Insurance claims + pharmaceuticals purchased elsewhere

RE: Insurance claims + pharmaceuticals purchased elsewhere

Bob Russell — Wed, 21 Oct 2015 13:02:01 GMT

We don't get involved beyond enclosing receipts if requested by the owner. They have to do their own claims form because we can hardly sign a claim for things we have not supplied and have no knowledge of!

Not fussed if owners want a prescription. We charge enough to cover time profitably. Not going to subsidise on line suppliers so will charge for my time properly.

How long do people really think these suppliers will continue in business without making an adequate profit? Amazon is no longer a dirt cheap option now they have killed off a lot of high street competition. Veterinary practices are incredibly resilient and the on line suppliers will go first!

RE: Insurance claims + pharmaceuticals purchased elsewhere

Martin Atkinson — Wed, 21 Oct 2015 09:44:06 GMT

I don't know what our legal obligation is here but as of now I would not complete a claim form for medicines obtained elsewhere, I have no knowledge that they were actually ever obtained. The occasion for the need to do so has not yet arisen anyway but I have told the client on a couple of occasions that the matter has been raised that I would not be able to claim, they would need to get the person who supplied the medicines to complete that part.

Admittedly it is a slightly cynical policy to discourage clients asking for prescriptions as is a prohibitive prescription fee but these are generally going to be arkward, low value clients so I don't mind if they go elsewhere

RE: Insurance claims + pharmaceuticals purchased elsewhere

Andy Elliott — Wed, 21 Oct 2015 08:42:42 GMT

I think we all realise that in the future we need to be increasingly more realistic with charging for our time and less dependant upon medicine sales however we have a long way to go with this. Competition has become fairly fierce in a lot of areas for first opinion practice and currently every income stream is essential to make ends meet. The reality is that there has been a downward pressure on pay for all members of first opinion practice over the last decade (including business owners). Wages for vets and nurses in real terms have gone down quite a lot. I know an RVN who earns more money in her private cleaning jobs than she does with her Veterinary Nursing. Locum vets earn no more now than they did over a decade ago. We wonder why so many young vets chose to leave the profession!

I think most of us are very sympathetic to clients with a limited budget and would do whatever we could to help them. The client who triggered the original comment for this stream just happens to be a partner in a large lawyer firm and his role is head of personal injury claims. It is not unusual for some lawyers to charge £200 + for every letter they write! Does this change anything? I think it is good that you charge for completing insurance claim forms Stephen. We currently don't but times are changing!

RE: Insurance claims + pharmaceuticals purchased elsewhere

Stephen Courtney — Wed, 21 Oct 2015 07:36:39 GMT

You seem to be falling into the trap of counting potential earnings as lost profit. If you never earned it, you can't lose it, and you can't earn money the client doesn't have to spend. i'm not talking about tight arses - this is more about folk who simply don't have the cash. Those that just won't spend it, i have little time for..

We charge properly for our consulting time and tests etc. We charge to dispense, we charge to write a prescription, we charge to do insurance claims. We don't lose money through prescriptions, but sure, we can end up earning a bit less, but equally those drugs are then not bought and handled/ stored etc by the practice, so that saves money...I would suggest any potential losses are small.

We stock, and sell, no non prescription diets either - by your accounting methods this means every one who is feeding their pets food we haven't taken a cut of, is costing us money? Really?

i would rather the animals are on the correct medication. my branch is very profitable, my consults are usually full, the practice is profitable.

I appreciate that being an owner of the practice means you have to think about other things, but you don't own your staff, you don't own your clients and you have no automatic right to profit by selling medications. If you are not making money, being the last person to get paid, then your business model needs attention and making money from drugs is supposed to be only a small part of the big picture.

I doubt we'll ever see eye to to eye on any of this. Maybe things re different up North in mixed practice.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Michael Woodhouse — Tue, 20 Oct 2015 23:46:04 GMT

Kate - it is almost impossible to model (for my brain anyway).

Generally the biggest spend on fees is at the start of the case. Monitoring later can cost money, but rarely anything like the cost of investigation and diagnosis. The majority of fees are generated initially, with drug income following. By spending that drug income elsewhere what does that mean for the practice?

The fixed pot lasts longer - pays for more prescription fees, more rechecks, more monitoring.
The fixed pot lasts longer, meaning more money spent elsewhere on drugs, with almost none coming into the practice
Ultimately what does it do to the remaining profit?

It will depend what is wrong. Your £1000 on medicines is actually £833 after VAT is taken off. If you assume 50% mark up then the margin is £278. If you assume the owner can buy online at list price then they spend £555 on drugs (before VAT, online). They could afford to buy 3 months longer supply going down that route - assuming they spent nothing extra on fees. In reality it will last less time as they will have recheck consults, bloods, prescription fees.

In the first year the practice takes £1111 in fees and medicine margin if they buy drugs via the vet.

In the first year the practice takes £833 (plus whatever you charge for prescriptions 4X£10?) £873 - minus £238 if they buy drugs via the internet.

Now it depends what happens with the remaining £238. Whether some is swallowed up with checks. Spent on next years medicines. If they have a fixed insurance pot then the practice has lost £238 in the year. That bit of money left won't go far when you start wanting rechecks next year, ongoing meds and prescription fees.

BUT - the practice loses 21.4% of it's 'profit' before costs [other than direct drug costs] are taken off. I was in a talk last week at BCVA suggesting that a healthy operating profit was around 20%. This dog has now been treated at a loss. When all the costs of providing the service are taken into account - money is LOST treating this dog. That is why this seemingly small loss to help the owner really hurts the profitability and the bottom line.

The last person to get paid is the owner. The assistant cost comes out before that profit figure.

Have I made any sense?

RE: Insurance claims + pharmaceuticals purchased elsewhere

Kate Richardson — Tue, 20 Oct 2015 23:13:06 GMT

Interested in the economics- not sure I am going to explain this well though, so bear with me!

So theoretical situation- Owner has insurance limit of £2000 for an ongoing condition that requires monitoring and long term medication, over a 12 month period, would there be more profit in the fees generated than sales of meds? A higher percentage of the £2000 would be spent on professional fees than medication costs if the meds were obtained via prescription compared to buying the meds from the practice. So compare the 2 options

1) Owner gets meds from the vets- £1000 of the £2000 is used to purchase medications, leaving £1000 available to spend on fees

2) Owner gets meds via prescription- £500 of the £2000 is spent on medications, leaving £1500 available to spend on fees

I know this is very oversimplified, but which option generates more profit for the practice? I appreciate that with second option only £1500 goes to the practice, £500 goes to tinternet pharmacy, but does this necessarily mean less actual profit? £1000 on medications doesn't equal £1000 profit.

Not a practice owner, but genuinely interested- don't be too harsh on me!

RE: Insurance claims + pharmaceuticals purchased elsewhere

Stephen Courtney — Tue, 20 Oct 2015 21:20:42 GMT

I'm an employed vet.

We have no ability to negotiate a lower price to prevent a client from using an online supplier. That's up to the boss.

Prices are set and stuck to.

Getting pissy with clients who choose to save money by using online suppliers is bad client service. You can only squeeze a stone so hard.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Andy Elliott — Tue, 20 Oct 2015 19:53:02 GMT

Just for the record Stephen, can you clarify if you are a practice partner/director or an employed veterinary surgeon?

RE: Insurance claims + pharmaceuticals purchased elsewhere

Michael Woodhouse — Tue, 20 Oct 2015 19:41:36 GMT

[quote user="Stephen Courtney"]I'm here to help the animals and i have no time for that attitude. I'm 25 years qualified and don't need lectures in economics.[/quote]

It would seem that you do.

[quote user="Stephen Courtney"]the aim of legislation as well as governing bodies is that we make our living from professional activities other than selling medication.[/quote]

That is very noble, but it doesn't work in practice. If we lost the right to dispense medicines overnight and pricing didn't vastly change 99% of conventional practices would go bust overnight. The pricing may have changed and practices may be less reliant on medicine sales than they once were, they still make a massive contribution to practice profitability. If that income stream is lost, it only comes off the bottom line.

You still earn the same as an employee, but the boss suffers. The loss to the practice is clearly greater with more expensive medications! It is why I would much rather negotiate with the client and maintain a smaller margin on the medicine than lose the sale.

I would love to be able to sell medicines covering their costs and make a good living from professional fees. It's simply not possible. Ask ANY business owner. Ask any accountant who deals with vets.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Stephen Courtney — Tue, 20 Oct 2015 19:15:42 GMT

[quote user="Michael Woodhouse"]

[quote user="Stephen Courtney"]from good clients who need to make their funds go further[/quote]

From that comment I can only deduce you are an employee with none of your money in the business?

It doesn't work like that. If someone takes a prescription then everyone else has to make that up or the business makes less money.

I have absolutely no desire helping clients who want to get drugs elsewhere. They would absolutely not be going on my claim form and that would be brought to their explicit attention!

[/quote]

I'm here to help the animals and i have no time for that attitude. I'm 25 years qualified and don't need lectures in economics.

I'd rather they got their drugs from the practice but I'd also rather they got the drugs anywhere than not at all. We charge properly for consultations and to write the prescriptions. Not everyone has bullet proof insurance, and the aim of legislation as well as governing bodies is that we make our living from professional activities other than selling medication.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Hannah Wynne Richards — Tue, 20 Oct 2015 09:38:49 GMT

It states in the Gto PC that filling in insurence claims should be regarded as certification, and also that one should only certify what is from one's own knowledge.

I think a letter to RCVS, requesting a firm yes/no answer (in writing) would be indicated. That would settle the issue, for once and for all.

Wynne

RE: Insurance claims + pharmaceuticals purchased elsewhere

Richard Carter — Tue, 20 Oct 2015 09:37:17 GMT

think the insurance forms quite specifically asks for details of work done by the practice. Buying medicines elsewhere can be added by the owner as an addendum

As for losing money - if you haven't bought it, you haven't lost money and it isn't sitting on your shelf going to expire because you cannot match the latest loss leading promo of a huge internet organisation (which may or may not go bust).

The wholesaler is also losing out by losing our business and to some extent so is the manufacturer because which product are you going to recommend in the future?

RE: Insurance claims + pharmaceuticals purchased elsewhere

Glenn Hodgson — Tue, 20 Oct 2015 09:37:17 GMT

[quote user="Stephen Courtney"]

I have no problem filling the insurance form in for this. I get several a month, from good clients who need to make their funds go further, as well as from penny pincher types I am less fond of. i make it clear on the submitted invoice which part of the claim is for work done by the practice and which is for internet medication - which i have prescribed - and include the receipts provided by the owner. Nowhere am I implying that I provided the medication or received payment for it.

I'm surprised this causes a problem for any of you - and i have never had an insurance company refuse such a claim. I'm not surprised your clients were pissed off - I would be too. It seems mean spirited at best. If you feel so strongly about signing the form, put a written caveat advising that it is based on receipts provided by the client, for medication you prescribed. In case it isn't obvious enough.

We charge £9.50 to complete insurance claims.

[/quote]

Happy to help clients in most ways. Would happily scan their receipts with the rest of the paperwork or post out in my envelope/stamp. Wont breach certification rules and sign off, also don't think it is right for me to make/edit insurance forms.

Only encountered this once, under my advice my client spoke to her insurance company, "exotics direct" I think, they had a SOP for this. Was very simple and no trouble for either party at all.

I could see this being harder with some insurers though.....

RE: Insurance claims + pharmaceuticals purchased elsewhere

Anthony Todd — Tue, 20 Oct 2015 09:29:50 GMT

I don't suppose, even though it's controversial, the RCVS or the BVA could be asked for direction?

I would think one could state that the prescription was issued for the pet the date sand condition treated so it was up to the client to claim the cost?

RE: Insurance claims + pharmaceuticals purchased elsewhere

Michael Woodhouse — Mon, 19 Oct 2015 23:37:09 GMT

[quote user="Stephen Courtney"]from good clients who need to make their funds go further[/quote]

From that comment I can only deduce you are an employee with none of your money in the business?

It doesn't work like that. If someone takes a prescription then everyone else has to make that up or the business makes less money.

I have absolutely no desire helping clients who want to get drugs elsewhere. They would absolutely not be going on my claim form and that would be brought to their explicit attention!

RE: Insurance claims + pharmaceuticals purchased elsewhere

Stephen Courtney — Mon, 19 Oct 2015 22:49:36 GMT

We charge £9.50 to complete insurance claims.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Glenn Hodgson — Mon, 19 Oct 2015 22:41:56 GMT

I tell owners they need to do this themselves. Very rare.

Not the smallest chance I'd be signing off a receipt presented to like that. Surely owner or pharmacy are the only people that can sign off...

RE: Insurance claims + pharmaceuticals purchased elsewhere

Rob Loxley — Mon, 19 Oct 2015 22:40:59 GMT

[quote user="Andy Elliott"]We currently do not charge for completing insurance claim forms but we need to cover the costs of this somehow[/quote]

And you can't really just charge for completing forms that are for internet purchases and not other forms.

We've done very few claims for internet purchases and while it rankles, they are few, and we charge a sensible amount for the prescription fee, and those animals on longterm medications will be coming in for other checkups.

RE: Insurance claims + pharmaceuticals purchased elsewhere

Catriona MacIntyre — Mon, 19 Oct 2015 21:54:41 GMT

Hi Andy

I have only been faced with this once, and when I looked carefully at the wording of the form, I couldn't see how I could possibly sign a claim for anything other than the prescription fee. I was being asked to certify that "these are my normal fees" or words to that effect, and well, they weren't!

Insurance company wouldn't discuss it with me because I wasn't the policyholder. Asked the owner to clarify with them if they could provide a appropriately worded form and they said just to sign anyway and they would overlook it (aye, so you will!) They refused to confirm this in writing.

So I explained that I couldn't sign a claim for the drug costs, and why I felt I couldn't. Cue massive tantrum from owner. Apparently I should have warned them about this issue when they requested a written prescription. Client now goes elsewhere.