[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.