Complaints

• Initial Complaint

  03/30/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  On my second attempt to do a claim for my pet with Embrace insurance I was denied again but I had to send an email every 10 to 15 days for 2 months to get some kind of feedback or information back from the company. it was a back-and-forth back-and-forth with over 20 emails. I asked the company in the beginning of February to cancel my plan which is $22.27 a month. I need a refund for two months of coverage that I asked to be canceled. I got a rude email response from Embrace and they gave me $3.44 which I have no idea what that is supposed to be. (Also that money has not shown up in my account ). I’m asking for a refund of $44.54. Also I just wanted to be known that the customer service has been absolutely terrible with this company and also they haven’t covered a single thing for my pet and denied every single claim I have made

  

  Business response

  04/01/2022

  Hello BBB,
  
  I would be happy to discuss this case further. ******* ********’s policy began with Embrace Pet Insurance (EPI) on 9/2/20. The policy had a 2-day accident waiting period, which ended on 9/4/20 and a 14-day illness waiting period, which ended on 9/16/20. The policy is for *********, 3-year-old, female, Domestic Short Hair cat, **** **********.
  
  Every pet has a medical history review to determine their pre-existing conditions. The medical history review can be completed at the end of the illness waiting period per request of the pet parent or when the first illness claim is submitted to EPI. A medical history review was not requested for Elsa Lancatster, so it was set to initiate when the first illness claim was received.
  
  On 2/3/22, a wellness claim was received, but as this pet did not have the optional Wellness Rewards plan this claim was not reimbursed. After our team worked with Charity on 2/7/22, we were able to determine this was intended to be an illness claim and the claim was reprocessed. It was at this time the previously mentioned required medical history review process was initiated. It was also at this time that Charity requested to cancel, but she did not confirm that request while working with our team on this claim.
  
  EPI requested via email full records from ******** *** ******** – Loganville (BPH) on 2/7/22, again on 2/12/22 and via a phone call on 2/22/22. A team member with Embrace spoke to Sherri at BPH on 3/10/22 who informed us that the clinic needed client permission to release records to us. We emailed Charity on 3/10/22 to let her know that she would need to call her clinic to give this permission. BPH then sent notes to us on 3/11/22, however we found that the full history wasn’t included as requested, and only included the 1/21/22 date of service. A new request was sent on 3/14/22 and then again on 3/19/22, with no response from the clinic. On 3/23/22 full records were received, and the required medical history review was completed on 3/25/22.
  
  The terms and conditions of the policy define pre-existing conditions as:
  
  10. Clinical Signs means changes in a Pet’s normal healthy state, bodily function or behavior observed by you, a Veterinarian, or other observer.
  
  27. 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.
  c. Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.
  
  31. Undiagnosed means the underlying or causative condition has not yet been identified.
  
  Based on the medical history provided, both Feline Immunodeficiency Virus (FIV) and Diabetes were noted on 11/4/19 and 8/31/20 respectively, which were prior to the policy purchase. This makes these conditions (and any related conditions and/or clinical signs) pre-existing, not-covered conditions. Both conditions were noted in a communication with Charity on 3/25/22, and then on the claim for the 1/21/22 visit for Diabetes.

  Charity requested to cancel the policy on 3/26/22 due to the previously mentioned claim not being covered due to a pre-existing condition. Per the policies terms and conditions, a full refund can only be given if the policy is cancelled within 30 days of the original start date and no claims have been submitted. Because Charity submitted a claim and requested to cancel outside of this 30-day window we can only offer a pro-rated refund based upon the time of cancellation. ********* cancellation was completed on 3/28/22, and she was given a pro-rated refund of $3.44 based on the policy terms below.

  PART V - LIMITS OF INSURANCE

  3. Cancellation Refund Upon cancellation, you may be entitled to a premium refund. If you provide us notice of cancellation within thirty (30) days of the Policy 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 based on the termination date of the policy

  If you have any additional questions, please do not hesitate to ask!

  Warm Regards,

  ***** *******, RVT
  Team Lead, Claims Adjuster

  Customer response

  04/07/2022

  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,
  
  ******* ********
  
  
  
  
   

• Initial Complaint

  03/28/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I filed a claim with Embrace for my dogs dental cleaning which falls under the wellness plan that I pay extra for. I got an email from Embrace telling me the claim was pending because they’ve needed my dogs health history for a year. I called my vet, and they told me they never received the request. I called Embrace and they told me that they had emailed my vet four times for this information; however, Embrace NEVER informed me that they needed this information and hadn’t heard from my vet. If they had COMMUNICATED this to me, I wouldn’t have intervened sooner. I called my vet and requested this information be faxed to Embrace which they did. I followed up by calling Embrace and the representative told me they had received it, but the claim had to be reviewed. I then I decided that I was going to cancel my dog insurance coverage with this company. I tried to call them to cancel , but it was after hours, so I emailed instead requesting them to cancel my policy before the next billing, and also requested information about my claim, but got no reply. This company is very unprofessional; I’m suspecting fraud. They don’t return emails There is ALWAYS a 30 minute wait on hold, or longer. They have not honored my wellness claim and reimbursed-me my fee for my dogs dental cleaning as is covered under my wellness plan.

  

  Business response

  03/30/2022

  Hello,

  
  I would be happy to explain this case with you. We received ******** ****** claim on 3/22/22. Since the diagnosis on the claim was dental wellness and this was her first illness claim submitted, a medical history review was required to process the claim. Typically, this process does add to the processing time of the first illness claim as we must request the medical history from the pet’s veterinarian(s) and then review it. Our normal estimate for first time illness claims is 30 days. We do try to request the medical history ahead of time to help decrease the timeframe, and did for ********’s policy; however, we never received any response from her veterinarian. If a pet parent does not request the medical history to be reviewed prior to the first claim, which in this case it wasn’t, we wait until the claim is submitted. We disclose this, as well as what medical history we will need, in an email at the start of the policy. Since she did not request this review to be done, we did not review any medical history nor notify her the medical history wasn’t received. After receiving the claim and requesting the medical history again, we received the medical history on 3/25/22. Both the review of the medical history and the claim were processed yesterday, 3/30/22.

  
  Regarding her email being unanswered, I do not have any record of us receiving the email attached and noted by ********. We do have record she emailed us a different time on 3/23/22; however, she called shortly after sending it and her concerns were discussed over the phone, so no reply was sent. If she wishes to have her policy cancelled, we just need her to either email or call us and we would be happy to assist her with that request.

  
  I apologize for any frustration there has been with this policy. I hope that helps clarify the situation, but if you have any further questions or concerns, please let me know.

  
  Sincerely,

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

  Senior Claims Adjuster

  

  Business response

  04/01/2022

  Hello,

  
  I am sorry if there were any misunderstandings about the medical history we needed. We do not usually ask our pet parents to get us the medical history needed since they typically do not have this information. We ask your veterinarian for it directly. The wellness check you are referring to is the orthopedic report card and is only to shorten the orthopedic waiting period for the policy. The orthopedic report card was not the information needed to complete the medical history review nor did it replace the review we needed to do.  I’m sorry if you misunderstood what the purpose of the form was. We try to explain everything in emails sent at the start of the policy; however, sometimes there is misunderstandings.
  Regarding the claim, a dental cleaning is performed to treat dental disease. Dental disease, even if a low grade, is an illness and the some of the procedure can potentially be covered under the dental illness sublimit of your policy. Due to this, we must review the pet’s medical history prior to processing these claims to see if dental disease is a pre-existing condition to the policy.

  
  Regarding the reimbursement for the claim, you should have the reimbursement now or be receiving it shortly. Even with direct deposit, it doesn’t immediately deposit into your account. Unfortunately, there is still a delay of a day or two for both banks to process it & it to get deposited in your account. As for the April premium, I do see your policy has been cancelled as of 3/30/22 and you are getting a prorated refund for April. As with your claim’s reimbursement, this typically will take a few days to show up in your account. Unfortunately, we can’t always stop the next payment if you don’t notify us in sufficient time since they are set up to automatically be done. I’m sorry this occurred. If you have any further questions, please let me know.

  
  Sincerely,

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

  
  Senior Claims Adjuster

  Customer response

  04/07/2022

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.  However, I was only reimbursed $45.95 and I paid $87 for the month of April. I am VERY disappointed with this company’s lack of professionalism and the inadequate communication between client and business which is why there was so much confusion in the first place.

  Wait times on the phone are too long, and ALL emails should be answered regardless of how “important “ you feel it is. I will never be doing business with this company again, AND I will definitely NOT recommend it.
  
  Regards,
  
  ******** ****
  
  

  
  

• Initial Complaint

  03/22/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  We purchased embrace pet insurance on 5/23/2021. We were told we either had to submit an exam or wait a waiting period for the insurance to kick in. On 1/16/2022 we brought our dog to the vet for a skin infection. She was treated but it caused many trips to the vet. No pre-existing conditions with our dog. Embrace reviewed all of our records and receipts and decided on their own this was caused by pre-existing conditions and they will not cover any of what we paid except for $120. Our total cost out of pocket was over $1,600. Our vet wrote a letter appealing this decision explaining there is no pre-existing conditions that would have caused this. They denied the appeal. Embrace Pet insurance is a complete scam.

  

  Business response

  03/23/2022

  Hello BBB,

  I would be happy to further discuss this case with you. A policy was purchased 5/22/21 by *** ***** for his canine ****. When a policy is first purchased, it is stated in the first email sent out by Embrace Pet Insurance (EPI) that a pet has to be examined by a veterinar*** in the 12 months prior in order for coverage to be active and coverage will not start until an exam is completed. During the application for the policy, Mr. ***** indicated **** had not been to the veterinar*** in the past 12 months for an exam. Another email was sent to Mr. ***** explaining **** needed to be seen within the 14-day illness waiting period or your coverage will not begin. There is another email sent the day a policy is purchased that explains EPI will send a request for medical records; however, we will not review medical history until the time of your first claim unless a medical history review is requested. We received ****’s first illness claims on 1/26/22 and it initiated the medical history review to determine if there were any pre-existing conditions.
  
  When reviewing a pet’s medical records, we review records from 12-months prior to the policy start date, until the end of the 14-day illness waiting period (5/23/20-6/6/21). In the medical records we received for **** from **** ***** ****** ******** * ********* ******* the first exam occurred on 7/27/21. There were also medical records from ****** however, the first exam at this facility was 8/21/21. Since **** was not seen in the 12 months prior to the policy start date, her coverage did not start until the first exam completed on 7/27/21, which meant that any abnormalities found during this exam would be listed as pre-existing conditions. Vomiting was noted during this examination and since this illness is outside of the pet’s normal, healthy state, it created a pre-existing condition on the policy for ****.
  
  16. Illness means sickness, disease, or any change in a Pet’s normal, healthy state, which is not caused by Injury to the Pet
  27. 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.
  c. Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.
  
  As it was noted in emails to the client that **** had to be examined within 12 months prior to the policy start as well as in the policies terms and conditions, ****’s illness waiting period was extended to 7/27/21. Due to **** not having illness coverage during this time frame, there was a refund issued for the amount paid into her illness portion of the policy due to no coverage being present for $24.52.
  
  PART II – CONDITIONS
    1. Your Pet must have been examined by a Veterinar*** in the twelve (12) months prior to the Pet Original Start Date as shown on the Schedule Page(s) within 14 days after the Pet Original Start Date. Failure to do so may result in your policy being voided. If your policy is voided, your premium will be refunded. No Coverage is available until a qualifying Veterinar*** has examined your Pet, and Pre-existing Conditions, if any, may be determined upon the date of the qualifying Veterinar***'s examination.
  Regarding the not covered claims. In the medical records from **** ***** ****** ******** * ********* ******* on 1/16/22, it was noted **** was adopted 9 months prior and has become progressively pruritic since adoption. This places the onset of the pruritus prior to the purchase of the policy with EPI, which creates a dermatological pre-existing condition on the policy for ****. EPI’s definition for dermatological conditions from the terms and conditions includes ear infections.
  14. 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.
  
  For a pre-existing condition to expire, a pet must go 12 months without a sign, symptom, or related condition. Since **** was unable to go 12 months without a related sign, symptom, or condition, the claims for the ear infection (dermatological condition) and vomiting were not eligible for coverage.
  
  If you have any additional questions, please do not hesitate to ask.
  
  Sincerely,
  
  **** ******* RVT
  
  Senior Lead Claims Adjuster

  

  Business response

  03/25/2022

  Hello BBB,
  
  I would be happy to further discuss this case with you. I have reviewed the communications with Mr. ***** and our customer service department. During a phone call on 8/6/21, Mr. ***** asked if his policy was fully active or if anything was needed to start it. Our customer service representative asked Mr. ***** if there was a wellness exam for **** at the veterinar*** in the past 12 months and Mr. ***** replied there was not. **. ***** goes on to explain they received **** from a family that could not care for her and there was no veterinary record. Our customer service representative explained to Mr. *****, **** would need an exam before the policy could become active.
  
  There was another call on 1/18/22 with Mr. ***** and another customer service representative. Mr. ***** asked if the policy was fully ready to go. The customer service representative stated we had information from Vetco and Mr. ***** confirmed that is what he submitted as proof of an exam. The customer service representative explained we did not need anything further at this point and we would reach out if we did. Mr. ***** went on to ask questions about his deductible. Pre-existing conditions were not discussed during this phone conversation and no coverage was guaranteed.
  
  The last phone conversation occurred on 2/22/22 due to confusion around why the claims were on hold. A customer service representative explained to Mr. ***** we were looking for medical history prior to the policy purchase. Mr. ***** confirmed **** had only been to Vetco and West Hills Animal Hospital and he believe the first exam would be around 8/2021.
  
  EPI was in contact with both veterinary facilities confirmed by Mr. ***** and the first available examination was on 7/27/21. The illness waiting period was extended to this day as the policy was now made active with this exam.
  
  PART II – CONDITIONS
    1. Your Pet must have been examined by a Veterinar*** in the twelve (12) months prior to the Pet Original Start Date as shown on the Schedule Page(s) within 14 days after the Pet Original Start Date. Failure to do so may result in your policy being voided. If your policy is voided, your premium will be refunded. No Coverage is available until a qualifying Veterinar*** has examined your Pet, and Pre-existing Conditions, if any, may be determined upon the date of the qualifying Veterinar***'s examination.
  
  Embrace Pet Insurance (EPI) was previously provided the letter from Dr. Kristie Williams and an appeal of the claims decisions was completed by our underwriter and not overturned. Every policy with EPI is governed by a set of terms and conditions, which are provided to the pet parent when the policy is purchased. As previously explained, **** was first examined on 7/27/21 due to vomiting. Since this was the first exam to make the policy active, it created a vomiting pre-existing condition on the policy.
  
    PART I – DEFINITIONS
  16. Illness means sickness, disease, or any change in a Pet’s normal, healthy state, which is not caused by Injury to the Pet
    27. 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.
  c. Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.
  
  A claim for vomiting from date of service 1/25/22 was received by EPI and due to the vomiting pre-existing condition still being active, the claim was ineligible for coverage.
  PART IV – EXCLUSIONS
    1. Pre-existing Conditions;
  Specific situations include but are not limited to:
  ii. If your Pet has been treated for Undiagnosed vomiting and/or diarrhea prior to the end of your Pet’s Waiting Period, your Pet must be free of conditions with the same Clinical Signs for twelve (12) consecutive months before any conditions with the same Clinical Signs may be covered again.
  
  The medical history also mentioned **** had been progressively pruritic since adoption, which was prior to the purchase of the policy. Since the pruritus began prior to the purchase of the policy and is a condition of the skin, it created a dermatological pre-existing condition on the policy. As previously explained an ear infection, which is what ****’s claims were related to, is also considered a condition of the skin and related the pre-existing condition.
  

  PART I – DEFINITIONS
    14. 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. Pre-existing Conditions;
  Specific situations include but are not limited to:
  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.
  
  EPI was up front from the beginning with Mr. ***** about the requirement of the examination to make the policy active. All communications with Mr. ***** aligned with this information. As an insurance company, we are bound by the terms and conditions of our policies and are unable to provide coverage for claims related to pre-existing conditions as defined by those terms and conditions. I hope this helps to clarify the situation.
  
  If you have any additional questions, please do not hesitate to ask.
  
  Sincerely,
  
  **** ******, RVT
  
  Senior Lead Claims Adjuster

  Customer response

  03/25/2022

  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.
  
  The company is twisting everthing to their side. 
  

  I demand a refund of all policy premiums paid. 
  
  Regards,
  
  *** *****
  
  
  
  
   

• Initial Complaint

  03/15/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I signed up for a pet health insurance plan and was charged $108.55 on 1/3/2022. I was promised that a medical record review would be conducted and provided to me within 30 days. I have copies of the email that my vet sent the medical records to Embrace 1/5/2022. With 30 days, the latest the review should have been completed on would be 2/3/2022. I was never sent the medical record review and what would be covered and was charged AGAIN on 2/3/2022 for $83.55. I contact them again and they said they did not have the records which I know for a fact were sent to them, and they even said they would reach out to get more records. THEN I WAS CHARGED AGAIN for $83.55 on 3/3/2022 with absolutely no contact from them regarding the medical record review or what was going to be covered. They are committing fraud by charging without completing the review or offering any service. I expect a full refund of 108.55+83.55+83.55 = $275.65

  

  Business response

  03/15/2022

  Hello BBB,
  
  Please let me explain. *** ****** purchased a policy for her dog, *******, on 1/2/22. He had a 2-day accident waiting period that ended on 1/4/22 and a 14-day illness waiting period that ended on 1/16/22. *** ****** requested a medical history review to identify any pre-existing conditions on her policy. This was requested on 1/11/22, but records cannot be obtained until after the 14-day illness waiting period ends. Requests for records to all clinics that *** ****** notified us of, were sent out on 1/16/22 and again on 1/28/22. Medical records were obtained from ******* Veterinary Clinic on 2/25/22, ******* Dog Resource Center on 2/25/22, ********** ****** Vets on 2/25/22 and *********- ***** ******** on 2/25/22. After review of these records on 3/15/22, it was determined that ******* had been seen at ********** Veterinary Referral Center prior to the policy and we were also missing records from ********** ****** Vets. Requests for records were sent to both of those clinics on 3/15/22. It is standard protocol that all previous medical records are reviewed for pre-existing conditions before we can finalize the medical history review. We still have not received all previous records at this time, so the review is not complete. I hope this helps clarify the situation.
  
  ****** ****** RVT
  Senior Lead, Claims Adjuster
  Embrace Pet Insurance

  Customer response

  03/15/2022

  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.]

  This is not what I was promised. I was promised a medical record review that would be completed within 30 days of the start of my policy (which should have been 2/3/2022. The only reason you obtained records on 2/25/2022 is because I called and emailed you to ask the status of the records reviews which you had not completed. You had not ever requested records prior to that time and i have the email from my vet to prove it.  You said you only need files from 12 months prior to the policy start date and the files that you are referring to are from more than 12 months to the start date, so they should not be included in the medical record review. I expect a full refund. Send me confirmation that my policy is cancelled and that I will be receiving a refund. The records that you are referring to are outside of the window of time that you need records for the review.  

  
  Regards,
  
  ***** *******
  
  
  
  
   

  

  Business response

  03/16/2022

  Hello BBB,
  
  While we do strive to have our medical history review’s completed within 30 days, if it is discovered that records are missing, this timeframe can be delayed. After the initial review of *******’s records on 3/15/22, it was determined that we were missing medical notes from two different hospitals and the additional records were requested at that time. The review cannot be completed until all records have been received. Ms. ******* cancelled her policy prior to Embrace’s receipt of this response. I hope this helps clarify the situation.  
  
  ****** ******, RVT
  Senior Lead, Claims Adjuster
  Embrace Pet Insurance

• Initial Complaint

  03/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I initiated a policy for my pet on Feb 19, 2021. I immediately received an email from Embrace stating that the policy would be in effect following 2 day waiting period for accidents, 14 days for illnesses and 6 months for Orthopedic problems. I received no further communication from the company until I filed a claim that was rejected. After providing additional paperwork I was informed that there is a note in my account that states my policy has an exception for tumors because there was an unresolved test in the paperwork I provided. That condition was diagnosed 4 months PRIOR to application for coverage and was resolved and has not presented again making it a temporary condition per section IV.1 of the policy documents. I was never notified of any limitations to my coverage, instead received multiple emails stating that the policy was in effect. Had I been notified that my coverage would not cover tumors I would have been able to cancel the policy within the cancellation window, but since I was not informed of this exception until 4 Mar 2022 I was no longer in the cancellation window and unable to cancel.

  

  Business response

  03/14/2022

  Hello,
  I apologize for any confusion there has been with your policy. I was unable to locate a policy under your name, but I will do my best to explain the situation in general. When a policy is first purchased, there is a 14-day illness waiting period, when the end of this waiting period is reached there is an email sent out explaining that you can request a medical history review. If a medical history review is not requested at that time, the email states that we will not review any records until the first illness claim is received.
  When the records are being reviewed, any abnormalities that are noted within the 12 months prior to the policy purchase until the end of the 14-day illness waiting period are then listed as pre-existing condition. In cases where there is a permanent exclusion under the policy, such as a skin mass, an email is sent out after the review explaining what conditions are excluded from the policy.
  If you do not agree with a pre-existing condition, there is an option to appeal a condition as listed in your policies terms and conditions. If you have any additional questions, please let us know!
  
  Sincerely,
  ******** ******* ***
  Senior Lead Claims Adjuster

  Customer response

  03/15/2022

  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.
  
  Thank you for your response. I have have previously stated- the problem is that the exception to the policy was not provided WITHIN the cancellation window. AS you stated, the communication started in APRIL, which is after the cancellation period- and ONLY occurred because I made a claim in April... and the information requested was NOT the fine needle aspirate results. The information that was requested was due to a translation error. The vet visit for the first claim was for a paw infection that listed "re-exam" so you requested information on the previous visit. The problem is that there was never a previous visit, Japanese language doesn't have Past tense.. on present and future- so it was poorly translated- The word they used literally means "Checkup exam", but translated came out "re-exam". I provided that information, and it was at that time that the aspirate was requested. I don't have any lab results for the aspirate and don't live in Japan anymore so I can't go get them. I have tried contacting the clinic to get them as well- but that's irrelevant. 

  I would like the policy refunded because I WAS NOT NOTIFIED OF ANY EXCLUSIONS WITHIN THE CANCELLATION WINDOW- which would have allowed me to cancel. By waiting until the cancellation window had closed you did not afford me the opportunity to make an educated decision. This is why I got the BBB involved. This is a deceptive business practice. Had my issue just been about missing records I would handle it with your company directly, but because your practice is deceptive it warrants BBB involvement to get it resolved so that others know and can steer clear. 
  

  Waiting until the cancellation window has closed to notify of exceptions would be like waiting to ship an item from a retailer until the return window had closed- so that I would not have time to inspect the item and ensure satisfaction. This is deceptive and fraudulent. 

  
  Regards,
  
  ****** *****
  
  
  
  
   

  

  Business response

  03/15/2022

  Hello,
  I would be happy to provide additional information. As stated in the first response, an email is sent explaining that a medical history review may be requested after the 14-day illness waiting period, if one is not requested, we will not review any records until the first illness claim is received. As Mr. Smith stated, his first claim was submitted in Apriil, which is when we began the medical history review since no request was made prior to that.
  Hi Jeremiah,  
  You are now out of the accident and illness waiting periods. Nice! We wanted to check in and review a common topic that often comes up for new pet parents.
  We cover a lot of claims (93% in 2017, to be exact!), but unfortunately there are some that we’re just not able to cover, due to pre-existing conditions. We define a pre-existing condition as:
  ·       “A chronic condition, injury, illness, or irregularity noticed by you or your veterinarian before the end of your waiting period, even if your pet never went to the veterinarian for it.”  No pet insurance company covers pre-existing conditions. Learn more about pre-existing conditions here.
  If any part of the above definition may apply to your pet, and you’d like to see if it might not be covered, let us know. We’ll be happy to conduct a Medical History Review, where we evaluate the last 12 months of your pet’s medical history (or less, if they are a new addition), and let you know what – if anything – would be considered pre-existing.
  If your pet hasn’t shown symptoms or been treated for anything in the past year, you probably don’t need to request a medical history review. However, we’re happy to conduct one if you’d like. If you choose not to, we still attempt to collect the medical history from your vet, but we don't review it until your first claim is submitted.
  
  You can request a medical history review by replying to this email.
  
  Thank you again for Embracing *****.  Have a great week.
  Your Embrace Customer Care Team
  Embrace Pet Insurance
  ***** ********
  
  
  As we have stated in previous emails, we were trying to obtain the results of the fine needle aspirate or more information regarding the mass that was noted, so the pre-existing mass can be narrowed down. If we are unable to obtain additional information or a diagnosis on this mass, it will remain an undiagnosed skin mass and we can move forward with the medical history review.
  Unfortunately, we are unable to refund the entire policy as ***** still had active coverage for the entire length of the policy. As no medical history review was requested at the end of the waiting period, her records were not reviewed until the first claim was received as it states in the email you received. I will make a note on her policy that no additional records are able to be obtained from Japan and that her previously noted skin mass is undiagnosed. If you have any questions, please let us know!
  Sincerely,
  ******** ******* ***
  Senior Lead Claims Adjuster

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩