S & W Machine LLC

(Attachment)Dear Revdex.com,I am happy to provide more information about why Mr. [redacted]’s claims for “Atty’s” intervertebral disk disease (IVDD) was not covered.The medical history notes “back issues” with ataxia, a clinical sign of IVDD, on 7/27/17. Mr. [redacted] did not purchase Atty’s policy until 7/30/17....

That makes IVDD a clear cut pre-existing condition. Embrace Pet Insurance does not cover pre-existing conditions, no pet insurance company does.The following is the pertinent excerpt from Atty’s medical history at [redacted]:The following are a few excerpts from the policy terms and conditions regarding non-coverage of pre-existing conditions:PART I – DEFINITIONS26. Pre-existing Condition(s) means:b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions.Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.PART IV – EXCLUSIONS1. Pre-existing Conditions;Please let me know if you have further questions on this case.Regards,Jenna M[redacted], RVTClaims Director andChief Underwriter on behalf of [redacted]EmbracePetInsurance.com

[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.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. However, I still maintain that this company provides misleading information regarding pet insurance and coverage. I have shared the Embrace  RVT’s response with my vet and colleagues. I was advised to not use Embrace for pet insurance nor would I recommend this business to anyone. 
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I am a small business owner myself (I own 7 restaurants with a partner) and the idea that a business needs to make money is one with which I am very familiar.  That being said, to do so ethically and legally is also important.  This business has put in place an auto renewal policy that is meant to "trap" the consumer...period.  Were they a purveyor of informercials of some similar sort of snake oil, it would be expected.  They are not.  They are an insurance company and they should hold themselves to a much higher standard.  Their lack of concern or regard for their customers is "impressive" to say the least. The fact they have yet to reach out to me directly to even apologize is stunning.Here are all the facts they aren't telling you: (1) the auto renewal notice was not sent to me.  They used the email address of my girlfriend (which they apparently acquired from the vet).  So I received no notification. I intend to file a small claims court claim against them in Chicago as a next step.  I would strongly encourage them to review their files and confirm what I just stated - because it is true.(2) while this is not directly relevant to my case since they sent the renewal to someone who was not the person with whom they contracted, you should know that the language is buried in the contract and is meant to "catch" people.  I would think this would bother you as the Revdex.com.  (3) The customer service rep I spoke to prior to the manager was clearly not surprised by my complaint and it was obvious this is a common issue and they had a script to follow.  If I am correct, why do they continue the practice? Presumably it is very profitable.I would encourage their in-house counsel to contact me at 312-560-2762 if they want to discuss any of the above.  I told the manager I was disturbed by their business practices and that I would contest the charge with [redacted] (which I have already won for the stub portion of 2016) and that I would file a Revdex.com complaint. I followed through on both of these because I'm very upset.  I'm now telling them I will file a small claims court complaint in Chicago regarding the 2015 premium unless they do the ethical thing.  I'm an attorney and it will cost me nothing.  If they won't choose to act legally and ethically on their own, I will help them along the way.
Regards,
[redacted]

Aratched is a letter written to Embrace from a Veterinary Surgeon of 20 yrs experience disputing their excuse with his medical expertise. An underwriter for Embrace overruled his opinion. Not a Veterinarian, but an insurance underwriter. On Embrace's Facebook page in guests comments and reviews as well as Yelp, there are hundreds of complaints citing Embrace's non payment of claims, always citing pre-existing conditions.
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]

I am happy to further explain and address Ms. [redacted]’s
response statements.
Her first statement is untrue as she has truncated my
sentence. My prior response states, “We did not know about [redacted] at the
very start of the policy.” This is a factual statement. The picture of the
email Ms. [redacted] has provided states she was taking her pet in for a senior
exam, but it does not tell us where
the exam was to be. Also, the email pictured was a full 30 days after she
started the policy. So there was no way for us to know at the start of the policy what clinic to request records from. As
I stated previously, we only do this request at the very start of the policy
and from clinics we have been notified of.
A medication refill is an illness claim. There are two parts
to our policies. Wellness or routine care reimbursement for things like
vaccinations and spay or neuter procedures etc. The other part is the accident
and illness insurance. A prescription medication refill falls under this
portion of the coverage.
As stated previously, I am unable to provide a refund for
the prior months of insurance. Each policy holder is given ample opportunity to
request a medical history review at the start of the policy if they fear their
pet may have any pre-existing conditions that would affect their decision to
continue coverage. We often are able to complete this review within the first
30 days so a pet parent can cancel the policy within the 30 day money back guarantee
period. Ms. [redacted] did not request a review at any point and as such I am unable
to refund her for the period her pet was insured.
Please feel free to contact me with any further questions or
concerns on this complaint.[redacted]claims manager(800) 511-9172

This business response was received by Revdex.com staff member ** via email and is a copy/paste.Hello [redacted] I am happy to respond to [redacted] complaints. 1.      Any terminology used on the website or other documentation is defined in the policy terms and...

conditions. This is done for clarity and to avoid policyholder confusion with other policies and colloquial meanings. Pre-existing condition and waiting period are defined as follows: Part I - Definitions26. Pre-existing Condition(s) means: a. a Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for your Pet(s) and any related conditions; or b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions. Undiagnosed conditions with the same Clinical Signs as those in (a) or (b) above are also considered pre-existing. 32. Waiting Period means the time period where the policy’s Coverage is restricted. For this policy, the time period is two (2) days for Injuries and fourteen (14) days for Illnesses, except for Orthopedic conditions for dogs where the Waiting Period is six (6) months. The Waiting Period starts from the Pet Original Start Date. Conditions that occur during the Waiting Period will be excluded from your policy’s Coverage as Pre-existing Conditions. The Waiting Period also applies to Coverage increases but is waived for policy renewals and Optional Coverage renewals. Part IV – Exclusions1. Pre-existing Conditions; In [redacted] case, he had been diagnosed with feline asthma in February of 2016, if not earlier. [redacted] policy began on 10/26/16. Since asthma is a chronic condition, which began before the policy start, it is a pre-existing condition as defined by the policy. Some non-chronic conditions that occur before the policy start can be covered if they are clear for a full 12 months. Asthma is not a curable condition.   Additionally, Embrace provides the option for a policy holder to request a medical history review to inform them of any pre-existing conditions to make sure they are comfortable with their coverage. If they are not comfortable, they have the ability to cancel the policy in the first 30 days for a full refund. Ms. [redacted] did not request a review at any point.   2.      The policy terms and conditions inform policy holders the policy auto-renews. This information is also on the website, and in our standard phone call acknowledgements read to each policy purchaser if they begin on the phone. 3.      I’m not actually sure what Ms. [redacted] is saying here, but since she cancelled her policy at the 12 month renewal, all she was able to be refunded for was the unused part of the renewed policy. She received a full refund for the second policy term. A policyholder is able to send in claims within 60 days or a policy cancellation or renewal. On 12/6/17 Ms. [redacted] submitted claims for January 2017 through September 2017. The claim was accepted, but was not covered because it was all for feline asthma. Most complaints we receive on yelp, Revdex.com, and other places are from people who do not understand pre-existing conditions. We do try to educate the policyholders on these subjects as much as we can. I hope this explanation helps Ms. [redacted] understand what occurred with her policy and please let me know if there are any additional questions.                                              Jenna M[redacted]Claims Director andChief Underwriter on behalf of American Modern Insurance Group[redacted]
[redacted]

Dear Revdex.com, I am happy to provide more information in this case to clear up any confusion. Mr[redacted] policy for Chase was purchased on 11/28/16, and the illness 14 day waiting period was over on 12/12/16. The claim we received was for “abnormal behavior” for a date of service of 12/23/16 through...

12/25/16. The notes from the veterinarian on 12/24/16 states, “Chase is a fourteen week old, intact male, Weimeraner with a progressive history of worsening pelvic limb ataxia and paresis since the owners got him in mid November.” The following is a screenshot of this statement in the medical history: The policy defines a pre-existing condition as follows: PART I - DEFINITIONS 26. Pre-existing Condition(s) means: a. a Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for your Pet(s) and any related conditions; or b. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions. Undiagnosed conditions with the same Clinical Signs as those in (a) or (b) above are also considered pre-existing. Since the signs started when they adopted Chase, were progressive, and began before the policy started, this is clearly a pre-existing condition. No pet insurance company, including Embrace Pet Insurance covers pre-existing conditions. Mr. F[redacted] is welcome to appeal the outcome of the claim if his veterinarian can provide more information either that the medical history is incorrect or there were other/ different reasons for the ataxia that occurred before the policy that are unrelated to the current ataxia and neurological issues Chase is experiencing. Though I think this is unlikely given the clarity of the medical records, Mr. F[redacted] is welcome to try an appeal. He has been given this opportunity previously and we have not received any veterinary statement to that effect. Please let me know if you have any further questions on this case. Sincerely, [redacted] Claims Manager Embrace Pet Insurance Tell us why here...