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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 16 factors. Get the details about the factors considered.

Factors that raised 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 8 complaint(s) filed against business.
  • Resolution of complaint(s) filed against business.
  • BBB has sufficient background information on this business.


Customer Complaints Summary Read complaint details

8 complaints closed with BBB in last 3 years | 5 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 0
Billing/Collection Issues 0
Delivery Issues 1
Guarantee/Warranty Issues 0
Problems with Product/Service 7
Total Closed Complaints 8

Customer Reviews Summary Read customer reviews

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

Additional Information

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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  


Additional Locations

  • 4530 Richmond Rd

    Cleveland, OH 44128

  • PO Box 22188

    Beachwood, OH 44122

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Professional AffiliationsX
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Types of Complaints Handled by BBB

BBB handles the following types of complaints between businesses and their customers so long as they are not, or have not been, litigated:

  • Advertising or Sales
  • Billing or Collection
  • Problems with Products or Services
  • Delivery
  • Guarantee or Warranty

We do not handle workplace disputes, discrimination claims or claims about the quality of health or legal services.

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BBB Complaint Process

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BBB Business Reviews are provided solely to assist you in exercising your own best judgment. Information in this BBB Business Review is believed reliable but not guaranteed as to accuracy.

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Additional Phone Numbers

  • (800) 511-9172(Phone)
  • (800) 238-1042 (Fax)
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Complaint Detail(s)

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

5/22/2013 Delivery Issues | Read Complaint Details
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Additional Notes

Complaint: I took out a policy on my 10 year old Cat because I adopted a dog and wanted accidental coverage. Embrace took the policy and did a medical review. They did not say there were any pre-existing conditions. My cat got sick and I took her to the vet. She was vomiting frequently. Turns out after blood work her liver values were elevated. We did a sonogram, and cytology of her liver in fear of cancer. it turned out her GI tract couldn't handle a specific food. $942 later. i submitted a claim to Embrace. 1 month later I get told nothing is covered because it was a preexisting condition. her liver values were elevated at point of policy. The cat has not had any issues related to vomitting or anything of its sort in 10 years. Embrace finds anyway not to pay. I do not see how a preexisting condition existed especially since they never MENTIONED it when the policy was purchased. I have another insurance for my dog and the pay no questions asked. Stay away from Embrace. Did not cover one cent.

Desired Settlement: I would either like a refund of the premium I paid to this service, since I never made a claim and the one claim I made was rejected, or for them to cover the amount that should be since I paid for insurance. They did not cover ANYTHING.

Business Response:

The medical history showed clinical signs of the illnesses listed on the claim were present prior to the start of the policy. These clinical signs were not diagnosed at that time.  Embrace’s terms and conditions state that, “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” is considered to be a pre-existing condition.  In this case, the pet parent’s cat did have elevated liver enzymes prior to the policy start date.  Elevated liver enzymes are a clinical sign of a liver condition; therefore claims for liver conditions, such as in in this case, cannot be covered.

Each pet parent is informed at the start of his or her policy that a Medical History Review can be done if requested.  The pet parent had thought a Medical History Review had been done at the start of the policy, but that review was never actually requested.  If a Medical History Review had been requested at the start of the policy, this liver issue would have been listed as a pre-existing condition.  The adjuster did let the pet parent know that the claim could be appealed if his vet sent us additional information showing the current diagnosis is unrelated to the prior clinical signs of elevated liver enzymes.  The pet parent has not responded with an appeal.  

v

Consumer Response: Hi *****,

In regards to claim *******:

Thank you for contacting them. The information is not accurate. They had my pets medical records on file and performed what I believed to be a medical review. They contacted all the vets my pet was too. They even sent me a renewal form with no exclusions. I did appeal the claim. My vet is in process as well as appealing. The liver was not the reason for illness, it was the GI tract. Two different organs. I already emailed them and told them I was not happy and why I feel it is inaccurate. I read my terms before taking out the policy and it was over 10 months since I purchased the policy that I made the claim. The underwriter even mentioned the claim was a big challenge. Their practices are unethical. You get a policy, they lead you to believe the did a medical review, than you have to guess what they consider preexisting. The process is not ethical. There should be no surprises to what they consider preexisting. To say a liver condition is preexisting is absurd. The symptoms never showed and were never prevalent to the infection she had. Anyone who knows basic biology knows liver values can be elevated anytime you have a virus or illness. So anytime my pet is sick it is going to be preexisiting because her liver value is elevated? If she had conjunctivitis it would be elevated. The vet said at the original blood profile in his professional opinion the liver values were nothing unexpected of an older cat. Embrace is quick to take the premium, but not quick to give you reasons to not pay. 

Warm Regards,


****
Sent from my Windows Phone

Business Response:

Regarding response to complaint #*******

 

Hello,

I do understand Mr. ******’s disappointment with the claim outcome but all of our practices and communications have been clear and fair.  As previously mentioned, Embrace Pet Insurance will provide our pet parents with an optional medical history review but this service must be requested by the pet parent.  I reviewed all of the correspondence that we have on file and I do not see this service was ever requested by Mr. ******.  On 6/3/2012 an email was sent to Mr. ****** explaining that we will need his pet's medical history for one year prior to policy purchase and that unless he specifically requested a medical history review, we would just file the history for the first claim. The exact wording that was sent is “Please note that unless you specifically request a Medical History Review when sending in your records, I will just be filing them until ******'s first claim; we will not be reviewing them until then.”  I do not have any record of a response from Mr. ****** requesting this information either via phone or email.

Embrace Pet Insurance did receive some medical history for Mr. ******’s pet but it didn’t appear to be complete so the following email correspondence was sent to him on 6/6/12.  I do not show any record of Mr. ****** responding to this email nor was a medical history review requested.

“Hello *******,

Thank you for sending in some of the medical history for ******. While this information is helpful, it doesn’t appear to be enough but let me ask you a few questions before making this determination.

I received detailed notes for 5/10/12 and 5/14/12 from Pleasant Plains Veterinary Hospital. I’m looking for a full twelve months of history so I need any and all visits between all of 2011 through current 2012.

It would help me to know the following information:

1. When did you bring ****** home or how long have you had ******?

2. Did ****** have any other visits in the time frame previously mentioned even for shots?

3. Did ****** visit any other vet clinics in the time frame mentioned previously?

Thank you for helping us establish a clear picture of ******’s history which will assist us in processing your claims. If you have any questions, please feel free to contact me at (800) 511-9172.”

Mr. ****** renewed his policy and submitted a claim, at that time he was informed that Embrace still did not have a complete history for ****** and we needed additional information.  It would not have been possible for us to provide Mr. ****** a medical history review at the beginning of his policy because we did not have all of the information and Mr. ****** had not responded to our requests nor did he specifically request a medical history review.

Mr. ****** reported to the adjuster that he had received a medical history review from Embrace but the adjuster had no record of this being performed.  The adjuster requested he forwarded the medical history email that he received to her attention so she could look into it further.  Mr. ****** forwarded the above email that was requesting information and the adjuster explained this email was only requesting additional information and not a medical history review.  Unfortunately, Mr. ****** did not request a medical history review when his policy was purchased nor did he respond to any of our requests for additional information to ensure his pets history was complete.  It was only when his pets claim was received that he let us know the other clinics his pet had been to so we could collect that information for the claim.

Embrace Pet Insurance cannot provide coverage for conditions that have been diagnosed or clinically symptomatic prior to the purchase of the policy or within the policy waiting period.  This is clearly defined in our policy terms and conditions that was sent to Mr. ******.  The remaining medical history was collected and reviewed at the time of Mr. ******’s claim for ******.  Mr. ******’s pet was found to have elevated liver enzymes on lab work that occurred prior to the purchase of the policy.  The policy terms and conditions classify this and any condition related to be pre-existing and not coverable.  Unfortunately, the claim that Mr. ****** presented was for chronic vomiting and the veterinarian wrote on the claim form that the pet had elevated liver enzymes and further testing was done, which revealed an enlarged liver indicating a liver issue to be the cause of the vomiting.  Mr. ****** is correct that many things can cause elevated liver enzymes but unless we can tell the current issue is clearly unrelated to the elevated liver enzymes prior to the purchase of the policy, the policy cannot provide coverage.

Mr. ****** noted in his most recent complaint that he has appealed this claim.  At this time, I only show the request for appeal and we would need a letter from the veterinarian explaining why this issue is unrelated to the prior elevated liver enzymes and proof the prior condition completely resolved.

Embrace would be happy to review any additional information for his appeal and we will create the appeal as soon as the additional information from his veterinarian is received. Unfortunately, Mr. ****** does not qualify for a full refund because coverage was in place for any condition that is not pre-existing to the policy.  Mr. ****** did not request a medical history review and did not provide us with the information needed to perform the medical history review.

 

7/23/2012 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I am an Embrace customer who holds a pet insurance polices for each of my two dogs.Embrace Pet insurance has, without warning, sharply reduced the reimbursements for a specific required treatment (Laser therapy), from $250 per treatment, to $50 per treatment. (Our dogs require the laser treatments for current ailments and diseases).Embrace Pet Insurance claims that our vet's $250 charge per laser treatment is exorbitant and unnecessary, and that is why they have only agreed to stop paying $250 per treatment, and pay only $50 per treatment. We have explained that the $250 charge we pay for a house-call vet to administer the treatment is necessary because it is the current going rate for the what we are receiving in terms of quality and care (versus what is obtained via a $50 per treatment that Embrace identifies as 'customary'). We pay $250 per treatment because:1.) our dogs cannot travel to see a veterinary office (they get severe anxiety, vomiting, and diarrhea).2.) The comparative $50 treatment, referenced by Embrace, is for unlicensed, inexperienced vet techs who conduct brisk and non-clinical, unsupervised treatments. Our Vet is licensed, has a PhD, receives continued certified education for laser treatments, and has the knowledge to administer the treatment at varying degrees of intensity, in multiple concentrated areas where our dogs have their ailments (vet techs do not have said experience). What is worse is that Embrace health insurance has been holding back ALL reimbursements to me (regardless of type of treatment) for over 45 days now (they promise 15 business days or less) in an effort to intimidate me into accepting their sharply reduced reimbursement for the aforementioned laser treatments.Finally, Embrace has resorted to making multiple phone calls to our dogs Veterinarian, Dr. ********** *****, unnecessarily interrogating her and asking her for records (that Embrace already has), which is, what I perceive, an effort to intimidate her and us.

Desired Settlement: Where applicable, full reimbursement of the additional $200 per laser treatment, as filed in 2011 and 2012 to date.Full and complete processing and reimbursement for all claims to date.

Business Response: Dear Ms. ****** *****, This information is in response to complaint number ******* made by one of our pet parents, ****** *****. Mr. ***** is correct that we have recently reduced the allowable amount reimbursed for laser therapy treatment for both of his pets.  A review of Mr. *****’s claims caused us to question the amount for the service being charged by his veterinarian.  A total of nine veterinary hospitals in Mr. *****’s area were contacted to review the usual fee for the therapy and the highest charge found was $50.00, confirming his veterinarian’s charge was higher than usual for the same or similar treatment. Mr. ***** disagreed with this explaining his veterinarian performs the treatment and  the veterinarians we contacted have technicians perform the treatment.  He notes the technicians are not trained or qualified to do this and the cost reflects the expertise of his veterinarian. Due to Mr. *****’s dispute we offered Mr. ***** an external review where we find a veterinarian to review the file, including the pet’s medical history, and Embrace would cover the fee for review.  A veterinarian was agreed upon by Mr. ***** in Sleepy Hollow, New York.  The veterinarian was asked if it is medically necessary for a veterinarian to perform laser therapy or if it is acceptable in the industry for a veterinary technician to perform the therapy, if the cost was within a reasonable range or excessive and whether the frequency of treatments was medically necessary.  The veterinarian who performed the review noted that he uses a class IV laser in his practice.  He could not say whether or not this is the identical laser used by Mr. *****’s veterinarian but he was able to explain they are similar.  He went on to state both he and his technicians were trained by the laser company on the use of the laser.  He noted it is not medically necessary for the veterinarian to perform the procedure but this is up to the individual veterinarian.   This veterinarian also noted that his practice is located in arguably the most expensive county in the state and Mr. *****’s veterinarian charges four to five times what most practitioners in the area charge.  He concluded that unless other regional practices are charging similarly, the charge is significantly more than should reasonably be expected. Based on the information provided from the external review, we agreed to increase the allowable amount for the treatment to $62.50, which is one fourth of the treatment fee charged by Mr. *****’s veterinarian.  This is due to the Veterinarian stating it was 4 times higher than the regional charge for the same treatment. The veterinarian, who performed the review, noted that he could not comment whether or not the frequency of treatments was medically necessary.  He explained the reason for this is the medical records he received do not follow commonly accepted principles of medical record keeping.  The medical records sent were the records presented to us by Mr. *****’s veterinarian and we were informed these are the only records she keeps.  This is what has caused us to contact his veterinarian to request additional information.  Mr. *****’s veterinarian does not always specify details needed in her records which has caused us to obtain additional information.  An example we have recently come across is not naming a medication given but only a classification of a medication.  To ensure the policy terms and conditions are met, we require the specifics of the medication. Mr. *****’s claims are delayed but have not been delayed because of the current dispute.  Our claims processing time has recently been extended due to a system upgrade.  Updates were sent to Mr. ***** letting him know we were behind in our claims processing.  Mr. *****’s claims were not delayed any more than our other pet parents claims and we are working diligently on correcting this for all of our pet parents.  ***** *****Claims Managing EmbracerEmbrace Pet Insurance(  ************ EmbracePetInsurance.com
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1/12/2012 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Embrace Pet Insurance was recommended by the vet in MA. I signed up over the phone and have been carrying coverage that costs over $40 a month approximately a year. My pet was acutely ill with a stomach bug, the vet said often they can pick it up anywhere, especially if a dog with the illness was where you were. That the disease was rampant in dog parks. Embrace adeptly looked for every excuse not to cover it the claim. They even said they had not received the claim, although the vet had sent it to them and cc'd me. They did a review of my pet's history and said she had a degenerative back disease (Embracer ********* ******)! Because I had request the vet to send the orthopedic report THREE times to them. They suddenly reopened a problem my dog had with her feet they did not cover, for $200. I emailed ***** ******, an adjuster, requesting an update as they advertise to cover claims quickly. I have never heard back. The $425 claim I had to remind them that were passing their limit for settling the claim. A head adjuster, ********* ***** would write lengthy emails trying to make me understand all the reasons she would not pay the claim. They even told me on the customer service line, when I called to ask a question! They are EXPERTS in not covering any claims, and I am a reasonable person who spends money on preventative medicine, healthy food, exercise and take care of my pet. It turns on they are underwritten by RLI Insurance in Ohio. When I contacted the MA Division of Insurance, they were not regulated by them. In fact NONE of the top advertised pet insurance companies that you find on the internet were on the MA DOI's list of regulated pet insurance companies. In fact, I had not heard of one of these companies on the list and I do a lot of research. These unregulated companies are taking advantage of well meaning pet owners as well as animals, who cannot speak for themselves. The claims were "Gastroenteritis and Pancreatitis" $428.31 and "Pododermatitis" $212.79.

Desired Settlement: Due to the problems and number of hoops and emails Embrace has put me through, I respectfully request:1)Monetary compensation instead of their endless reasons not to cover claims2 Stop unregulated pet insurance, warn owners to use regulated pet insurance. 3)Stop not apprising clients the status claims and lying about not receiving claims & omitting critical medical information they receive and be audited4)Stop making fake claims such as speedy hassle free settlement

Business Response:

Thank you for the opportunity to discuss **** ****** complaint.  My name is ********* ***** and I’m the Claims Manager for Embrace.  ***** asked that I provide you with information regarding **** ****** dispute because I’m familiar with her account and have corresponded with **. *****.

 I’ve attached a timeline of events for this pet parent that has additional information and also attached her policy terms and conditions.  I feel bad that we couldn’t provide coverage for **** ****** claims but I feel we delivered everything we agreed to and as we promised.  I’d like to take a few moments to address each of her concerns and disputes.

*** **** mentions in her complaint that she has had her policy for approximately one year.  The amount of time she has had her policy does not have an impact on her coverage. *** **** purchased a policy from us on 12/12/10 with coverage starting the next day on 12/13/10.  Unfortunately, there was a billing failure with her account and her policy was cancelled on 3/4/11 due to non-payment.  She purchased a new policy on 6/10/11 with coverage starting on 6/11/11.

 **** indicates in the below complaint that we were untimely in processing her claims.  I show that *** *eay submitted 2 claims to Embrace and I reviewed all email correspondence and timeline relating to these claims.  I do note in our records that she called on the second claim and we did not show a record of receiving it at the time of her call.  The following is the timeline for these claims.

Claim 1 – Pododermatitis (medical condition) in the amount of $212.79

8/25/11 Claim received

8/26/11 email sent advising we received the claim and she would hear back from us in 15 business days (9/15/11)

9/15/11 Claim completed and email sent to pet parent.  

 Claim 2 – Gastroenteritits and Pancreatitis in the amount of $428.31

This claim was not scheduled to be completed until 12/7/11 but I show that we exceeded the expectations around completion time.

11/17/11 claim received.  Email sent advising we received the claim and she would hear back from us in 15 business days (12/7/11)

12/1/11 email sent advising pet parent we were working on her claim and were running a bit behind.

12/2/11 claim completed – advising pet parent not covered

 The review of *** ****** pet’s history was done so she would be aware of any conditions which may be pre-existing to her policy and she did not have any surprises with her coverage.  The medical history review revealed notations in the pet’s medical history of back pain prior to the purchase of the policy.

 I’m not sure what *** **** is referring to when she states “reopened a problem”.  I assume she is referring to the first claim we received which wasn’t covered because the pet was having clinical signs of a dermatologic condition prior to the start of the policy making the condition pre-existing and not coverable.

I do show that ***** ****** responded to *** ****** emails in a timely manner and most were responded to within the same business day.  The following is the timeline of correspondence:

11/29/11 email received by ***** ****** and the pet parent asked how her claim was coming along.

11/30/11 ***** emailed her a status letting her know we had everything we needed to process the claim

11/30/11 pet parent responded asking how long it takes to process a claim and if we had the doctor’s notes

11/30/11 ***** responded advising it takes 15 business days and that we didn’t need any additional information

12/1/11 pet parent emailed ***** asking about specific date she would hear back

12/1/11 ***** ****** responded explaining the date and calculating the date she would hear back

 The NAIC number (National Association of Insurance Commissioners) for our underwriter RLI Insurance Company is 13056 and is an approved insurance company in MA as can be seen in the spreadsheet listed under “Massachusetts Licensed or Approved Companies” on this MA gov webpage http://www.mass.gov/ocabr/licensee/license-types/insurance/insurance-companies/massachusetts-licensed-insurance-companies.html   

 Embrace Pet Insurance Agency is also licensed in MA, license number *******.

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

 Best regards,

***** *****

Claims Managing Embracer

Embrace Pet Insurance

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

EmbracePetInsurance.com
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