Insurance

[heide210]

When I took out a policy with Embrace Pet Insurance I knew that if I took Gabby for a orthopedic exam I could reduce the waiting time from 6 months to 14 days for orthopedic issues.Of course that is if Gabby was healthy.I would also be able to get a heath review from Embrace stating what they would not cover after they had Gabby's exam and a yrs worth of medical records.I thought that would be a great idea.Gabby had her exam and I found out she did have a grade1 luxating patella. Shortly after Embrace received they sent this email below:


Thank you for giving Embrace the opportunity to conduct a health review of Gabby.

We strive to be upfront and transparent about our coverage. Overall, Gabby has been pretty healthy, but there are a few conditions your policy would not provide coverage for. This medical history review tells you what is and is not covered based on the information we were given.

The following pre-existing chronic conditions shown in Gabby’s vet records are excluded permanently:

Luxating Patellas

Osteoarthritis; this condition is at a greater risk of developing due to the luxating patellas. Future coverage of this condition in other joints will be determined on a case by case basis

Vaccine Reactions



After reading what would not be covered I looked at the form my vet filled out and he states the luxating patella is only a grade 1 and is within normal range for breed and age.

I did not understand how they could say luxating patellas,when it was one,and why they would not cover if it was within normal range.So I talked with vet and he wrote this email back to Embrace:


Dear Ms Hokes,

My name is Dr Todd Kyle, and I practice at Rosehill Veterinary Hospital in Reynoldsburg, OH. I have examined "Gabby" Bellestri, and I completed Embrace Pet Insurance's health evaluation for the Bellestris.

I am disappointed in and confused about your assessment of Gabby's exclusions. First, her patellar luxation is only unilateral, not bilateral. Secondly, it is merely a grade I out of IV. Grade I luxations are ones in which the patella naturally sits in its normal position, and moves out of position only under manual pressure. In my experience, it is relatively common for Yorkshire terriers to have Grade I luxations and not have further problems with their stifles throughout their lives.

My other concern has to do with your statement on osteoarthritis, stating that it would be determined on a case by case basis. Even if you did not cover the stifle joint (and, again, I would ask that you reconsider, or at the very least cover the one that ISN'T luxating), I don't understand why you would not definitively cover other joints. Yorkies are obviously very small, and any impact one stifle would have on, say, the hip joint even of the affected side, would be minimal if any.

I am requesting that you look at this information and reconsider the coverage of this policy for Gabby. I know that the Bellestris would appreciate it.

Thank you for your time and consideration. Have a good day.

Sincerely,
Todd J Kyle DVM

Bout a week and a half later Embrace sends this email :






Regarding your Orthopedic Waiting Period Appeal
Hello Heide,
I have reviewed the additional information you sent regarding Gabby's luxating patellas, which was deemed pre-existing in your recent Orthopedic Waiting Period review.
From the veterinary information you supplied to us, Gabby has visited Rosehill Veterinary Hospital on 3/13/12 for the orthopedic examination to waive the six month orthopedic waiting period. Dr. Kyle noted on exam that Gabby has a grade 1 out of 4 medial patellar luxation on the right side and noted the left patella did not luxate.
This condition was not covered because it was found on orthopedic exam, which means the condition was present in the orthopedic waiting period and considered pre-existing.
Dr. Kyle wrote in asking Embrace to reconsider coverage. He explained in his letter that the condition is unilateral and not bilateral. He also went on to say that Gabby has a grade 1 patella luxation, which is common in Yorkshire Terriers and usually never causes a problem. Lastly, Dr. Kyle mentioned the osteoarthritis exclusion and I feel there is some confusion surrounding this exclusion that I would like to clear up.
Under the Terms and Conditions of your policy (see details below), Gabby's Medial Patella Luxation is pre-existing because the the condition was found in the orthopedic waiting period. While I do understand the condition is very mild at this time, it is present and is the reason I cannot provide coverage. The reason the condition is not coverable in either leg is because the condition is considered bilateral. Since, the condition is present in one leg, it is at a much higher risk of developing in the other leg and is the reason it's considered to be a bilateral condition.
The policy will cover osteoarthritis in other joints as long as they are not related to the patella luxation. The reason we determine coverage for osteoarthritis on a case by case basis is because there are so many variables to the coverage. An example is if Gabby develops osteoarthritis of the spine but does not have it in her knees. Osteoarthritis would be covered at 100% in this case. If she had the condition in both her spine and her knees, the condition would be covered at 50% because the treatment is being split between a covered condition/location and a condition/location not covered by the policy.
I had hoped we might have been mistaken from our first adjudication of your Orthopedic Report Card but the facts around the case clearly show Gabby's condition to be pre-existing. I am very sorry this is not the news you were waiting to hear.
Sincerely,
Laura Bennett
Chief Underwriter on behalf of RLI Corporation
Embrace Pet Insurance (800-511-9172
www.EmbracePetInsurance.com
Policy Wording Details
Part I: General Definitions
Item 28 – Pre-existing Condition
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.

Item 11 – Clinical Signs
Clinical Signs means observable changes in a Pet’s normal healthy state, bodily function or behavior.
Item 32 – Waiting Period
Waiting Period means the time period where the policy’s Coverage is restricted. For this policy, the time period is fourteen (14) days for Injuries and Illnesses, except for Orthopedic conditions for dogs where the Waiting Period is six (6) months.

The Waiting Period starts from the Original Start Date for the Pet. 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.


I guess i should of just waited out the six months.Gabby was fine and we never knew anything was wrong. I just thought it would be good to have the waiting peroid 14 days instead of 6 months.I also hate that they consider this condition bilateral.

[heide210]

Sorry about the colored fonts in my post. Guess that's why we have a preview button.lol

[Rescuemomma]

What a disappointment. I had Pet Assure on my dogs - I found they're alot more generous with their exclussions!

[RileyDC]

I'm confused. If you had waited, they would have covered it??

[gemy]

This is the reason I abhor Insurance Companies. With their language; and there Oh so sounding reasonableness; they make out like the Bandits they are!

This waiting period is a complete SCAM; in that given 6mths of "normal" wait time; they are hoping that "if" anything comes up with your pet; they can exclude that something over the life of the pet.

For most of us dog owners the first six months of a puppy's life is when lots of things can happen. From innocuous gastro intestinal upsets, to actual slip/falls and an injury occuring in the joint.

I'm so sorry you got taken by this bandit calling itself an insurance company.

All I can say is; once bitten thrice shy. Take an insurance policy to your lawyer prior to signing it.

And as a by the way; what research is the Insurance company looking at that validates their "opinion" that an LP grade1 predisposes a dog to other osteoarthritic conditions?

I hope your vet tries another kick at the can; and challenges their exclusion on OA once again.

[Ellie May]

I'm sorry that happened to you. Petplan is the same so my vet and I decided to skip the knee exam and wait the six months while hoping nothing went wrong. Ended up working for us. This was easier in a non yorkie breed because yorkies are fairly likely to show some lp symptoms as pups. Grade one lp is still lp and not all yorkies have it, so I think they were very honest and up front with you if the waiting period thing was in your contract.

[Rescuemomma]

Originally Posted by RileyDC

I'm confused. If you had waited, they would have covered it??

In other words - if they hadn't taken him for an extra orthopedic exam to get the 6 month wait waived and waited the 6 months for orthopedic issues to be covered the knee problem never would have been brought into the picture since not previously diagnosed. Make sense?

[RileyDC]

Originally Posted by Rescuemomma

In other words - if they hadn't taken him for an extra orthopedic exam to get the 6 month wait waived and waited the 6 months for orthopedic issues to be covered the knee problem never would have been brought into the picture since not previously diagnosed. Make sense?

Ohhh, WOW! Yeah... gotcha. - That is unfortunate.

[dlaureanonw]

I had embrace pet insurance for my Lola Belle and recently canceled. Sorry to hear that really sucks.

[heide210]

Originally Posted by gemy

This is the reason I abhor Insurance Companies. With their language; and there Oh so sounding reasonableness; they make out like the Bandits they are!

This waiting period is a complete SCAM; in that given 6mths of "normal" wait time; they are hoping that "if" anything comes up with your pet; they can exclude that something over the life of the pet.

For most of us dog owners the first six months of a puppy's life is when lots of things can happen. From innocuous gastro intestinal upsets, to actual slip/falls and an injury occuring in the joint.

I'm so sorry you got taken by this bandit calling itself an insurance company.

All I can say is; once bitten thrice shy. Take an insurance policy to your lawyer prior to signing it.

And as a by the way; what research is the Insurance company looking at that validates their "opinion" that an LP grade1 predisposes a dog to other osteoarthritic conditions?

I hope your vet tries another kick at the can; and challenges their exclusion on OA once again.

Originally Posted by gemy

This is the reason I abhor Insurance Companies. With their language; and there Oh so sounding reasonableness; they make out like the Bandits they are!

This waiting period is a complete SCAM; in that given 6mths of "normal" wait time; they are hoping that "if" anything comes up with your pet; they can exclude that something over the life of the pet.

For most of us dog owners the first six months of a puppy's life is when lots of things can happen. From innocuous gastro intestinal upsets, to actual slip/falls and an injury occuring in the joint.

I'm so sorry you got taken by this bandit calling itself an insurance company.


All I can say is; once bitten thrice shy. Take an insurance policy to your lawyer prior to signing it.

And as a by the way; what research is the Insurance company looking at that validates their "opinion" that an LP grade1 predisposes a dog to other osteoarthritic conditions?

I hope your vet tries another kick at the can; and challenges their exclusion on OA once again.

Really nothing I can do now.I just hate knowing if I would of waited for this 6 months to expire Gabby would of been covered for her patella. Who knows the patella may always be a grade 1.

Yeah,I was not happy with this osteoarthritis B.S. I am going to continue my policy with Embrace for the simple fact that there are soo many other things that may or could happen with Gabby,and now she does have a pre-exsisting condition and I'll be in the same boat with all the other money hungry insurance companies.

I did send this email to my vet. I just wanted him to see and have not heard back from him. It would be nice if he had something up his sleeve.

[heide210]

Originally Posted by dlaureanonw

I had embrace pet insurance for my Lola Belle and recently canceled. Sorry to hear that really sucks.

LOL....do i dare to ask why

[heide210]

Originally Posted by RileyDC

Ohhh, WOW! Yeah... gotcha. - That is unfortunate.

Sorry,i am all over when I write and probably did not make sense (:

[heide210]

Originally Posted by Ellie May

I'm sorry that happened to you. Petplan is the same so my vet and I decided to skip the knee exam and wait the six months while hoping nothing went wrong. Ended up working for us. This was easier in a non yorkie breed because yorkies are fairly likely to show some lp symptoms as pups. Grade one lp is still lp and not all yorkies have it, so I think they were very honest and up front with you if the waiting period thing was in your contract.

I would of waited like you if I had of known,but I did not know there was any problems. Gabby has never limped or had any problems at all

[RileyDC]

Originally Posted by heide210

I would of waited like you if I had of known,but I did not know there was any problems. Gabby has never limped or had any problems at all

Riley was diagnosed with slight LP in each leg during his first yearly exam in September. His vet said not to downplay it but that it is fairly common in small breeds and a lot of them never need to do anything about it. Riley has never limped but ever since then I am constantly watching him when he is walking or running.

[heide210]

Originally Posted by RileyDC

Riley was diagnosed with slight LP in each leg during his first yearly exam in September. His vet said not to downplay it but that it is fairly common in small breeds and a lot of them never need to do anything about it. Riley has never limped but ever since then I am constantly watching him when he is walking or running.

You're right RileyDC. I took my bed frame apart the other day and now my mattress is on the floor. I did not want to take the risk of her jumping off our bed. She is a crazy girl on the couch though.When she hears somebody out back she bolts of the couch.

October is her next annual exam and I will discuss the possibilities of her taking supplements.