ComplaintsforEmbrace Pet Insurance

• Initial Complaint

  10/01/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have been an Embrace client for years. I've paid thousands in premiums and never had enough bills to meet my deductible. This year, my dog fell ill and Embrace has made a difficult situation even worse. In addition to the unacceptably long wait long times others noted, I've been denied all prescription charges. The *** of my policy (page 5 of 10, part 3, section 2, item h) clearly state meds are covered, and the website says the same and even boasts "But we cover pretty much everything, except pre-existing conditions" and that If the condition is covered, so are the?prescription meds used to treat or manage it." I appealed the many claims denying my meds, and was told my coverage did not include meds. I looked back to my renewal documents and found in the last attachment of nine documents, a single page stating they were cancelling any drug coverage in opposition to my actual policy doc and on their site. This is intentional hiding of a clause, which is fraudulent and deceptive.

  

  Business response

  10/04/2021

  Hello BBB,

   

  Please let me explain. *** *** ****** first purchased a policy for her dog, *******, on 1/24/18. The prescription drug coverage was not a chosen extension for her policy and was declined at that time. Without the addition of the prescription drug coverage, Embrace is unable to cover any FDA approved prescription medications or medications that are included in the *********** ************* of the United States. I hope this helps clarify the situation.

   

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

  Senior Lead, Claims Adjuster

  Embrace Pet Insurance

  
  

  

  Business response

  10/04/2021

  Hello BBB,

   

  Please let me further explain. When *** *** ****** first purchased her policy on 1/24/18, she declined the optional prescription medication extension and confirmation was sent via email. The email notice also explained that she could add on the coverage by calling our customer service department. With each renewal, *** *** ****** received an email with related documentation regarding not having prescription medication coverage on her policy. Our website indicates the coverage is available for all new policies, but *** *** ****** did not choose it and has she not added it on as of the time of this response. I hope that helps clarify the situation further.

   

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

  Senior Lead, Claims Adjuster

  Embrace Pet Insurance

  
  

  Customer response

  10/04/2021

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID 15983234, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  

  Allow me to clarify. This is incorrect. I have kept and reviewed all of my documents, including the original policy which was purchased and sent to me on 1/23/18, not 1/24/18. There is nothing in my correspondence that tracks with *** ******s assertion that I was offered prescription coverage and denied it. By her own admission, this was also not brought up again at any renewal date. The website does not state that prescription coverage is available with any new policy, it states that it is available with every policy. She has also failed to acknowledge why it is not made clear on the website that prescription coverage is an added expense, when they do make clear that wellness rewards are an added expense. She has also failed to explain why the website states "we cover pretty much everything, except pre-existing conditions" and that "if the condition is covered, so are the?prescription meds used to treat or manage it." This is patently false, regardless of the multiple attempts by Embrace and *** ******s to justify this deceptive language. I'm not going to continue arguing reason with someone who is unreasonable, but I hope the BBB recognizes tricking people into thinking they have purchased services they haven't is not the proper way to do business. and hopefully by sharing my experience I will help another potential customer know to beware when doing business with this company.

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

• Initial Complaint

  09/19/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had Cancelled My Pet Ins Policy on 9/13/2021 and in a confirmation E-Mail it Stated to ( Please note that you have 60 days from the date your policy was closed to submit any final claims) I then Filed a Final Claim on 9-17/2021 for Tiger who was Neutered. My Claim was denied, they claim it isnt covered under their Wellness Rewards, which is FALSE. I called them about it and then they said No it's not covered because you cancelled your Policy, yet I had a Remaining Allowance of $59.25. I have attached all the Documents that will show Proof of everything I am stating. Please feel free to contact me to resolve this issue or if there are any questions.

  

  Business response

  10/05/2021

  Hello BBB,

   

  *** ******* opted to cancel his policy with Embrace Pet Insurance effective 9/3/21. He was issued a pro-rated refund and notified of the cancellation confirmation on 9/3/21. In this notification, it stated, "Please note that you have 60 days from the date your policy was closed to submit any final claims." This means that a pet parent has 60 days to submit any claims they had not submitted up until their cancellation date. The coverage was no longer effective as of 9/3/21, so the claim Mr. Krenzer requested be covered from 9/13/21 was after coverage was terminated.

  Unfortunately, as *** ******* did not have an active policy as of the date of the claim in question, coverage for this claim is not possible.

  If there is any additional information or clarification I can provide, please do not hesitate to contact me.

  Take care,

  ****** ******
  Claims Manager at Embrace Pet Insurance

  Customer response

  10/06/2021

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

   In their own words and response as well as in the original email sent to me they state  " In this notification, it stated, "Please note that you have 60 days from the date your policy was closed to submit any final claims." , it does NOT however say anything about Claims Prior to Cancelling but only that I had 60 days to File any Final Claims. I Still had a Credit on the Wellness Portion of My Policy that I would have been Entitled to Receiving. 
  
  
   

  

  Business response

  10/07/2021

  Hello BBB,

  Although I understand *** ********* complaint, it does not change the conditions of the Wellness Rewards plan. *** ******* was notified that has policy was cancelled and therefore no longer in effect for coverage or reimbursement. We provide 60 days after cancellation to submit any outstanding claims as a courtesy to our pet parents. This information is provided in the policy terms and conditions.

  Take care,

  ****** ******
  Claims Manager at Embrace Pet Insurance

• Initial Complaint

  09/15/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Embrace Pet Insurance has a policy of wanting to have a year health report even if the pets are not a year old .I have been waiting on claims since May 2021 on **** ***** **** and ******* *** claims . The vets office in Omaha gave all the information to Embrace and they claims it not enough From ******* ****** ******** in Omaha. Their phone says claims are process in 10 to 15 days. They need to change the way they process claims. My name is ****** and ****** ******* **** ** *** ** ******** ***** phone is ************. Our three ****** are not 1year old when we got them. Our Vet Office is in Omaha **** ***** ****** ******** ***** ***** ************.

  

  Business response

  09/20/2021

  
  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.
  When claims were submitted for both ***** **** and **********, EPI requested their medical history from Pittman Animal Hospital so they could be reviewed and determined if there are any pre-existing conditions. Once those records were received, it was determined that Pittman Animal Hospital does not keep exam notes on file and only a “summary” was sent to EPI. When a summary is sent over, it only contains information about what services were provided on each day; however, there is no information as to why these services were performed and what was found. A request for exam notes was sent to Pittman Animal Hospital for both pets, which is when Pittman Animal Hospital informed us that they did not have those notes. EPI then sent a “questionnaire” to the hospital to determine what was found on each individual visit.
  Since this questionnaire was sent, EPI has only since received **********’s response back and we are still waiting on the response regarding ***** ****. Once the information was received regarding **********, her review was completed, and her pending claims were processed. As soon as EPI receives a response regarding ***** ****, her review can also be completed, and her pending claim can also be processed.
  If you have any additional questions, please do not hesitate to ask!
  Sincerely,
  ******** ******, RVT
  Senior Lead Claims Adjuster

  

  Business response

  09/24/2021

  
  Hello,
  I would be happy to provide additional details regarding this matter. A typical claim is usually processed in 15 business days; however, if it is a pet’s first illness claim it can take a little longer due to having the pet’s records reviewed. As this was ***** ****’s first illness claim, her records have to be reviewed to determine if there were any pre-existing conditions prior to her claim being processed. Unfortunately, in these situations, we are at the mercy of clinics in sending the required medical records. If they delay in sending these, it can take longer in the processing of claims.
  There was a conversation between one of our claims adjusters and the clients wife on 9/2/21. During this conversation, it was explained what was needed for ***** **** and an email was sent to Pittman Animal Hospital with a questionnaire. The email that was sent also had the client copied on so they could see all responses. Embrace has yet to receive a response from Pittman Animal Hospital, so a follow up email was sent today to see if they were able to complete the questionnaire. Once the questionnaire is received from Pittman, ***** ****’s review can be completed, and her claim can be processed.
  If you have any additional questions, please do not hesitate to ask!
  Sincerely,
  ******** ******, RVT
  Senior Lead Claims Adjuster

  Customer response

  09/30/2021

  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.]

  RECEIVED VIA EMAIL BY BBB STAFF MEMBER:

  Embrace Pet Insurance still doesn't meet my needs on timey customer service for filing claims . This cause hardship  on the vets and meeting the pets needs for medical attention.  This is bad service from this company and can't be tolerated. Claims no ********.   ****** ******* **** ** *** ** ****** ** ***** phone ************* 
  

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

• Initial Complaint

  09/14/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have submitted two claims this year and am still waiting for them to be paid out. They are both for wellness claims. It takes the company a really long time to determine if your claim is eligible or not. If I knew they took this long I would have used another company

  

  Business response

  09/15/2021

  Hello BBB,

  Please let me explain. *** ****** submitted a claim for his pet, ***** on 8/5/21 with a date of service of 7/28/21. The claim was submitted as wellness, but after review, it was determined there were illness related items on the invoice. It is standard protocol that before we can process any illness claims, a medical history review must be performed to determine any pre-existing conditions on a pet. We reached out to ***** *** ****** ******** on 8/17/21 for *****s medical records but did not receive her complete records. We reached out to them again on 9/7/21 and are still waiting on the information at this time.

  The additional claim in question is for *** ******’s other pet, ********. This claim was submitted on 8/30/21 with a date of service of 8/13/21. This was submitted as a wellness claim for heartworm medication from 1-800-Pet-Meds, but a complete invoice was not provided. We reached out to Mr. Cooley on 9/2/21, 9/7/21, and 9/12/21, letting him we know we require a complete invoice to process the claim and cannot do so until that is provided. We have not received the required information at this time. I hope this helps clarify the situation.

   

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

  Senior Lead, Claims Adjuster

  Embrace Pet Insurance

  
  

• Initial Complaint

  09/13/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 7/24/21 we received an email from Embrace stating "Upon reviewing your claim for ***** from *** ********* ***** *** ***** ********** ****** on 7/24/2021, we found that the claim was not ready for a final decision" in response to a claim submitted regarding an acute leg injury of our dogs leg. This injury had never occurred in any way shape or form prior to this. We filed the claim for the amount of $120.50. Embrace denied the claim as "pre-existing" which is patently, verifiably false. They stated that her medical records stated a non-specified limb had been injured previously. In fact, what they are referring to is an instance where we called because she got a splinter in her paw during a walk. We called simply to see if we should even do anything about it. We only talked a receptionist and never pursued any further action on the matter. The vet wrote a letter stating exactly that and Embrace denied the claim again. It's fraud plain and simple and we have no recourse besides BBB.

  

  Business response

  09/16/2021

  
  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 8/3/20 for his pet *****, that went into effect on 8/4/20 with the 14-day illness waiting period ending on 8/18/20. It was noted in *****’s medical records on 7/30/20 that ***** was limping after a walk and may have stepped on a stick; however, there was no notation as to which leg or what portion of the leg was injured. As *****’s limping was noted to be present prior to the policy purchase, it was made a temporary exclusion with the possibility to expire after 12 months if she remained free of any additional limping/lameness during that time frame.
  A claim was later submitted for a visit on 7/24/21, where ***** was taken in due to lameness on her rear leg. After the examination, the vet suspected a soft tissue injury or a possible muscle strain, tear, bruise, or ligament injury. Due to *****’s pre-existing lameness that occurred prior to the policy purchase, this claim was not eligible for coverage. With this claim occurring during the 12-month window for her temporary exclusion, the new 12-month window restarted on 7/24/21. If ***** can go another 12 months free of any lameness, this exclusion may be eligible for expiration.
  After the claim was not covered, *** ****** submitted an appeal letter from his veterinarian. In this letter, the veterinarian stated that ***** was suspect to have a soft tissue injury on 7/24/21 and that the most recent injury is affecting a different portion of the leg then the notation on 7/30/20. Unfortunately, as there was no indication on 7/30/20 as to where the lameness was occurring, we are unable to determine if the pain is affection a different portion of the leg. The appeal was unable to be overturned due to the lack of information pertaining to the original notation on 7/30/20.0
  In a recent conversation with the client, it was discussed that they will try and obtain additional information from their veterinarian so a second appeal can be completed. If you have any questions, please let me know!
  Sincerely,
  ******** ******, RVT
  Senior Lead Claims Adjuster
  

• Initial Complaint

  09/07/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Took my pet to doctor; filed a claim and they covered zero we never received and answer to our claim; don't buy pet insurance from them they make up reasons to deny claims and pocket all funds received as profit of grred

  

  Business response

  09/10/2021

  Hello BBB,

  
  I would be happy to discuss this case with you.
  We have an active account for ***** ******** *** ****; however, we have no indications a claim has been submitted to us via any submission form – email, fax, mail, or portal.
  I reached out to ***** ******** on 9/7/21 to let her know we have not received any information regarding a claim and to offer assistance with filing a claim. *** ******** let me know she would submit the claim information directly to me via email so I can assist her. At this time, I have not received any further information.
  If you have any additional questions, please let me know.
  

  Sincerely,
  **** ******* RVT
  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. ↩