Claim Denied that Should have been paid

1
Out of 10

My dog recently had an ear infection, which was not a pre-existing condition and yet Embrace denied the claim. The "reason" cited was that somehow the ear is related to a dermatological condition. The Veterinarian could not believe this bogus reason for denying the claim since an inner ear infection is of course NOT a dermatological condition. If Embrace does not reprocess and pay I will never renew this insurance and plan to address this in my newspaper column. As a consumer advocate, I try to give the benefit of the doubt, but this is ridiculous. Like my Veterinarian, I am incredulous.

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Injury/illness

Ear Problem

Claim Amount
Under $100
Breed

Coton De Tulear

Age of Pet
1 - 8

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Posted: 11/11/2015
By:  

Bill, I completely understand your disappointment. The reason for linking ear infections (otitis) to broader dermatological conditions that occurred in the 12 months prior to your policy start is that published veterinary resources show otitis to be a known manifestation of underlying allergic disease in dogs and cats. If the ear infection wasn't a sign of allergies, then the pet should be able to go 12 months without any other dermatological conditions and then we'll cover dermatological conditions, including ear infections, again.
I know that doesn't solve what happened in your case but I thought clarification of our reasoning might help others understand what happened here.

Sincerely,

Laura

Posted: 10/21/2015
By:  

I also recently had a dermatological visit declined because of a temporary exclusion of dermatological issues due to some scarring of my boxer's ears noted while the policy was still in the 2-week waiting period. My regular vet wrote a letter to Embrace that was unable to reverse the decision so I followed up with someone in claims to see if they could reach out and speak with my vet to further discuss that what was noted on his ears was in no way related to his current dermatologic issues. The claims rep and my vet spoke over the phone and because he provided additional information to her the decision was reversed and now the dermatological visit will be covered. Before you go and bash Embrace in your column speak with someone in claims and find out exactly what they need in order to possibly reverse their denial of the claim. Work with them and you will see they are very helpful. It took a few extra weeks but everyone's efforts paid off and if you work with the claims processor you will understand why their initial decision was made and how it could be possibly reversed.