Mr. ******** was offered a medical history review once medical records were received. He did not respond with a request for a review. He was also informed in the same email and another email on 8/6/14 the medical history is collected but remains on file until we receive ********’s first claim. We would not have any way of knowing what pre-existing conditions exist until the history is reviewed for the first claim unless a history review was requested by the pet parent. In this case, no review was requested.

“Third, the vet specifically documented the complete lack of any relation of the conditions the claims were submited for to the pre-policy dermatitis.” With the policy terms and conditions written the way they are, the pre-existing dermatological condition does not need to be ‘related’ to the claimed dermatological condition, they just have to both be dermatological in nature as defined by the policy to apply to this exclusion.

The dermatological exclusion for ******** is temporary and can expire as long as he is clear of dermatological conditions for 12 months.

Due to the above factors we are not able to cover the claims and comply with Mr. ********’s request to “pay the claims in the amount of $341.13 as submitted.”

In regard to his other request, to “refund all premiums paid,” we can only do something of this nature within the first 30 days of the start of the policy. Mr. ********’s policy has been in place since 7/19/14. This is also outlined in our policy terms and conditions:

Part VII- Other terms and conditions

3. Cancellation refund. Upon cancellation, you may be entitled to a premium refund. If you provide us written notice of cancellation within thirty (30) days of the effective date and you have made no claim, we will refund the premium you paid us and the policy will be cancelled.

 

If Mr. ******** would like to cancel his policy at this time we can offer him a prorated refund for the unused portion of the current policy month.

I am sorry if the exclusions and policy terms and conditions were not clear at the start of the policy and Mr. ******** should feel free to call us with any questions, concerns, or if he would like to cancel his policy at this time.

I hope this addresses the complaint in its entirety and feel free to contact me directly with any issues.

Best regards,

***** *****, RVT

Claims Manager,

Embrace Pet Insurance

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

First, Ms. ***** says, "it is not really a waiting period, but an exclusion due to a pre-existing condition".   Well if I have to wait 12 months, to me, that is a waiting period.

Second, she can get into the semantics of what is or isn't dermatological, but the vet did submit documentation to Embrace that clearly stated the ear infection had nothing to do with any other type of skin condition, and should not be considered pre-existing.  For the record, the dog had an allergic reaction causing irritation on the bottom of her paws and an infected incision from the spaying surgery.  The ear infection occurred as a result of water getting in the ear from a bath at a grooming facility.

Third, she references email to me on 8/5.  The only email I have that resembles anything like what she is referring to was actually on 8/18 about an orthopedic report card.  I admittedly did not send that to my vet to complete, but that is not related to this issue.

Fourth and most importantly, they are standing on the grounds of "Our policy states no dermatological conditions can be covered if any dermatological conditions were noted before the start of the policy."  This is not the case.  The policy started on 7/19.  The condition that Embrace is considering pre-existing occurred on 7/14 but was only brought to their attention on 9/22 when I erroneously submitted a claim for the 7/14 vet visit because I had forgotten that was prior to the policy being in effect.  So Embrace in fact did not note any dermatological condition prior to the start of the policy.  Per their policy exclusions, "clinical signs of any dermatological condition prior to the end of the waiting period" - the waiting period would have been 7/19-8/2.  That should eliminate anything prior to 7/19.  They bound the policy on 7/19 with receipt of medical history from the vet.   

So again, I stand by my complaint that either the claims should be paid or my premiums refunded, less the one $38 claim that was paid.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

**** ********

Business Response:

Dear BBB,

I have reviewed Mr ********’s response and would like to discuss his rebuttal statements below.

This case all boils down to the fact that dermatological condition occurred before the start of the policy. Mr. ******** himself acknowledges this. The policy is clear that if any dermatological condition happens before the start of the policy, no matter the cause, (water in the ear, contact dermatitis from a shampoo, etc.) no dermatological conditions can be covered until all dermatological conditions are clear for a full 12 months. Relationship between the conditions does not have to exist to fit this clause of the terms and conditions so the veterinarian's statement of non-relation in this case is immaterial.

Part I- Definitions

15. Dermatological Condition means an Illness related to your Pet’s skin and is deemed to include ear infections and skin lumps but not conjunctivitis or parasitic infestations.

Part I- Exclusions

1.    i. If your pet showed clinical signs of any dermatological condition prior to the end of the waiting period, your pet must be free of any dermatological conditions for twelve (12) consecutive months before any dermatological conditions may be covered again.

His reasoning about why we found out about the pre-existing dermatological condition, his erroneous claim, is a non-starter. We routinely request all medical history before we process the first illness claim so we can learn of any possible pre-existing conditions. Whether the claim had been submitted or not, the prior dermatological conditions were recorded in the medical history and were listed as pre-existing conditions upon our review.

Additionally, Mr. ******** states, “Per their policy exclusions, "clinical signs of any dermatological condition prior to the end of the waiting period" - the waiting period would have been 7/19-8/2.  That should eliminate anything prior to 7/19.” The date of 7/19/14 is prior to the end of the waiting period. The policy does not say only things in the waiting period are pre-existing. It says any illness or abnormality before (prior) the end of the waiting period will be deemed pre-existing conditions. We routinely review the last 12 months of medical history and make note of pre-existing conditions, not just what occurred in the first 14 days of the policy. This practice is standard for every pet insurance company, though some review 18 or 24 months of medical history.

Again, I assert ********’s claim was processed appropriately according to the policy terms and conditions, and I therefore cannot offer Mr. ******** a full refund as per his request.

If Mr. ******** would like to cancel his policy at this time we can offer him a prorated refund for the unused portion of the current policy month as is our policy for any policy holder.

I am sorry if the exclusions and policy terms and conditions were not clear at the start of the policy and Mr. ******** should feel free to call us with any questions, concerns, or if he would like to cancel his policy.

I hope this addresses the complaint in its entirety and feel free to contact me directly with any issues.

Best regards,

***** *****, RVT

Claims Manager,

Embrace Pet Insurance

v

11/19/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I signed up for Embrace when we got our new puppy over a year ago. I got one of their more comprehensive packages, and even opted in for the wellness coverage to help offset the cost of her spaying and other potential costs. Since signing up for the coverage we have followed all of the steps that they requested of us to reduce the waiting period and make sure that everything is above board. About 8 months ago our dog caught giardia at a dog park. We noticed her being a bit under the weather and took her in to see the vet where she was diagnosed and treated. We sent this information off to Embrace to get reimbursed and were denied. In fact, we have been denied for every claim we have submitted to some degree or other. The reason for being denied was that when she was 4 months old she had diarrhea and it was noted on a vet report. They are claiming that this is related to that, and that despite not having been diagnosed with giardia then, since ONE of the symptoms is the same, she must have had giardia from 4 months. She is well over one year now, and had she had giardia for a year, she would be dead. This simply isn't possible. Yet they still refuse to reimburse the claim. We have been round and round with these people, and there is no satisfaction to be had. So after more than $1000 in vet bills for this one incident, and MONTHS of time trying to fight this, I have cancelled.

Desired Settlement: I would like to be refunded for all of the useless insurance payments that I have made to this terrible company, and/or I would like to be reimbursed for the giardia claim.

Business Response:

Dear Ms.*******

Thank you for advising us of ***** ****’s complaint; ID ********.  I do understand the pet parent’s frustration, but I’m afraid we are unable to provide coverage for his claims or to provide him a full refund as he requested. The policy terms and conditions clearly define his pet as having a pre-existing condition that has not remained resolved for 12 consecutive months and Mr. **** has received coverage for his pet for other coverable conditions.

Mr. ****’s pet, *****, was noted to have undiagnosed diarrhea prior to the purchase of the policy making the clinical sign of diarrhea and any related conditions a pre-existing condition.  The policy considers this a temporary exclusion and will provide coverage for the condition as long as ***** is free of the clinical signs and any related conditions for 12 consecutive months.  Unfortunately, ***** had recurrent bouts of diarrhea and has been unable to meet the 12 month requirement. 

*****’s policy began on 1/6/14 and had a fourteen (14) day waiting period for all illnesses and accidents, which ended on 1/19/14.  The policy defines a pre-existing condition as: an illness or injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions.

*****’s medical history documented diarrhea on 7/17/13 and on 8/1/13 noted “has always had loose stools”.  Diagnostics to determine the cause of the diarrhea and loose stool had not been performed, so the policy considers this to be an undiagnosed clinical sign.  ***** was noted to have diarrhea/loose stools again on 2/16/14, 2/17/14, 2/21/14 and 3/3/14.  The diagnosis presented on the claim form for the 3/3/14 claim noted the pet to have giardia, which is an intestinal parasite that causes diarrhea.  The claims for giardia cannot be covered because ***** had undiagnosed diarrhea prior to the start of the policy making diarrhea and any related conditions, such as giardia, pre-existing and not coverable unless resolved for 12 consecutive months.

The policy cannot provide a full refund of premium paid because Mr. **** did have coverage for his pet, *****, for any condition deemed coverable by the policy terms and conditions.  The policy reimbursed the full amount agreed upon for his wellness coverage, and provided coverage with reimbursement for two illness claims that were submitted.

I would also like to address Mr. ****’s reference to reducing the waiting period of the policy.  In addition to the fourteen (14) day waiting period, the policy has a six (6) month waiting period for orthopedic conditions.  There is no option to waive the fourteen (14) day waiting period but pet parents due have the option to reduce the six (6) month orthopedic waiting period. The orthopedic waiting period can be reduced from six (6) months down to fourteen (14) days or the date of the orthopedic examination if this occurs after the fourteen (14) day waiting period.  The policy requires an orthopedic examination to occur after the start date of the policy.  A specific form must be completed by the examining veterinarian and sent to Embrace.  To date, Embrace has not received the orthopedic examination form to reduce this waiting period.  Mr. **** submitted a claim for an orthopedic condition during this six (6) month orthopedic waiting period.  This claim was not coverable as the condition was found prior to the end of the orthopedic waiting period making the condition pre-existing.

I’m sorry that we cannot provide coverage for Mr. ****’s claims or provide him with a full refund.  The policy does provide a pro-rated refund amount, which Mr. **** received when he cancelled, but cannot provide a full refund because coverage was in effect.  The policy would and did provide coverage for conditions not noted to be present prior to the start of the policy or within either of the policy’s waiting periods. I would have hoped Mr. **** could see the benefit of the policy and the many conditions that would have coverage; however, I understand his frustration with not having some of his claims covered and his decision to cancel.

 Please feel free to contact me if you have any questions or need additional information.

Best regards,

***** *****

senior claims adjuster

(800) 511-9172


EmbracePetInsurance.com  |  Facebook  |  Twitter

Consumer Response:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

***** ****

11/12/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I had my veterinarian office fax over the claim paperwork and supporting documentation on October 15, 2014, the same day as my vet appointment. I am in dire need of this reimbursement for the wellness claim for my animal. I am waiting for reimbursement for my follow-up vaccinations for my cat. I was told no more than 8 to 10 business days. I was told this on October 15. Now I'm being told it's 10 to 20 business days, counting from October 20. I intentionally called on October 15 to make sure that the paperwork was received and entered, and this is what the representative told me on the 15th she said that she went to retrieve it to make sure that it got entered That day. I was also told several days ago that an expedited request had been issued. I was just told now that I still had another 8 to 10 business days before any reimbursement would occur.

Desired Settlement: I need my reimbursement today. Not 8 to 10 business days. I am broke and I am hurting for money. I've been waiting for this reimbursement that has been due back to me.

Business Response:

I am sorry for Ms. ********’s frustration. The main points of her frustration seems to be a delay in processing her claim and the inconsistency in what information she was given about the timeline for claims processing.

I will first address the timeline itself of this claim. The claim documentation was received into our fax system on 10/15/14, was processed and setup as a claim on 10/20/14 and was processed on 10/29/14. We are experiencing some delays at this time due to a systems upgrade that has put some kinks into our efficiency, however, this claim was processed within the 8-10 business day window Ms. ******** was given on her first contact for this claim.

The second issue is one of consistency with the time line estimates. I agree the outline of what Ms. ******** was told through the contact center was inconsistent. We are experiencing some delays of our normal processing times, and had not updated our ‘claim received’ email to reflect this. We also had not updated our estimate for the customer contact group to give to our policy holders when they called to inquire on their claims. We have addressed these issues in the following ways: the email now accurately reflects our current processing time (20-25 business days) while we endeavor to catchup with our current backlog of claims, and we have also instituted more training for our customer contact center group in regards to estimates for claims.

 

***** *****, RVT

Claims Manager

Embrace Pet Insurance

8/20/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I have attempted the claims to use my pet insurance service for my dog. All three times, they continue to say that due to the first visit, and mucinosis was not covered. After the third claim I have submitted, my dog was diagnose with alopecia and they continue to say its related to mucinosis! I made it clear after the first claim and questioned Embrace how they would be able to determine whether its mucinosis or not. I was concern they would continue to justify anything related to skin problems be listed as mucinosis. I am so sick of this insurance company finding anyway they can to not pay out to the dog owners. I have asked them to speak directly to my vet regarding the claim and continue to hear back with nothing.

Desired Settlement: I want at least one month's payment back. I have done everything this insurance company had ask which included having all the forms signed and dated. I'm tired of continuing to waste my time on a insurance company that continues to cheat their customers out of claims by coming up with excuses to not pay.

Business Response:

Dear Ms. ******,

Thank you for advising us of **** ****’s complaint; ID ********.  I do understand the pet parent’s frustration, but I’m afraid we do not have enough information at this time to overturn the decision of the claims.  As we have advised Mr. ****, he is always welcome to have his veterinarian submit additional information for the appeal process.  Embrace would need information from the veterinarian showing the current clinical sign for the most recent claim is unrelated to the pre-existing conditions.

At this time, the medical history and claim forms provided by the veterinarian show that **** was presented to the veterinarian during the policy 14 day waiting period and diagnosed with mucinosis affecting the skin, along with other medical conditions.  The policy terms and conditions define a pre-existing condition as a condition that is diagnosed or clinically symptomatic prior to the end of the policy waiting period.  This also includes conditions or clinical signs associated with the pre-existing condition.  Mr. ****’s first two claims for **** were not coverable because the condition being claimed occurred prior to the policy start date and within the policy 14 day waiting period.  Mr. **** contacted Embrace Pet Insurance regarding his disappointment with the claim decision.  At that time, it was explained why the policy could not provide coverage and we performed a medical history review to further clarify conditions that would not be coverable by the policy.  Prior to the submission of the third claim, Mr. **** was advised that **** would not have coverage for mucinosis and that there was a temporary exclusion for all dermatological conditions due to another clinical sign that was present prior to the start of the policy.

Embrace Pet Insurance received a claim for a dermatological condition following the medical history review and Mr. **** was advised that the policy could not provide coverage for the claim.  Embrace Pet Insurance advised Mr. **** of the appeal process and that we would need information from his veterinarian in writing explaining how the current condition is unrelated to the pre-existing dermatological condition and the mucinosis.  

We have not heard back from Mr. **** regarding his wishes to appeal the decision.  If he would like to cancel the policy, Embrace Pet Insurance will respect his wishes; however, we would be unable to refund a full month of premium because the policy is past the thirty (30) day money back guarantee.  This is a time period offered by Embrace Pet Insurance where a pet parent may cancel their policy for any reason and receive a full refund of premium.  Mr. **** was advised of any conditions that would not be coverable within the thirty (30) day money back guarantee period providing him with an opportunity to cancel and receive a full refund.  At this time, the premium would be refunded on a pro-rated basis.

I do understand and sympathize with Mr. ****’s disappointment in not having these conditions covered, but we must abide by the policy terms and conditions.  The documentation from the veterinarian clearly shows the condition to be pre-existing; however, we would be happy to have our underwriters review additional information for appeal.

Please feel free to contact me with any questions or additional information.

Best regards,

********* *****

Claims Embracer

Embrace Pet Insurance

( 800-511-9172

 EmbracePetInsurance.com

5/28/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I had 3 policies with Embrace and I called to give them a temp mailing address. I asked them not to change my permanent address. The main reason was I am trtaveling quite a bit in the next two months and my daughter is coming home from university and would be living at this address. I had been very imnpressed with the quality of the service and was recommending them to others I know at work with pets. I actually contacted them in regards to referals and they told me they do not haver a formal process but would send me a box with goodies I could hand out. Since it was a box I wanted to make sure I got it so that it the same day I asked to add an address. I was told that my policy would be increased if I added that address. I explained that it is not where I reside so I do not see what the issue is - it is temporary. They said that was the policy so I stated that I wanted to cancel my policy on April 10, 2014 in an email. I then received another email stating my policy was cancelled due to non payment on April 28, 2014 (which is odd since I cancelled it April 10, 2014.) On May 1, 2014 my credit card was charged $86.85. When I inquired to the company 1) I was told that they did not charge me. 2)I was told that I received wellness rewards and I should be happy because I am ahead with their reward program by $500. 3)That I would not be refunded because I cancelled on April 30, 2014 (it was April 10) 4) Finally I was told "we don't give refunds!" I am even ok with that if I was told and I had not cancelled on April 10, 2014. Embrace Pet Insurance took my credit card number and made an unauthorized transaction and then tells me I am still not covered and they won't refund the unauthorized payment. In essence they took an unauthorized payment and state they I don't have any coverage anyway???

Desired Settlement: I would like the $86.85 reimbursed.

Business Response:

Hello,

I have looked into the complaint filed by ****, and through recorded e-mails and phone calls determined that we did follow the correct and established procedures;  however, in a good faith effort, we will comply with ****'s request and refund the $86.85.

Here is the timeline for our communication, which shows our efforts to contact **** and her lack of response:

4/9 - **** e-mailed the following (there is no mention of this address being temporary):

First Name: ****
Last Name: *******
Email Address: ***********@me.com
User Agent: Mozilla/5.0 (Macintosh; Intel Mac OS X 10_9_2) AppleWebKit/537.75.14 (KHTML, like Gecko) Version/7.0.3 Safari/537.75.14
Referrer: http://www.embracepetinsurance.com/after-you-enroll/billing
Message: I needed to change my address: **** ****** * ******** ** *****
Existing Customer: True

 

4/9 - We responded with the following: 

Hello ****!

Thank you for updating your address. You will be receiving updated policy documents shortly. There was a slight premium increase due to the move. This is because part of the premium is based upon your address. The new monthly premium is $182.37. There would be a prorated charge today of $6.44 due to the move. I did need to make sure that this charge is alright to put through on your account. If I do not hear back by 4/11/2014 then I will assume you are comfortable with this.

I also wanted to check if this is your billing address as well. We currently have your billing address as *** ***** ** *** ****** **. Would you like me to update this for you?

Thank you for your help, and if you have any questions please let me know.

Warm regards,

***** ****** 

On 4/10, **** responded via e-mail:  I am at the 201 address with two of my dogs but my daughter will be at the new address for the summer. Does this matter??

On 4/10, we responded via e-mail:  Hello ****,This would change your policy a bit. If they are living at separate addresses they would need to have separate policies. This is because a portion of the payment is based upon the zip code that the dogs live in. I would recommend calling us at 1-800-511-9172 to go over the options here.

On 4/11, **** responded via e-mail (stating she THINKS she wants to cancel, not that she does):  For two months????? and the dog doesn't even stay with her constantly. I was only putting it at that address because I travel so much. I think I want to cancel my policies.

On 4/11, we responded via e-mail:  Hello ****,I think I may have misunderstood you. Do all three dogs typically live with you? Also is one of your dogs temporarily living with your daughter? If this is the case then we do not need to change anything. We would only need to create a separate policy if your dog consistently lives with your daughter. This is what I thought you had meant.

After not getting a response from ****, we called and left a voicemail on 4/11 asking her to confirm where the dogs live, if she wanted to cancel or straighten out the problem, and to give us a call back so we can fix anything.  She did not respond to this voicemail.

On 4/12, 4/14, 4/21, 4/28 we sent notices that her billing had failed and we received no response.

On 5/19, **** called and said she had cancelled on 4/10 and that she wanted a refund. 

On 5/19, **** also sent the following e-mail to our billing person: I had embrace pet insurance and then because I travel I was going to have the billing sent to my daughters temp address for two months. I was told that my premiums would increase even though my dogs don’t live there. I told them if it is such a problem then cancel the policy because that is not my permanent address but a mailing only that would be temporary. Then I receive an email that payment DIDN’T process for May. I saw it and was thinking why would you process payment when I just had that conversation with I believe *****, but the payment was processed anyway. I would like it taken off of my card please. It is attached.

The payment was not actually for May, it's just that it showed up on ****'s statement in May (it takes several business days from the time we put it through to the time the Pet Parent sees it on their statement).

I hope this helps, please feel free to contact me if you have any questions.

4/18/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Embrace pet insurance has denied 90% of my claims stating that these are pre existing conditions. My dog had two Ruptured disc's and brused spinal cord which required emergency surgery in order for him to ever walk again. Two different vetrinarians ( one a neurologist) has clearly stated no pre existing orthopedic condidions, even with previous Negative X-rays however Embrace is over riding the Dr's and denying claim # ************, *********** totaling over $9000. This is not including pryor claims from the previous year that are still in the (Appeal Process).

Desired Settlement: My insurance covers up to $5,000 or %80 per calander year. i believe %80 is over the $5,000 cap. I would like to be refunded $5,000 for these claims ***********, & ***********(year 2014)

Business Response:

Dear Ms. ******,

Thank you for advising us of Ms. *******’s complaint.  I do understand Ms. *******’s frustration with not having her claims covered.  I understand how difficult it must be to not only be faced with an ill loved one but also with high medical expenses. I have reviewed all of the information we have for her pet and at this time, Embrace cannot provide coverage for her claims. Embrace has very few limitations to coverage but unfortunately, Ms. *******’s claims meet one of our limitations; however, we are in the process of a second appeal. If a pet parent feels Embrace is incorrect, they have the option of pursuing a second appeal once they’ve completed a first appeal, which Ms. ******* has done.  This service is paid for by Embrace and an independent veterinary specialist is selected to review the case file and make a decision as to the relationship or lack thereof between the claim and the pre-existing clinical signs. 

At this time, the medical history for Ms. *******’s pet indicate an undiagnosed clinical sign occurred in the waiting period of the policy making that clinical sign and any condition sharing the same clinical sign or directly related, a pre-existing condition.  The information we have, which includes veterinary medical history and claim forms, indicate her pet was experiencing the same clinical sign (ataxia) as previously experienced in the restricted time period of the policy.  In addition, there was not enough information provided to clearly show these clinical signs did not share the same underlying cause or are in no way related.

It is still possible for Ms. ******* to have her claims overturned if the independent veterinarian feels the conditions are in no way related.  I would request placing this complaint on hold until the results of the second appeal have been received.

Thank you for your time in this matter and I would be happy to answer any additional questions you may have.

 

Best regards,

********* *****

Senior Claims Adjuster


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