S & W Machine LLC

[redacted] is absolutely correct - we thought we fixed the issue when he called us in June of 2016, and we were unaware that the double charge was still happening I am so sorry for that mistake on our part, and [redacted] will absolutely be refunded the $in over-payments He will see this credit on the payment type we have on file within about business days Please give us a call at 800-511-if you do not see this credit within the next two business days, or if there are any other issues we can help with

[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 Regards, [redacted]

Hello Revdex.com,I am unsure what Ms [redacted] is referring toWe received the required evidence of pre-policy examination and the medical record on 1/13/The medical history and claims were put in line to be reviewed at that timeThey came up for review on 2/2/and the claims were processed and covered on 2/3/Sometimes it takes a bit longer to receive all of the medical history we need in order to process a claim, perhaps this is what Ms [redacted] is referring toWe are beholden to the veterinary clinics to provide us with their detailed medical recordsWe cannot help how long it takes for them to send itRegardless, the claims are covered and Ms [redacted] has received payment on them.Please let me know if there are any further questions about this caseJenna M***, RVTClaims ManagerEmbrace Pet Insurance

Bear Revdex.com,I am happy to explain Embrace Pet Insurance’s decision to not cover this mass claimOur policy terms and conditions specify any undiagnosed mass present before the start of the policy will create an exclusion of coverage for all other massesThe following is an excerpt for the policy: Part IV - Exclusions: eIf a Pet has been treated for undiagnosed masses prior to the end of the Waiting Period, any mass, or condition where a mass is a Clinical Sign, is not covered, including those caused by cancerIf the cause of the mass that occurred prior to the end of the Waiting Period can be diagnostically narrowed down via cytology, un-related conditions may be covered.The situation is this case is the same as what is stated in this policy exclusionThere was a mass noted before the start of the policyIt was never tested or definitely diagnosed, therefore according to the policy, no other masses can be coveredMs [redacted] can certainly appeal the outcome of this claim, but we would need more definitive information to do soHer veterinarian saying it is a “harmless mass” is not enough informationAn actual diagnosis, as the policy states (via cytology) such as sebaceous cyst, lipoma, or mast cell tumor would be needed to narrow down the exclusion and see if it is related to the current issueWithout this diagnosis we are unable to cover the claimIf further information is needed by the Revdex.com or Ms [redacted] , I would be happy to help[redacted] ***,Claims Manager,Embrace Pet Insurance

Darcy L [redacted] 2:PM to me Dear [redacted] , Here is Embrace Pet Insurance’s response to complaint # [redacted] : Embrace automatically renews policies each year, and we let Pet Parents know by sending them an e-mail about their upcoming renewal 60-days before the renewal date We sent these e-mails to Mr [redacted] at the e-mail address he entered when he purchased the policy online: [email protected] If this was not the correct address, we were never informed by Mr***, and we were never provided with an alternate address The e-mails were sent on the following dates: 11/26/13, 11/26/14, and 11/23/ We also follow up on the day of the renewal each year with an e-mail that includes the updated policy documents This e-mail was sent to Mr [redacted] on 12/of each year that he held a policy Below is a copy of the renewal e-mail that is sent: Hello ***,I hope everything is going wellI am writing to let you know that your Embrace Pet Insurance will automatically renew on 12/31/Annual premium for the new policy term will be $?Learn more about premium changes at renewal.I've attached a summary of your coverage, so please take a moment to reviewPlease review the terms and conditionsThere have been no changes to the terms this year.The Healthy Pet Deductible (not available in WA) is now in place! If your pets do not exceed their annual accident and illness deductible during this policy term, you will receive an automatic $reduction in their deductible for the next policy term.If we do not hear from you, we will automatically renew your policy on 12/31/using the payment method on fileIf you need to update your billing information, please give us a call at 800-511-9172, M-F 8:30am-8pm Sat 9am-1pm ETWe appreciate your continued business, and look forward to continuing to “Embrace” you and your petPlease don’t hesitate to let us know if you have any further questions or concerns about the renewalWarm regards,Embrace Customer Care Team EmbracePetInsurance.comConnect with us on Facebook & Twitter Additionally, by signing up with a policy a policy holder agrees to electronic delivery of policy documents including the automatic renewal noticesThe following is the pertinent excerpt from the terms and conditions: PART VII - OTHER TERMS AND CONDITIONSElectronic Delivery By accepting the terms of this insurance as evidenced by the payment of premiums, you agree that this policy, any endorsements and any notices shall be delivered to you by electronic mail via the InternetWe also define our cancellation reimbursement policy in our terms and conditions: PART VII - OTHER TERMS AND CONDITIONSCancellation Refund Upon cancellation, you may be entitled to a premium refundIf you provide us written notice of cancellation within thirty (30) days of the Original Start Date and you have made no Claim, we will refund the premium you paid us and the policy will be canceledIf you have made a Claim within thirty (30) days of the effective date, the premiums paid for or allocable to the first month of Coverage become fully earned upon the submittal of the Claim, and you will only receive a refund for any premiums paid for periods beyond the first monthAfter the first thirty (30) days of the policy period, we will compute any refund due on a daily pro-rata basisSince Mr [redacted] had active coverage from 12/31/to 2/2/16, we would not be able to issue a full refund as it is past the day money back guarantee We have done everything in good faith and according to our policy terms and conditionsMr [redacted] was provided a copy of the terms and conditions at the start of the policy and at every renewalPlease feel free to contact me with any further questions, darcy l [redacted] contact center manager(800) 511-x

I personally uploaded the actual claim forms TWICE WHICH CLEARLY state the medical diagnosisThey ignored the claim forms and both times and just put the claim on hold claiming they didn't have the information needed [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 Embrace customer service was notified about the appointment I had for [redacted] for her medical reviewI told a representative via email, so that records could be reviewed, see attached copyThe response from Embrace (to Revdex.com) states, "we did not know about The [redacted] Hospital." This is not true, as the address is on the invoice- embrace paid for -- dated 8/Embrace had the address at that time & was told via my email about the appointmentI did not send an illness claim; I sent an invoice for a medication refill- given on the 8/examAgain, I would not have paid months of coverage (which I have not used ) dated 9/2014-3/--had I known Embrace considered [redacted] to have pre-existing conditionsI want my money reimbursed for these months.Attached photo is a copy of where I notified Embrace about my Dog's visitAgain, the invoice was sent with [redacted] vca's address (so you could have requested records & notified me of "pre existing" before I paid the monthsMy pic I am attaching is in response to an Embrace representative asking for medical history Regards, [redacted] ***

Dear Revdex.com and Mr [redacted] ,I cannot see how following our terms and conditions could be seen as unethicalWe state this requirement in many places so our policy holders know there is a deadlineIt would be unethical if we were trying to hide the deadline, but aren't trying to hide it, we are advertising it! Any company out there would do the same thingWe have to close our books of business from term to term with our underwriter, so we have to set a date for claims to be submitted byThis is the underwriter's rule and we have to follow itSometimes, as in this circumstance, it creates a bad experience for the policy holder, and while we would like to avoid this, the vast majority of claims are submitted within the required time frame.I looked at the claims in question and all of them would have been covered had they been submitted in a timely fashionPlease let me know if you have any questions.Jenna M***, RVTClaims ManagerEmbrace Pet Insurance

Aratched is a letter written to Embrace from a Veterinary Surgeon of yrs experience disputing their excuse with his medical expertiseAn underwriter for Embrace overruled his opinionNot a Veterinarian, but an insurance underwriterOn 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]

(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/Mr [redacted] did not purchase Atty’s policy until 7/30/ That makes IVDD a clear cut pre-existing conditionEmbrace 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 – DEFINITIONSPre-existing Condition(s) means:ban 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 aor babove are also considered pre-existing.PART IV – EXCLUSIONSPre-existing Conditions;Please let me know if you have further questions on this case.Regards,Jenna M***, RVTClaims Director andChief Underwriter on behalf of [redacted] EmbracePetInsurance.com

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 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 leastThe 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 notificationI 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-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 complaintI 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 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] ***

I am happy to further explain and address Ms***’s response statements Her first statement is untrue as she has truncated my sentenceMy prior response states, “We did not know about [redacted] at the very start of the policy.” This is a factual statementThe 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 beAlso, the email pictured was a full days after she started the policySo there was no way for us to know at the start of the policy what clinic to request records fromAs 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 claimThere are two parts to our policiesWellness or routine care reimbursement for things like vaccinations and spay or neuter procedures etcThe other part is the accident and illness insuranceA 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 insuranceEach 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 coverageWe often are able to complete this review within the first days so a pet parent can cancel the policy within the day money back guarantee periodMs [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-

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 [This consumer response was received by Revdex.com via email and is a copy/paste by ***] [redacted] -I had previously filed the complaintEmbrace's response does not address the fact that my email exchange and conversation with Embrace led me to believe the policy covered my pet's preexisting conditions I recognize that their fine print states the terms, but my complaint is that I relied on their reps telling me the truth in advance of my decision to get insurance Also, the company reinforces customer misunderstanding by using terms like "waiting period" in ways very different than is commonly understood in our own personal health coverage There is no way I would have purchased insurance had the rep been honest in answering my questions when I called in advance of my decision I provided them the email to show the lack of integrity.I request two things:A refund of my premiums I provided them the email exchange that clearly shows I was misled.Embrace to clarify its website that the waiting period is not for pre-existing conditions[redacted]

Hello *** and Revdex.com,
I can understand your disappointment in the outcome of these claims, but the fact is Belle has not been free of urinary tract infections for a full months as the policy requires for coverageThe first visit we have for Bella was on 10/3/
which noted that Belle
was urinating often and she was treated for a urinary
tract infection. This visit was prior the start of Belle’s policy which was
10/4/which makes it a
pre-existing conditionThis pre-existing condition started out as temporary
and for all temporary conditions, the exclusion is for year and would
then have expired on 10/3/ as long as Belle would remain free of any
related conditions and/or clinical signs of urinary tract infections
Unfortunately, Belle did not remain free of urinary tract
infections for a full yearThe medical notes indicate on 9/8/that Bella
was seen for hematuria (blood in the urine) and inappropriate urination (which are clinical signs of
a UTI) and the diagnosis for this visit was an antibiotic resistant infection/
predisposition to UTI’s. Because Belle did not go a full year without having urinary
issues, the exclusion is then extended another year from the most recent
occurrence (9/28/14) making the expiration of the pre-existing condition
9/28/
The medical history again indicated on 1/5/that Belle
was having blood in her urine, was straining to urinate,
and had urinary crystals (another clinical sign of UTI's)Belle was again treated for a urinary tract infection
This extended the exclusion another year making the expiration 1/5/
On April 15, 2015, Belle was again seen for a urinary tract
infection and in the medical notes the veterinarian stated that Belle has "chronic urinary
tract infections." Because the UTI's were noted as chronic
before the temporary exclusion expired this exclusion was made permanent as any chronic conditions that began before the start of the policy are excluded
from coverage for the life of the policy
I hope this helps to understand the pre-existing condition
for BelleIf you are unsatisfied with the medical history review or claims outcomes, you can appeal the pre-existing conditionsTo do so you would need a letter
from your veterinarian (which can be in the form of an email) stating why the
urinary tract infections should not be a pre-existing condition, or that they did clear up for a full months at some point and the records they have sent us are incorrectThis
information can then be emailed to [email protected]
or faxed to 1-800-238-
Best Regards,*** ***, RVTClaims ManagerEmbrace Pet Insurance

Revdex.com:
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.Had I been
satisfied with the original reasons for denial of coverage for Trigger's pet insurance claims, I would have not taken the time or energy to file a formal complaint on this platformI continue to feel I have been robbed of time, money, trust, and am determined to make sure Embrace cannot continue to operate under their current and fraudulent operationsThe response from Rachel/Embrace received today was merely the same as initially shared with me in FebruaryHowever, of grave and new concern, so obviously portrayed in Embrace's response, is that Embrace is unfairly, unjustly, and purposefully choosing to rely on one excerpt from a medical reference, the Merck Manual to deny my claimEmbrace should be well aware that the Merck Manual is to be used solely as a reference and not appropriate medically or ethically to be used to base decisions for or against animal health coverageThey should be forced to use the expertise and individual care of our animals, my *** by physicians that individually diagnose, treat, and manage our pets, my Trigger In fact, the Merk Manual itself notes this on the homepage of its Veterinary Edition (I have attached this as an image above with the following website source : https://www.merckvetmanual.com)Now, I am proposing that Embrace be forced to not only reimburse myself for the months for which I paid for their service which was never provided (roughly $816); but also, they should be forced to reverse denial of my appeal based on the following: Also attached above, is the email communication between myself, Embrace, and DrJack G***, DMV, DACVS, Trigger's Orthopedic Surgeon who physically examined *** reviewed his x-rays, and diagnosed his ACL tearOn 3/7/18, DrG*** successfully performed the $surgeryI call your attention to the attached email communication specifically where DrG*** states, that "The slight effusion in this knee, along with only mild discomfort, was suggestive that this was a recent tearThere was also no development of arthritis"He then closes by saying, "his exam and radiographic findings suggest this to be very recent (less than 4-weeks)", which very definitively contraindicates Embrace's assumptions and sole reference of the Merck ManualThis would also then confirm injury taking place after the orthopedic waiting period, which also contraindicates and refutes Embrace's bogus denial for coverageI am more deeply concerned that there is significant inadequacy, whether voluntary or not, in Embrace's attention paid to each patientIt is clear they are choosing to use whatever reference, excuse, or perhaps reliance on client ignorance to exclude coverage.This, regardless of waiting periods, should be considered insurance fraud as they continue to collect monthly payments from pet families who continue to innocently believe Embrace is providing any service whatsoeverI request you communicate with Embrace's top Leadership Team from here forward and avoid meaningless interactions with low to mid level supervisors, as I have been restricted to up until this pointEmbrace's choice reliance on a medical reference, in my situation, the Merck Manual, for their defense of their refusal for coverage should draw significant attention from the Revdex.com's Leadership TeamI again ask the question: How is this not insurance fraud for Embrace to be allowed to deny coverage based on the following, "any symptom that leads to a diagnosis is considered pre-existing", and to make matter's worse, they are allowed to pick and choose what part of a patient's chart and medical history they want to include or exclude to justify their decisions Sincerely, *** *** *** ***
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meEmbrace has finally processed the claimsI'm not sure where the error occurred, but it should be noted that the documentation that Embrace claims to have just received was acknowledged by multiple Embrace employees as received back in December and JanuarySince then, my claims have been opened and closed multiple times following complaints by me, but they were only paid once I filed with the Revdex.comI also had to resend invoices that were ignored by Embrace; these have also been acknowledged and paid by Embrace immediately now that the Revdex.com is involvedAgain, I have no way of knowing exactly what is happening on Embrace's end, but my Veterinarian and I have time-stamped proof of all exchanges that clearly contradict the written response Embrace sent the Revdex.com. Regardless, I'm happy that the claims have finally been processed.
Regards,
*** ***

MrL***'s Wellness plan was refunded in full per his request, on the date he requested. Refunds to bank accounts take 5-days to process through our billing system, so the refund was not seen immediately by MrL***, and he did not believe that it was submitted. His main policy was
also cancelled as of the date he requested. Embrace did exactly as MrL*** requested, on the dates he requested itThank you, and please feel free to contact me if you have any questions
*** ***
*** *** ***
*** *** ***
***

Hello Revdex.com,I am happy to explain what has transpired with *** ***'s claimsBefore we can process the first illness claim for a pet, we must receive and review the medical history for pre-existing conditionsWe requested the detailed medical notes from *** ***'s veterinary hospital, however
they only sent us a list of charges for ***, basically a summary of invoicesThis is not what we require for our reviewWe called the clinic and they stated the written/ detailed notes are on colored paper and they would have to transcribe them before they could send it, otherwise the copy we receive would not be legible due to the nature of faxing something on a piece of colored paperAfter several days, the clinic was able to instead make an acceptable photocopy to fax to usWe finally received the notes yesterday, 4/26/17, they were reviewed and the claims went through for processing today, 4/27/*** *** was kept up to date and informed of where we were in the steps of this process via MyEmbrace portal messages and emails from the adjuster working on her caseIn summary, while I regret the claims took as long as they did to process, we are beholden to the veterinary clinic to provide the detailed medical history to us for reviewI feel we tried as hard as we could to get the records in a timely manner, and kept the policy holder up to date on the progressI do hope she decides to keep her policy for ***, especially since the claims and urinary conditions are coveredIf she were to change companies, the urinary issues would become pre-existing for the new policyPlease let me know if you have further questions,Jenna M***, RVTClaims ManagerEmbrace Pet Insurance

Hi,I received an email requesting a copy of my policyI am requesting this tonight via email to EmbraceI never formally got a copyI signed up for the wellness policy and added rx coverageI will send a copy as soon as they send me one. I am attaching a few more photos of email correspondence for clarification. 7/28/I received an email thanking me for purchasing a policy7/29/I responded to clinics my dog had been seen at7/30/I received an email stating *** must be examined and documented by a vetThis email says, "we'll be asking for ***'s health history in a few weeks." 7/I request clarification- if I needed to schedule exams (for wellness and additional) to start my policy7/response from embrace says I do not need an appointment for wellness (no mention of anything else needed for my dog).The next response was 8/20/requesting history, which I replied about the Sr dog exam. The email from 7/31/says Embrace would be requesting records in weeks (not months later)I was under the impression my claims would be paid, as I was not notified by Embrace about any questionable diagnoses (until last month)I would not have paid months of coverage had I been notified *** had what they say is "preexisting." I want these months of coverage reimbursed to me. As also mentioned in previous correspondence, Embrace did indeed have *** *** VCA address & phone number on a faxed invoiceHad they (the vet) been contacted (like I was told 7/31)- "we will request history in a few weeks" Embrace could have notified me of any changes or denials to my planIt would have also likely kept me a customer. I will send a copy of my policy once I receive it from Embrace.Thank you,*** ***

Hello Revdex.com,I have corresponded with *** *** and I was able to find a loop hole to use to remove the pre-existing condition of gastroenteritis without needing a letter from her veterinarian*** *** sent me documentation noting *** was adopted only days before the bout of vomitingVomiting due to stress and diet change is very common and not something we consider pre-existingWe did not have information about ***'s adoption date previously, so the vomiting was listedI have sent an updated history review in writing to *** *** and covered the recent claim for vomiting, so this issue should be resolvedPlease let me know if there are any further questionsJenna M*** RVT Chief Underwriter and Claims DirectorEmbrace Pet Insurance