Squaring the Circle - Principles of Certification & Insurance Claim Forms

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

Thomas Johnson — Fri, 14 Feb 2014 16:27:09 GMT

[quote user="An On MRCVS"]

[quote user="Thomas Johnson"]it's not 'cancer' therefore it's not covered[/quote]

Another ambiguity - what definition of cancer are they using? There's more than one... do we take a strict defintion that it's only epithelial neoplasias? or a loose one invoving any destructive condition?

Where is the supporting guidance?

[/quote]

My understanding, and this has come via the owner, is that they consider anything malignant to be cancer. I find it very frustrating that policies like this even exist. As you say we often don't have a definite diagnosis, so it's very difficult to fill in certain parts of the forms. I will ignore the yes/no options and write 'don't know' or 'maybe'.

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

An On MRCVS — Fri, 14 Feb 2014 14:53:33 GMT

[quote user="Thomas Johnson"]it's not 'cancer' therefore it's not covered[/quote]

Where is the supporting guidance?

Do I need to do histopathology to include it as a "cancer"? Or in your case if you didn't do histopathology can you include it as a possible cancer?

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

Thomas Johnson — Fri, 14 Feb 2014 14:43:06 GMT

[quote user="An On MRCVS"]

PetPals:

You need to tick at least one of "1. Diagnosis / Details of treatment

For Cats and Dogs: Cancer ; Infectious Disease; Bone Fractures; Burns; Foreign Body; Ingestion Removal; Defined Poison Ingestion

For Cats: Diabetes Mellitus; Feline Asthma; F.L.U.T.D. (Feline Lower Urinary Tract Disease); Feline High Rise Syndrome (A fall caused by an

accident from an elevated dwelling of two or more storeys); Bite Wounds and Bite Wound Abscesses

For Dogs: Digestive Ailments; Ear Problems; Heart Disease; Allergic Reaction to Insert Bites; Motor Vehicle Accident; Bite Wounds / Lacerations

[/quote]

If the animal's condition doesn't fit one of these categories then I won't force it into one. Unfortunately that means that some owners who think they're fully covered find out they aren't. We've just had a claim refused for a removal of a hygroma from over the occipital crest of a young retriever, it's not 'cancer' therefore it's not covered, as they're good clients we've agreed to a payment plan.

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

Bob Russell — Fri, 14 Feb 2014 10:54:42 GMT

I am scrupulously honest when filling out claims forms. I cannot and will not enter a diagnosis that cannot reasonably be supported. No gaps allowed!

As there are significant financial benefits both for clients and practices I agree we need to be responsible filling them out.

I would not enter 'unable to certify' as this may be seen by the insurance company as a No!

Not clear, not sure does not seem to cause many problems.

The one I dislike is the question: 'is this likely to require further treatment?' Rarely the answer may be No but alternatives are unsure, possible, likely or Yes!

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

An On MRCVS — Fri, 14 Feb 2014 10:04:29 GMT

Thanks, Bob.

At least I'm not alone as I think your approach sounds similar to mine.

My boss gets annoyed as insurance claims are often delayed as a result as they ring up to ask why I have deleted questions and written "unable to certify this" etc.

But are you not nervous that infringement of the 12 principles of certification is deemed gross professional misconduct, filling in insurnace forms has now been deemed "veterinary certification" and even with the best of intentions you are probably infringing principle 12:

"12. When signing a certificate, a veterinarian should ensure that:

... b. the certificate contains no deletions or alterations, other than those which are indicated on the face of the certificate to be permissible, and subject to such changes being initialled and stamped by the certifying veterinarian;"

... e. no portion of the certificate is left blank, so that it could subsequently be completed by some person other than the certifying veterinarian."

[i.e. you can't alter a yes/no question to give other options and you can't leave it blank? Otherwise you are not fulfilling the principles of certification?]

Re: Squaring the Circle - Principles of Certification & Insurance Claim Forms

Bob Russell — Fri, 14 Feb 2014 09:56:58 GMT

Unsure, suspected and see attached history are key features of our claims forms!

Covers most things and in reality the insurance companies don't have much of an argument. we are being honest and filling the form in to the best of our ability. I will certify that bit!