2
out of 5
POSTED: | BY: Stephen Wintermeyer
Automate Review Process Highly Inaccurate
On 1/31/24, I submitted 4 claims for my dog. One claim was handled correctly. One was mishandled. Two were automatically denied as duplicates, which they weren't. In addition, a new claim was created inappropriately for services I never claimed. To address all these problems, I had to call Embrace four separate times. Each time, the Customer Service Representative (CSR) was knowledgeable and helpful. What I realized was that the automated systems in place work very poorly.
Specifically, the automated system cannot handle documentation for more that one Date of Service at a time. That is fine. However, the instructions should be clear for owners to include documentation for only one Date of Service at a time.
Drontal Plus is typically a preventive medication. However, my dog was on it for treatment purposes. My claim was initially denied automatically because Drontal Plus was the medication used. I supplied appropriate documentation to justify that Drontal Plus was being used as a treatment. I had to call to request an adjustor read the documentation. I should not have to do that.
I had two claims for Drontal Plus denied, despite providing documentation that is was used as a treatment medication. After I called to request the first claim be approved, it was. However, the second claim was automatically denied. I had to call again to ask an adjustor to review the second claim, even though a virtually identical claim had just been approved.
My suggestion is to have qualified human adjustor review the cases until the automatic processes are accurate. At this point in time, the automatic processes are highly inaccurate.
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