pet insur for vets with pets

Re: pet insur for vets with pets

Malcolm Ness — Fri, 25 May 2012 14:13:49 GMT

[quote user="Mark Holmes"] I have seen cases worked up with a "lets just see if an MRI will help[/quote]

A finer definition of clinical ineptitude would be hard to coin.

Re: pet insur for vets with pets

Mark Hedberg — Fri, 25 May 2012 13:06:24 GMT

My old internal medicine professor in uni would absolutely go spare if he asked you a question on a case and your answer started with ANYTHING besides "take a thorough clinical history and examine the patient" (woe unto you and your descendants if you mentioned CT or MRI.)

Re: pet insur for vets with pets

Mike Martin — Fri, 25 May 2012 12:58:10 GMT

I agree with your thoughts too. (Different angles on the same thing).

[quote user="Mark Holmes"] I have seen cases worked up with a "lets just see if an MRI will help" approach and an "O well it didn't never mind" reaction when it doesn't. [/quote]

Ohhhh, that so winds me up too. I've seen dogs with a history of collapse get the MRI before they discover the heart block. I sometimes wonder, how many I do not hear of because they died under GA for their inappropriate MRI?

Re: pet insur for vets with pets

Evelyn Barbour-Hill — Fri, 25 May 2012 12:56:12 GMT

[quote user="Mike Martin"]

Sometimes I think vets, think Specialists are expensive (and they often are) but they remain much better value for money than non-Specialist referral centres who sometimes do more tests than are actually needed, and have a higher rate of complications and more review surgeries (then charge for their review surgery too). Sounds like a prelude to clinical audit for referral centres......?

A sweeping generalisation I realise, but the principle is there, I hope.

[/quote]

A sweeping generalisation bordering on the slanderous (hooray! ) but I would hope the principle is not there.

This sort of thing has cropped up in other threads, so I'm going to start a new one.

Re: pet insur for vets with pets

Mark Holmes — Fri, 25 May 2012 12:49:18 GMT

[quote user="Mike Martin"]

[quote user="Mark Holmes"]it would not be unreasonable for an insurance company to expect a case review of 2nd opinion by a Specialist at every £5000.[/quote]

I guess the point - I was not making very clearly - was..... IF this dog had been seen a Specialist - I bet the final invoice would have been hugely less. A similar point Malcolm was equally not making very clear

A sweeping generalisation I realise, but the principle is there, I hope.

[/quote]

I would agree but I think its a bit much to expect all these cases to be referred, there are not that many specialists, there are alot of vets with facilities and ability to manage them. My point slightly different to yours was that it suprises me that insurance companys just wear bills like this. I have seen cases worked up with a "lets just see if an MRI will help" approach and an "O well it didn't never mind" reaction when it doesn't.

I think I would support insurance companys saying...OK you have X to spend but before we authorise more we would like to see evidence of the case being discussed with a Specialist. X being set at a level where immediate care is unaffected and I would think £3000 -£5000 would be a reasonable amount.

Personally if I have spent £1500 and am not happy with progress I discuss it with the team at Idexx. Not because I don't feel I could go further or even becasue I feel stuck but an independant opinion is always good and can avoid wasting money. Often its purely the amount things are costing that prompts me to call. I don't want to waste money barking up the wrong tree.

I think that when you have to justify what you have done so far it reduces any temptation towards over enthusiasm.

Re: pet insur for vets with pets

Mike Martin — Fri, 25 May 2012 12:29:39 GMT

[quote user="Mark Holmes"]it would not be unreasonable for an insurance company to expect a case review of 2nd opinion by a Specialist at every £5000.[/quote]

A sweeping generalisation I realise, but the principle is there, I hope.

Re: pet insur for vets with pets

Mark Holmes — Fri, 25 May 2012 11:01:40 GMT

There should be a system where these cases can be reviewed before money like this is spent. It may or may not be justified but is doesn't all et spent at once and it would not be unreasonable for an insurance company to expect a case review of 2nd opinion by a Specialist at every £5000. That would not interfere with emergency treatment. You cannot spend £5000 quick enough that there would not be time for a case history to be reviewed independantly.

Personally I am very comfortable saying whilst I am not sure what is currently wrong I think the chances of us being able to get a fit well dog out of this are very low. The best we can hope to achieve is a dog who remains poorly or dies slowly. It is one thing to keep an animal alive it is another thing entirely to make them well again and suggest euthanasia on those grounds.

Re: pet insur for vets with pets

Mike Martin — Fri, 25 May 2012 10:49:51 GMT

[quote user="Alet Engelbrecht"]I think your hat is safe[/quote]

Re: pet insur for vets with pets

Alet Engelbrecht — Fri, 25 May 2012 10:04:40 GMT

[quote user="Mike Martin"]Sometimes I have found that some non-Specialist centres have a policy of 'blunderbust diagnostics' because they seem to lack the necessary clinical acumen and experience to select the appropriate diagnostic tests. 3 surgeries for the same condition sounds pretty bad to me. [/quote]

I think your hat is safe - it is not a place where our practice often referred cases too. It was shortly before Christmas with snow on the ground and it was the most accessible place that could take the client at short notice. Needless to say, we also did not send that many their way again. I was on holiday at the time, so I have not got all the details.

Re: pet insur for vets with pets

Alet Engelbrecht — Fri, 25 May 2012 09:58:29 GMT

[quote user="Martin Atkinson"]It is cases like this that will make a pet insurance market untenable.[/quote]

I'll be honest - I don't like wasting money and I like a good deal. Therefore, I also don't 'waste' money unnecessarily for owners. When we had advocate cheaper than stronghold for a limited time period, I would suggest to the owner to use advocate on the cat until stronghold is cheaper again - I believe they are equal in efficacy for cats anyway. Similarly - when we had ceporex and rilexine on the shelf - I would check which one would work out a bit cheaper for the client at the correct dose for the dog. But it is amazing how many clients will say 'don't worry about the money, do whatever is necessary, he is insured'. Some clients do appreciate it, though.

For me that is not the point of insurance anyway and I am not familiar with enough policies to know which type of cap the insurance have per condition/per year to start spending someone else's money indiscriminately - be it Petplan, Tesco's or a client's. But it makes me wonder whether this attitude is not the reason why we got in the debt crisis in the first place - don't worry, spend it all, someone else will pay...

Saying this, if £18k can be justified (and I am not suggesting that it cannot in this case - I am not familiar enough with all the details), it is the clients choice and I cannot put a monetary value on the bond they share with their pets. I have paid for colic surgery twice when I still had horses in South Africa - and they don't come cheap without insurance.

Re: pet insur for vets with pets

bob lehner — Fri, 25 May 2012 09:57:21 GMT

[quote user="Mike Martin"]Sorry to sound cynical. So you if you tell me it was seen by a Specialist, I'll just have to eat my hat![/quote]

I trust the hat is not a chargeable item.

Re: pet insur for vets with pets

Mike Martin — Fri, 25 May 2012 09:37:47 GMT

[quote user="Alet Engelbrecht"]£18,000?![/quote]

[quote user="Alet Engelbrecht"] and in total 3 surgeries (complications after the first) - I never saw the referral report, but I assume a bile duct obstruction.[/quote]

I'd really love to know, what level of "referral practice" this was? One of the big Specialist practices + the dog was seen and operated on by a Specialist? Or a non-Specialist practice / vet.

Sometimes I have found that some non-Specialist centres have a policy of 'blunderbust diagnostics' because they seem to lack the necessary clinical acumen and experience to select the appropriate diagnostic tests. 3 surgeries for the same condition sounds pretty bad to me.

Sorry to sound cynical. So you if you tell me it was seen by a Specialist, I'll just have to eat my hat!

Re: pet insur for vets with pets

Malcolm Ness — Fri, 25 May 2012 08:22:53 GMT

Cynical referral surgeon throwing a pebble in the pond:

[quote user="Alet Engelbrecht"] in ICU[/quote]

Regular use of an ICU is a poor prognostic factor

[quote user="Alet Engelbrecht"]ICU for a few days[/quote]

A very poor prognostic factor

[quote user="Alet Engelbrecht"]two blood transfusions[/quote]

In response to trauma or medical disease, blood transfusion is good. In response to surgical blood deficits - another poor prognostic factor.

[quote user="Alet Engelbrecht"] £18k was a major shock[/quote]

If the medical implications of ongoing treatment had been properly discussed ("informed consent") then the costs should have been known.

[quote user="Alet Engelbrecht"]Dog died[/quote]

The worst prognostic factor.

This kind of story gets vets generally and referral practice in particular, a deservedly bad name (see earlier posts about cash-ectomy and insurance-centesis)

In our practice, we effectively "guarantee" as much of our surgery as possible to the extent that if a hip replacement, cruciate or fracture case develops complications the further costs to the owners are limited to drugs and additional implants - we do all surgery (inc disposables like hats and shoe-covers!),diagnostics, hospitalisation, consultations at our expense. We do similar for as many of the soft-tissue surgery and other procedures as are possible.

I am becoming increasingly unsettled by the "slaughtering of the golden goose" by some referral centres "gilding the lilly" as far as extra procedures go. Some smaller Cert led practices are just as guilty of this as the big, Specialist multidisciplinary centres. For example, we recently operated a couple of liver shunt cases one of which had been "pre-authorised" by insurance company following diagnosis at primary care practice and discussion with St Elsewhere's. The estimate included a repeat of all the primary care diagnostics (which were already very much more than adequate) and "2-4 days ICU @ £500 a day". Both dogs were discharged from our hospital 2 days after shunt attenuation surgery and that is not unusual.

We have ICU, an in-house blood bank and free access to MRI. We do not use any of these very often and if we lost all three it would have minimal impact on the level of care we were able to offer. I am coming to believe that the majority (ie more than half) the MRI scans done on SA patients are a complete waste of money and when those scans are ordered/performed by vets without specialist neuro or imaging expertise, the waste of money escalates.

Incidentally, we have never managed to get a client bill even half way to the £18k mentioned above - what are we doing wrong??

Re: pet insur for vets with pets

Martin Atkinson — Thu, 24 May 2012 18:38:05 GMT

With regard to Alet's case I would wonder whether not being insured would have been a better bet. Its seems everyone lost leave of their senses and if there hadn't been a virtually bottomless pit common sense may have prevailed and the poor animal put to rest a lot earlier. Referral centres have to take a share of the blame here: yes it is possible to do a great deal to treat previously untreatable conditions but how many are doing everything possible just for the sake of it and playing with owner's emotions rather than what is sensible? It sounds reading between the lines that this case should have been terminated a lot sooner. It is cases like this that will make a pet insurance market untenable.

Re: pet insur for vets with pets

Evelyn Barbour-Hill — Thu, 24 May 2012 17:46:49 GMT

[quote user="Mark Hedberg"]

A total cash-ectomy, by the sound of it!

[/quote]

Or an insurance -o-centesis?

Re: pet insur for vets with pets

Mark Holmes — Thu, 24 May 2012 16:16:58 GMT

After £18,000 was the dog dead, poorly for longer or better?

Re: pet insur for vets with pets

Alet Engelbrecht — Thu, 24 May 2012 16:16:31 GMT

[quote user="Cat Henstridge"]£18,000?! What on earth did she have done?! [/quote]

It was a colleague's case more than 2 years ago, so can't remember all the details (was on holiday and just saw the bill on return). It had a liver problem (emergency referral around Christmas) and in total 3 surgeries (complications after the first) - I never saw the referral report, but I assume a bile duct obstruction. Been in ICU for a few days, had two blood transfusions as well but died eventually. The bill was quite a site, with shoe covers and even surgical caps itemised.

This dog had good insurance so I assume the owner just told them to do everything they could, but £18k was a major shock to her too. It was a fairly young dog, so she really wanted to give it a chance. I can't really point fingers, don't know all the communications between the referral vets and the owner, but it illustrates to me that the sky is the limit with money and treatment options - rightly or wrongly - therefore I do recommend insurance to clients.

Clients often have no idea of the real costs of medical and surgical services, thanks to a functional NHS (despite all the complaints and criticism!) Vets in practice do, to a degree - so perhaps we are better able to judge what we can afford for our own pets.

**Edit: Dog died - sorry, should have clarified...

Re: pet insur for vets with pets

Mark Hedberg — Thu, 24 May 2012 16:14:14 GMT

A total cash-ectomy, by the sound of it!

Re: pet insur for vets with pets

Cat Henstridge — Thu, 24 May 2012 15:46:56 GMT

[quote user="Alet Engelbrecht"]

[quote user="Gillian Mostyn"]pay referral costs if it became necessary[/quote]

I thought so too until I had a lady return with a bill for £18 000.

[/quote]

£18,000?! What on earth did she have done?!

Re: pet insur for vets with pets

Catherine Williams — Thu, 24 May 2012 15:22:38 GMT

[quote user="mariette asselbergs"]it seems impossible to find just a third party insurance for a dog. [/quote]

Membership of Dogs Trust includes a reasonable 3rd party insurance for your dog, keep meaning to sort it out as my old boy is no longer insured, my youngster is on the basis that if she needs ortho work I want to refer her and I've seen the bills some of our referral clients come back with.

My cats aren't insured, too many of them and as indoor cats lower risks without any reduction in cover costs

Re: pet insur for vets with pets

Martin Atkinson — Thu, 24 May 2012 14:55:44 GMT

[quote user="patrick murphy"]

whatever was that for?

[/quote] If you mean the action of red star man again please note I agree with you and I've just improved your rating by giving you 5 stars. Please add unemotional, cynical and self-righteous to the list of attributes I gave myself in the neutering thread.

Re: pet insur for vets with pets

Martin Atkinson — Thu, 24 May 2012 14:51:27 GMT

[quote user="David Mills"]

and improves vet business in that clients are less likely to internet pharmacy visit. I think it's generally money well spent, provided the policy is right.

[/quote] Not necessarily, which are the insurance companies that advise customers that they must buy drugs from an internet pharmacy - one that is linked to themselves?

Re: pet insur for vets with pets

patrick murphy — Thu, 24 May 2012 13:33:34 GMT

whatever was that for?

Re: pet insur for vets with pets

Mark Hedberg — Thu, 24 May 2012 07:53:24 GMT

I don't generally diagnose/treat my own pets - i have a hard time staying unbiased and unemotional. :p (That's why I like the idea of insuring my pet - pay someone to do it proper instead of risking me doing something silly with her.)

(Yes, I'm sure it would be fine. Still, it's my kitty and it's somehow different when it's mine. Go science and logic!)

Re: pet insur for vets with pets

David Mills — Thu, 24 May 2012 00:59:25 GMT

I often wonder if there is a conflict of interest in a vet insuring his/her own pet then doing the work his/her self and being paid by the insurance company for it.

3rd party is going to become more and more important in the coming years.

Although I'm of Mr Atkinson's ilk broadly on this in not insuring own pets, some ortho procedures I would refer for, especially cruciates. However, I would strongly encourage clients to insure, because it encourages responsible pet ownership, reduces the chances of guilt-tripping vets for the meds the dog needs long term (but o can't afford), improves clinical care (recheck appointments more willingly attended etc), and improves vet business in that clients are less likely to internet pharmacy visit. I think it's generally money well spent, provided the policy is right.