Claim Example: traumatic injury to Bernese Mountain Dog tooth

The Embrace Pet Insurance policy covers dental accidents as part of the accident and illness coverage and dental cleanings and illness are covered by the Wellness Rewards Plus plan.

Here we have Wynston, a one year old Bernese Mountain dog living in Bellevue, WA with a broken tooth that suddenly appeared early January.

We did not see or know of a particular event, however we did experience unusual behavior during the night of January 2. He did not sleep well. His sleeping behavior was unusual in that he could not stay in one place for more than 30 minutes - he tried to rest in his bed, on the cool bathroom tile, the kitchen floors, on our bed, near the bed on the floor, back to the bathroom etc. with no where comfortable enough to sleep. I was extremely worried about him and feared that something else might be going on - like bloat. I sat up with him for over 2 hours- outside until I froze, because he seemed to feel a little bit better in the cool weather, but I never figured out what might be going on.

Wynston settled down for a while but then:

A week later we were at a conformation practice and as the judge inspected his mouth, noticed his grey/black tooth and informed me that I should check it out since it looked like it was "dead". I sought a dental vet consultation the next day in which the doctor confirmed that the tooth was dead and it was caused by a force and trauma. I mentioned the night that Wynston didn't sleep well and the vet thought that it could have been likely that this was when the trauma happened based on his discomfort and poor sleeping behaviors, but we don't know for sure.

After that, Wynston was off to the dentist for a root canal and a teeth cleaning procedure. Here are the claim details, which demonstrate how a claim can be split between a wellness claim (for the teeth cleaning) and an accident claim (for the treatment of traumatic illness):

ClaimType Diagnosis Claim Amount Covered Amount Paid
Amount
Accident Traumatic injury and
Fractured tooth
$1,909.12 $1,625.24 $1,140.19
Wellness Rewards Dental Wellness $1,909.12 $283.88 $283.88
       $1,909.12

$1,424.07

Wynston has a $200 deductible, 80% reimbursement percentage and $10,000 annual maximum with prescription drug coverage, plus a $400 Wellness Rewards Plus plan, all for $77 a month.

Here are the details of the accident claim - note how the shared charges are split 75% for for the accident and 25% for the wellness:

Wynston dental trauma accident claim
It's a little complicated when you first look at it but it works. And now Wynston's tooth feels sooooo much better.

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Claim Example: traumatic injury to Bernese Mountain Dog tooth
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