from loving it to feeling dread filing a claim

Out of 10

I got pet insurance when we got our pug puppy. She has been insured for like 9 or so months and she just turned 1. She has seen the vet many times. Took a little while to diagnose her with Demodex. She has been treated for this problem for 7 months now. The first day we had her we took her to be checked out by our vet. She had yeast in her ears so they now find any dermatological condition pre existing based on that. And that is fine with me. I understand how insurance works. One of our claims got partially denied because they felt part of her problem was dermatological. We filed an appeal and they said no it's not dermatological its secondary infection to her Demodex. They are usually good at paying claims fast so I know when there is a problem. It stays pending for a week or so. I have to call embrace and they always say. "We are waiting for doctors notes" I always say I have them and I submit them since the specialist is slow to get back to them. Would a courtesy email hurt to keep a customer up to date. Especially since I had the documents they needed every time!!! Then I get the same determination partially covered. Partially not due to dermatologivsl condition. For literally the same problem, same tests, and same medication the appeals adjuster approved, and other claims have been approved. As a customer I can not request a redetermination. The provider has to write something. Today was literally the 4th time this has happened. It is very annoying that they are an insurance company. How can they not review previous claims for the same exact thing that were paid and previous appeals that overturned the same exact wording they are using. Needles to say I think they need a better system or way to review cases that have a chronic condition. This I find is very poor claim management on their part. Luckily the condition has finally almost cleared and hopefully will not have to deal with so many claims soon. To me there is no reason to cover and antibiotic and the first refill but not the second refill. I give them a low rating based on the poor management of processing claims for chronic conditions. Also they should notify customer when they need more info not just the doctor.

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Claim Amount
$100 - $500


Age of Pet
Under a year

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Posted: 07/07/2015

Mark, our handling of this certainly sounds like a mess. If you could contact me through our website, I'd love to look into this.
Embrace CEO