ComplaintsforEmbrace 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

• Initial Complaint

  02/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have had Embrace Pet insurance for just under a year, totaling insurance premiums around $456. On 1/6/2022 I took my dog to the vet for continuous vomiting, diarrhea, inability to drink water, keep food down and lethargy. He was seriously ill for over a week which resulted in vet bills of around $500. I filed a claim with Embrace pet insurance on 1/8/2022 for reimbursement of the vet bills. They took a month to review the claim. Today, they sent an email saying that they will be rejecting the entire claim because on 1/13/2021 my dog went to the vet for vomiting. As such, vomiting and diarrhea and any conditions related to these are considered preexisiting conditions and will not be covered. These were not the same issues and were 11 months and 23 days apart. My dog was sick for over a week and could not move in January. Also, vomiting and diarrhea are symptoms that bring people to the vet, they are not preexisting conditions like allergies. I am seeking reimbursement for the vet bills and/or for the policy that did not cover my pet.

  

  Business response

  02/08/2022

  Hello,
  
  I would be happy to explain this case. When a policy is first purchased with Embrace Pet Insurance (EPI), an onboarding email is sent that contains all the policy documents as well as the policy’s terms and conditions. That email explains the policy waiting periods, which include a 14-day illness waiting period. This means any abnormalities noted 12 months prior to the policy start until the end of the 14-day illness waiting period are listed as pre-existing exclusions under the policy.
  
  When the end of the 14-day illness waiting period is reached, there is an additional email sent out explaining that a medical history review can be requested to determine if there are any pre-existing conditions for the pet. If this review is not requested, then EPI will not review any medical history until we receive an illness claim. As a medical history review was not requested for ****, EPI did not review his medical history until his first illness claim was received on 1/10/22.
  
  The terms and conditions of ****’s policy define clinical sign, pre-existing condition, and undiagnosed as follows:
  
  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 by ******* ****** ******, both vomiting and diarrhea were noted in the medical records on 1/13/21, which was prior to the policy purchase. This makes vomiting and diarrhea (and any related conditions and/or clinical signs) temporary pre-existing, not-covered conditions. **** must go a full 12-months without any signs/symptoms/treatment from the most recent occurrence for either condition to be eligible for expiration. Both conditions were originally set to expire on 1/13/22, however vomiting and diarrhea were both noted in a communication log with ******* ****** ****** on 2/4/21, and then the claim for the 1/6/22 visit was also for vomiting and diarrhea. As such, the expiration date was extended to 12-months from the most recent occurrence and is currently eligible for expiration after 1/6/23.
  
  If you have any additional questions, please do not hesitate to ask.
  
  Sincerely,
  ***** ******, RVT
  Senior Trainer, Claims Adjuster

• Initial Complaint

  02/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On January 31st, 2022. I took my dog to the vet because he had A horrible ear infection. They ended up sedating him, flushing his ear, and putting bacterial gel in his ear. I went to file a claim with embrace pet insurance company. However, they did not cover this ear infection because they consider it it as a pre existing condition for my dog. About a year ago my dog started his coverage and had what we believe to be allergies. We took him in for allergy medication, he ended up not having them. Since this visit, embrace has refused to cover any skin related ailments. Basically, they cluster all skin problems from parasite, infection, allergies, lumps etc. into one category and do not provide coverage for any of these items. Every time I appeal the claim, they simply say it’s skin related and not covered as a prior condition because my dog was seen for allergies a year ago. I believe this is unethical business practices clumping all skin related issues as one category. We do not, visit a allergy doctor for an ear infection. I do not see how my dog getting seen for itching and allergies is the same as being sedated and ear flush for an ear infection

  

  Business response

  02/14/2022

  Hello BBB,

  I would be happy to discuss this case with you. A policy was purchased on 7/21/20 by ****** ******** *** *******. When a policy is first purchased, there is a 14-day illness waiting period. Once a pet is past their 14-day illness waiting period, we request the records for the pet from any clinic the pet was a patient within 12 months prior to the policy start date, until the end of the illness waiting period. Once the first illness claim is received, the medical history is reviewed for pre-existing conditions. ******* was first noted to have a dermatological condition on 7/31/20 which fell within the illness waiting period.
  

  While insured Mr. ******** submitted two dermatological claims one for dermatitis (skin infection) on 4/3/21 and one for an ear infection on 1/31/22. These two claims extended *******’s dermatological exclusion out 12 months each. Leaving dermatological conditions excluded from coverage until 1/31/23. Mr. ******** stated in his complaint that he has appealed his claims whereas after reviewing *******’s policy I have not found any appeals submitted.  

  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

  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.

  In conclusion, ******* was noted to have a dermatological condition within the illness waiting period, making all dermatological conditions excluded from coverage for 12 months. Since ******* was noted to have additional dermatological conditions within the 12-month time frame, the claims were not eligible for coverage. Mr. ******** has chosen to cancel his policy effective 2/4/22.

  Sincerely,
  ***** *********** RVT
  Senior Claims Adjuster
  
  

  
  

  Customer response

  02/14/2022

  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 response from the business did not address the underlying complaint. They consider all skin ailments under one umbrella, this is not reasonable. I would like them to explain how allergies is under the same medical area of concern as an ear infection. Explain how my dog being sedated for an ear flush is similar to potential allergies for itching which is what they used as an “preexisting condition.” I also have not received my refund for the policy yet. I believe it was a little more than $200. I understand what they said about preexisting conditions but how are allergies and ear infections the same? 
  
  Regards,
  
  ****** ********
  
  
  
  
   

• Initial Complaint

  01/26/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Embrace Pet Insurance has denied 6 out of 7 of my claims to date. They claim "pre-existing" conditions for everything and find ways to link things together to make them all related. Obviously a pets body parts are all connected. My dog started a new thyroid medication and accidentally urinated in our home, I called our vet to ask if it may be due to the medication and brought my dog in to see the vet. The vet cleared everything and said it was just a one off incident. 8 months later my dog had an enlarged prostate and actual urinary incontinence. Embrace claimed a pre-existing incident happened 8 months ago and hence I was denied coverage. They told me if my vet wrote them a letter explaining they could let me appeal it. My vet explained to them at there was no incontinence at the time and they still denied my claim. This is the usual fraudulent insurance practice to deny as many claims as possible and keep collecting premiums. This shouldn't be a legal practice and there should regulatory oversight over these insurance and claims departments. Also, requirements and certificates should be in place for the heads of claims departments. The Director of Claims and Underwriting's LinkedIn claims she was a veterinary tech, then became a claims adjuster for one year, then made it to Director and only carries a bachelors in biology.. I would question this company and it's leadership qualifications. I want a refund of all the money I paid to them for nothing. What a rip off. And now I can't even get coverage for his incontinence anymore because it really is a pre-existing condition for any other insurer I go with. Can I file a lawsuit? Attorneys, please assist.

  

  Business response

  02/01/2022

  Hello,

  I would be happy to explain this case with you. When a policy is first purchased with Embrace Pet Insurance (EPI), there is a 14-day illness waiting period which means any abnormalities noted 12 months prior to the policy start (or from the first puppy visit if the pet is under a year old) until the end of the 14-day illness waiting period are listed as pre-existing exclusion under the policy.

  Joe Bui purchased a policy on 6/22/21 for his pet *****, that went into effect on 6/23/21 with the 14-day illness waiting period ending on 7/7/21. While reviewing *****’s medical records, there was a phone call noted on 2/12/21 that states ***** was having trouble with occasional urinary accident in the house, but no examination took place, and the underlying cause was not noted. Since the urinary accidents were prior to the policy start, these concerns along with any related/underlying conditions (including but not limited to urinary incontinence) or complications from it are excluded from coverage from the policy.

  A claim was submitted with medical records indicating ***** was leaking urine on 11/8/21. An enlarged prostate and subsequent neuter procedure were noted on 11/23/21. Finally, on 1/6/22 a claim was submitted for Proin, a medication used to treat urinary incontinence. Dr. ***** at ***** Animal Hospital submitted an appeal regarding these concerns and confirmed no examination took place on 2/12/21 and that only occasional urinary accidents were noted in the house, but there was no formal diagnosis as to what the underlying cause was. As ***** was unable to go a full 12 months without signs, symptoms, or treatments for these concerns prior to be diagnosed with urinary incontinence it is now a permanent pre-existing condition on his policy. Unfortunately, this means these claims were not available for coverage under the policy.

  I apologize for any frustration there has been with this policy. Unfortunately, due to conditions and/or clinical signs being noted prior to the policy start date, they will remain an exclusion under the policy.
  
  I hope that helps clarify the situation, but if you have any further questions or concerns, please let me know.

  
  Sincerely,

  
  Marco Terrano, RVT
  Team Lead, Claims Adjuster

  

  Business response

  02/08/2022

  Hello BBB,

  I would be happy to further discuss this case. Dr. ***** provided an appeal letter about ***** and a visit on 2/10/21. I have included the appeal letter with my response for review. The appeal letter stated an exam was not requested or performed by a veterinarian at the time of the 2/10/21 note in the medical history. The receptionist's notation in the medical record was “incontinence?”; however, Dr. ***** believed the question mark notation was added due to occasional accidents in the house and not true incontinence. When the urinary accidents were noted in the medical history, diagnostics were not completed to further explain the cause of the accidents. Since the occasional accidents in the house occurred prior to the policy purchase, a temporary pre-existing condition of undiagnosed urinary accidents/ possible urinary incontinence was created on the policy. Dr. ***** supplied us with information showing urinary incontinence was reported on 10/25/21. Since urinary accidents are a clinical sign of urinary incontinence and ***** was unable to go 12 consecutive months without a related condition, the pre-existing condition was made permanent with the official diagnosis of urinary incontinence.
  

  Related terms and conditions:

  PART I – DEFINITIONS
  
  10. Clinical Signs means changes in a Pet’s normal healthy state, bodily function or behavior observed by you, a Veterinarian, or other.
  
  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.
  
  PART IV – EXCLUSIONS
  
  1. Pre-existing Conditions;
  
  For the purposes of these exclusions, Temporary Conditions that started prior to the end of the Waiting Period that have not shown any Clinical Signs for a period of twelve (12) consecutive months shall not be considered 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.
  
  I hope this helps to clarify the situation, but if you have any further questions or concerns, please let me know.

  Sincerely,

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

  Team Lead, Claims Adjuster

  Customer response

  02/08/2022

  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.
  
  Hi, in the appeal letter Dr. ***** did not say HE believed the question mark was due to occasional incidents.  He stated that he believes the admin may of thought that and wrote a note with a question mark.  Dr. ***** also stated clearly multiple times that our pet did not have the pre-existing condition of urinary incontinence and it was FIRST reported true incontinence in October 25th 2021.   I am requesting a full refund for all of my premiums to date and vet bills related to this.  My pet can no longer see a vet and be insured for this condition due to this company's negligence and mal-practice.
  
  See appeal letter with highlights.
  
  Regards,
  
  *** *
  
  
  
  
   

• Initial Complaint

  01/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have had a policy was Embrace Pet Insurance on my dog ***** since 2012. One of the pre-existing conditions is neutropenia. I have been submitting claims for ***** since he was enrolled, never to have one denied. His claims have included multiple visits for infections, fevers, cellulitis. As a Veterinarian I am able to get a lot of my pets medical care for discounts. This along with a premium spike caused me to drop insurance on my other dogs several years ago. I kept *****'s insurance because he had an extensive medical history that had always been covered, so it was worth keeping the insurance. Recently (12/24/2021) ***** was admitted to the hospital with a fever and later determined, infection. This visit was very similar to the visit that was covered in June 2017 so I expected that it would be covered. I submitted the claim, for $9,055.13 and was denied due to it being a pre-existing condition. I reported the issue to the claims adjuster and was told his previous claims should not have been covered and it was an "error" on their companies part. This "error" misled me into continuing to pay claims for ***** after I discontinued insurance on my other pets. Had I known that future claims for the same problem that was previously covered would not be covered I would have never continued paying claims as it is not advantageous to me as a Veterinarian. The company has been terrible to work with and has just told me about the "error" on their part.

  

  Business response

  01/27/2022

  Hello,

  
  I would be happy to explain this case with you. When a policy is first purchased with Embrace Pet Insurance (EPI), there is a 14-day illness waiting period which means any abnormalities noted 12 months prior to the policy start (or from the first puppy visit if the pet is under a year old) until the end of the 14-day illness waiting period are listed as pre-existing exclusion under the policy.

  
  *** ******* purchased a policy on 11/14/12 for her pet *****, that went into effect on 11/15/12 with the 14-day illness waiting period ending on 11/29/12. It was noted in *****’s medical records on 3/14/12 that ***** had neutropenia (decreased white blood cells) and noted later on 7/26/12 to be immune mediated neutropenia. Since this was noted prior to the policy start, this condition along with any related conditions or complications from it are excluded from coverage from the policy.

  
  A claim was later submitted for a hospitalization from 12/25/21-1/1/22 where ***** was seen for spinal pain, not eating, fever and lethargy. An abscessation of the iliopsoas muscle was diagnosed, along with several secondary conditions noted to be resulting from this abscess. According to the medical history we received from *****’s veterinarian, the underlying cause of the iliopsoas abscessation was unknown; however, it is noted that Clyde’s historic neutropenia likely increased his risk of this condition occurring. Unfortunately, this means the claim is not available for coverage under the policy.

  
  Regarding the previously covered claims, we do not have any claims for ***** from June 2017; however, I believe the claims from May 2017 are those being referenced. For those claims, the diagnosis we received from the veterinarian was a resistant E. Coli infection of the toe. In the information we received, there was no mention of *****’s neutropenia having an effect on the infection or treatment for it. If this previous infection was caused by the neutropenia, then the claims were covered in error and we apologize.
  In a recent email conversation with *** *******, her option to appeal the claim decision was given if more is known about the underlying cause of the iliopsoas abscessation since the initial medical history was received. If you have any questions, please let me know!

  
  Sincerely,

  
  ******* *****, RVT
  Senior Claims Adjuster

• Initial Complaint

  01/21/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I’m writing to file a formal complaint against Embrace pet insurance. I have repeatedl* asked them to cancel m* insurance policies since m* dog, **** died on 8/29/17. When I asked them to cancel the polic* on ****, I also asked them to cancel the polic* on ******. The* told me on multiple occasions that the* would backdate a refund to the date of *****s death and refund ******s polic* from the date I first ask for him to be canceled. *ears later the* are still drafting the mone*, $174.56 out of m* account ever* month. It shouldn’t take multiple calls and *ears to cancel a polic*. I want m* mone*, $9241.68 refunded and at this point, it should be refunded with interest.

  

  Business response

  01/25/2022

  Hello, 

  We reviewed ever* correspondence with *** ********.  The first date that she requested the full polic* be cancelled was 5/17/19. 

  We have issued a refund backdated to that date. 

  We cannot go back further, as there was not a request to cancel the full polic* until 5/17/19. 

  ****'s cancellation was backdated to the the date of her passing. 

   

  Thank *ou! 

  *****
  Contact Center Manager

• Initial Complaint

  01/17/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I purchased a policy for my 4 dogs through embrace insurance in October of 2021 . I sent in all requested information and then checked back with them to make sure they had all records from my vet bc I had a wellness exam I paid for to get this insurance . I was told everything was good. December one of my dogs got sick I filed claim and waited then they said oh we dont have any medical records wait....you said you had everything,you have been taking my payments and now a claim is filed and you dont have records??? I called them they said oh they just need a diagnosis. Ok I yold them it was an ear infection. Then they waited for a few weeks and said we need records,you have records you said you did well they claim they never did so I sent all the records for all 4 dogs AGAIN. Meanwhile same dog gets sick again, a fever and is treated for several days so now I have 3 more claims I file and still no.payment on December 2021 claim and now have January 2022 claims . I have sent the records in to a Sarah at embrace AND uploaded to my account. Now they say they need the records Again. And of course have not paid me a dime. Multiple emails and calls no help BUT they keep taking my payments.

  

  Business response

  01/19/2022

  Hello BBB,

  
  I would be happy to discuss this case with you. A policy was purchased on 10/22/21 by ******* ******** for her four canines, Boo Boo, ****, ******, and ******* When a policy is first purchased, there is a 14-day illness waiting period and a 6-month orthopedic waiting period. For *******’s four canines, the end of the illness waiting period was 11/6/21 and the end of the orthopedic waiting period is 4/23/22.

  
  After the illness waiting period is complete and prior to any illness claims being processed, a medical history review must be completed of the detailed medical history starting 12 months prior to the purchase of the policy to the end of the illness waiting period. The first request for medical history goes out to the facilities on file the day after the illness waiting period ends. The medical history we have on file at this time regarding ****** occurs after the end of the illness waiting period or is considered a summary, which does not include notes about the veterinarian’s examinations. The clinic on file for ****** is Samaritan Animal Hospital. We have spoken to the facility and ****** had visits with detailed notes on 8/17/21, 12/17/21, 12/18/21, and 12/30/21. The facility stated they would send over the detailed medical history, but we have not received this information as of now. Communication has been completed to explain to ******* exactly what is needed to proceed with ******’s medical history review, which will be followed by the processing of ******’s claims.

  
  We have received the detailed medical history for *** *** and ******, and their medical history reviews, to the end of the illness waiting period, have been completed with a results email being sent to ******* via email. ****’s medical history review is almost complete; however, we are missing the detailed medical history from the visit occurring on 8/17/21. ********* ****** ******** has also been contacted for this information.
  As soon as the necessary medical history is received, we will proceed with the completion of ****** and ****’s medical history reviews and process the claims for *******
  

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

  Sincerely,
  **** ******, RVT
  Senior Lead Claims Adjuster

  

  Business response

  01/21/2022

  Hello BBB,

  I would be happy to discuss this case further. Since my last response, we have been in contact with ********* ****** ******** via phone calls and obtained the necessary, pre policy medical history for ******* The medical history has been reviewed and a results email containing details about any pre-existing conditions found in the medical history has been sent to ******* via email. Since the medical history review was completed, the pending claims for ****** have also been processed. The outcome of every claim was emailed to ******* with directions on how to access the explanation of benefits.
  
  Also, the medical history review for **** has been completed. A results email regarding **** and any pre-existing conditions found in the medical history was sent to ******* via email.
  
  If you have any additional questions, please do not hesitate to ask.
  
  Sincerely,
  **** ******, RVT
  Senior Lead Claims Adjuster

  Customer response

  01/21/2022

  [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. 
  
  Regards,
  
  ******* ********
  
  
  

• Initial Complaint

  01/14/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I got pet insurance from Embrace to help pay for the vet bills that would incur with my dog. I've spent a total of $102 dollars so far in the insurance. I had to take my dog to the vet because he was vomiting for a night. Now he has had these issues before so the insurance company weaseled their way out of reimbursement calling it a "pre existing condition." They were 2 different vet visits and I wasn't asking them to pay for both of them (which would've been well over $1000.) All I wanted was his last vet visit with was $408.00. They denied reimbursement so I canceled. They aren't going to pay back the $102 I've gave them over the course of 2 months. Why should I even pay them if they aren't going to fulfill their end of the contract? What did I pay for? So not only did I pay them for NOTHING, I'm still paying full price for all the vet bills. I'd at least like back the money I put in over the course of 2 months $102. It's really unfair to take food out of my dog's mouth and not help him on top of that.

  

  Business response

  01/19/2022

  Dear BBB,

  I would be happy to explain the case with you. This pet’s policy started on 11/16/21 and the waiting periods ended or will end on 11/18/21 (accidents), 11/30/21 (illnesses), and 5/16/22 (orthopedic conditions). Our policy requires a medical review for all pet’s before we can process an illness claim, so we can determine any pre-existing conditions since those are excluded from coverage.

  *** ****** submitted his first illness claim for ***** * on 12/13/21. He was then notified via email on 12/30/21 that Rocky 3’s medical records were in line to be reviewed. Our medical review was completed on 1/11/22 and the claim was completed on 1/12/22. *** ****** was made aware of the claim decision on the MyEmbrace portal that unfortunately, the claim was not eligible for coverage due to a pre-existing condition of vomiting.

  Vomiting was first noted for ***** * on 11/15/21 and 11/16/21, which was prior to the policy start and the day of the policy start making vomiting pre-existing and excluded from coverage. The vomiting was undiagnosed and no definitive cause was determined per the medical records we received. *** ******’s terms and conditions state if any undiagnosed vomiting is noted prior to the end of the waiting period the pet must be free of vomiting for 12 months before the policy will cover vomiting again. Since Rocky 3 did not remain free from vomiting for 12 months, the claim submitted on 12/13/21 for vomiting was ineligible for coverage.

  *** ****** decided to cancel his policy on 1/14/22 due to the claim not being covered. 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 *** ****** submitted a claim within the first 30 days, we can only offer a pro-rated refund based upon the time of cancellation. *** ******’s cancellation was completed and he was refunded $1.03 for insurance premium based on the above policy terms.

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

  Warm Regards,

  ****** ********, R.V.T
  Senior Claims Adjuster

  Customer response

  01/19/2022

  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. What they're claiming as a pre-existing condition was a possible obstruction in my dog's digestive tract. This Wasn't related at all to what I did claim, Gastritis. With all this said, I'm was under the impression that I was "covered" seeing how I was a month in before what was claimed happened. This wasn't a problem with Orthopedics. However I just want the money I put in. If I pay someone money, should I get a service provided?
  
  [To assist us in bringing this matter to a close, we would like to know your view on the matter.]
  
  Regards,
  
  **** ******
  
  
  
  
   

• Initial Complaint

  12/03/2021

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  This is a total scam company. I just received an email that my claims on my cat will NOT be covered. They said that he had diarrhea over a year prior to getting the policy, so any illness he gets will not be covered. He ate a lizard and got diarrhea!!! So because I wanted to make sure that a living creature would be okay, this company punishes people and lies to them and says that everything will be considered "pre-existing." Insurance policy requires you get a vet visit one year prior to getting a policy. I did that. The cat ate a lizard & threw up & had diarrhea. I took the cat immediately that day to the vet. The vet said the cat was fine. The symptoms resolved that day. The insurance company is now saying that, because he had diarrhea, then any illness/disease he gets, where diarrhea is a symptom, they will not cover those illness/disease claims. This is the most fraudulent thing because, as anyone knows, almost 100% of illness/diseases that a customer would file an insurance claim on an ****** will cause diarrhea. My premiums have cost from $65 to $85/month, and I now have over $2,000 in vet bills that they will not cover. The insurance company sent me an email today, after 2 months of waiting, that they were denying my claims. My account number is EP0028-4008 . I will no longer be able to get any pet insurance from any company because I treated my cat, with the understanding that this was a legitimate insurance company, and now any other insurance company will view those new illnesses as "pre-existing" and denying any and all claims.

  

  Business response

  12/07/2021

  Hello BBB,

  I would be happy to address this case with you.
  
  On 5/5/20, ***** ******* purchased a policy with Embrace Pet Insurance for her feline ******. After purchasing this policy, *** ******* received an email, which explains the waiting periods associated with the policy as well as a copy of the terms and conditions. When a policy is purchased, there is a 48-hour accident waiting period and 14-day illness and orthopedic waiting periods. Once a pet is past their 14-day illness waiting period, we request the records for the pet from any clinic the pet was a patient within 12 months prior to the policy start date, until the end of the illness waiting period. For ******, the end of the illness waiting period was 5/20/20.
  
  Every pet has a medical history review completed of their medical history 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 Embrace Pet Insurance. A medical history review was not requested for ******, so it was triggered to be completed when ******** first illness claims were received on 10/7/21.
  
  In the medical history from ****** ****** ******** on 5/4/20, prior to the policy purchase, ****** was noted to have on and off diarrhea for a couple of weeks. The medical history did not provide a cause, such as eating a lizard, or diagnosis for the diarrhea, creating a pre-existing condition on the policy for the clinical sign of undiagnosed diarrhea. The terms and conditions of ******** policy define undiagnosed, clinical sign, and pre-existing condition as follows.
  10. Clinical Signs means changes in a Pet’s normal healthy state, bodily function or behavior observed by you, a Veterinarian, or other.
  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.
  
  In the medical history from Little ********** ****** ******** on 5/6/21, ****** was noted to have on going occasional diarrhea, extending the pre-existing condition. The claims for ****** were sent to Embrace Pet Insurance with the diagnosis of inflammatory bowel disease. These claims are not eligible for coverage due to the undiagnosed diarrhea, pre-existing condition as diarrhea is one of the most prominent clinical signs for this disease.
  
  In communications with ***** *******, after the claims were processed, we explained she is welcome to file an appeal of the pre-existing condition. It was explained we would need a letter from ******** veterinarian with further information about the 5/4/20 diarrhea if ****** did eat a lizard, as this information was not within the medical history Embrace Pet Insurance was provided. The appeal letter could also include any information the veterinarian deems relevant to differentiating the 5/4/20 diarrhea from the ongoing diarrhea and inflammatory bowel disease in 2021. At this time, we have not received any further information to complete an appeal.
  
  If you have any additional questions, please do not hesitate to ask.
  
  Sincerely,
  **** ******, RVT
  Senior Lead Claims Adjuster

• Initial Complaint

  11/27/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I became a member with embrace roughly one year ago. All premiums have been paid as well as all waiting periods met. I have two dogs with Embrace. My dog ***** a 4 year old Pittbull had some teeth stains as well as a wart like tumor on his leg. He is a Healthy dog so I wanted to get him checked out. He also has wellness policy which covers routine visits and preventative medicine. However after his visit the Vet said his teeth are fine and his tumor is a non issue he was sent home clean bill of health. Embrace however is looking for a year worth of medical records vaccination records that do not exist. Why don’t they exist because he hasn’t seen anyone else. I did get his shots at the **** as part of a Municipal vaccination clinic and registration. That’s it. Meanwhile I sit for months waiting for them to bark up a tree over documentation that doesn’t exist. They are not a vet they are not doctors they are an insurance company. I have been ripped off over one year worth of medical premiums to have them go on a wild goose chase

  

  Business response

  11/29/2021

  Hello,

  
  I would be happy to explain this case. When a policy is first purchased with Embrace Pet Insurance (EPI), there is a 14-day illness waiting period which means any abnormalities noted 12 months prior to the policy start until the end of the 14-day illness waiting period are listed as pre-existing exclusions under the policy.

  
  When the first illness claim was submitted for ***** on 11/9/21, EPI requested his medical history from Cornerstone Animal Hospital so it could be reviewed to determine if there are any pre-existing conditions. Once those records were received, it was determined that ***** was also seen at the Anchorage SPCA during the pre-policy timeframe. The medical history from SPCA was received on Friday 11/26/21 and was reviewed today. Now that his review is complete, his pending claim was also processed today.

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

  
  Sincerely,
  ***** ******* ***
  Senior Trainer, Claims Adjuster

  Customer response

  11/29/2021

  My dogs wart that appears on his elbow is not a pre-existing condition.  It does not appear in any other medical records.   Yes he had a skin tag removed from his ear but that was a skin tag on the ear not the elbow and they are both very much different in nature.  Doctors and Vets like to generalize a condition but the true information is in the details.  Ear Elbow are not the same nor is it the same condition.   Embrace is attempting to make a generalization of a condition that in fact have nothing to do with each other in an attempt to deny coverage.   

  

  Business response

  12/01/2021

  Dear BBB,

  I would be happy to explain the case with you. This pet’s policy started on 12/16/20 and the waiting periods ended on 12/18/20 (accidents), 12/30/20 (illnesses), and 6/16/21 (orthopedic conditions). Our policy requires a medical review for all pet’s before we can process an illness claim, so we can determine any pre-existing conditions since those are excluded from coverage. *** ******* submitted his first illness claim for ***** on 11/9/21, so a medical review was initiated and completed on 11/29/21. *** ******* was sent a list of his pre-existing conditions for the policy and one of those conditions was a wart (papilloma). The wart was noted prior to the start of the policy on 5/22/20 and is therefore a pre-existing condition and excludes coverage for that wart as well as all future warts.

  *** ********* claim for ***** was for a skin mass, which in the medical records was identified as a skin tag, which we do differentiate from a wart. The claim for ***** was covered and was reimbursed under our optional wellness rewards plan as a way to better benefit the owner since it does not have any deductible or co-pay. The condition itself of a skin tag is a covered condition under the policy and we have not stated in any communications with *** ******* that this condition was ineligible for coverage.
  If you have any additional questions, please do not hesitate to ask!

  Warm Regards,
  

  ****** ********* R.V.T
  Senior 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. ↩