Should we ask clients if they are insured?

RE: Should we ask clients if they are insured?

Simon Neuhoff — Mon, 03 Oct 2016 19:52:33 GMT

I offer the same level of care whether the animal is insured or not. I also onlyebring up the question of insurance AFTER having gone through options - that way I feel it is clear that I am not offering different levels of care.

I think it is crucial though to always ask - I have had an amazing number of people over the years NOT claim for things that were perfectly claimable - and sometimes we only find this out much much later. After the dog has died in a couple of cases!

RE: Should we ask clients if they are insured?

Tiago Cardoso — Mon, 03 Oct 2016 18:43:17 GMT

This is an interesting issue. What I feel is that it is not our job to link a clinical recommendation with cost or whether the patient is insured or not. A dog with acute spinal paralysis will need imaging tests +/- surgery and that is what should be recommended.

If the cost happens to be prohibitive for a particular client - then the treatment plan will need adjusting accordingly. I normally have this discussion after making it clear what my clinical recommendation is.

Afterall, people come to us for technical advice, not financial.

Just my 2 cents.

Tiago

RE: Should we ask clients if they are insured?

Gillian Mostyn — Fri, 23 Sep 2016 09:39:31 GMT

[quote user="Wren"]Going back to my earlier point, do small animal policies have the same clause as most equine policies, in that the client is required to inform the insurers before they start a course of treatment/investigation/surgery that is going to result in a claim? [/quote]

Occasionally, but most dont.

We did have a problem this week though- somebody who has a policy with, in my opinion, the most truely useless company possible (animal friends) hadn't informed anyone about their insurance status. One of my colleagues (locum) didn't ask.....but just treated its infected cyst and recommended removal if it happens again. Which it did. Unfortunately, 3 months later.....at which point it isn't covered. Their policy states very clearly that a claim has to be made within 90 days of the condition being seen for the first time.

The owner realises that this is their fault for not reading their policy- but I do think it wouldn't have happened if our usual procedure is followed. We ask if people are insured, tell them to inform their company about the problem, and ask them to bring in their policy documents to check their excess, level of cover, exclusions etc. I realise this isn't our job to check- but if I was dealing with an insurance claim with my house or car, I would expect the tradesmen to have far more experience than me in dealing with claims, and help me avoid the possible pitfalls.

RE: Should we ask clients if they are insured?

Wren — Fri, 23 Sep 2016 08:51:06 GMT

Going back to my earlier point, do small animal policies have the same clause as most equine policies, in that the client is required to inform the insurers before they start a course of treatment/investigation/surgery that is going to result in a claim? If so, isn't it an easy way to get around the subject by asking the client "are you likely to be claiming on insurance for this? If so you need to notify them now that we are going to operate on Mr Fluffball"?

RE: Should we ask clients if they are insured?

Anthony Todd — Thu, 22 Sep 2016 17:36:20 GMT

[quote user="James Dunne"]professional obligation: discussion of fees. It is in the RCVS Guide to professional conduct. I agree that the proposed treatment path should be outlined in every case before discussion of fees.[/quote]

So that's it, I was right after all, and all I was on about!

The key word in the above is "before" fees are discussed and in most other replies it is "after" the best option has been recommended, which may be "gold standard" for some or the most sensible for others, vets that is...

RE: Should we ask clients if they are insured?

Gillian Mostyn — Thu, 22 Sep 2016 16:26:05 GMT

[quote user="Diana Kennedy"]I now mention insurance at the end after discussing all options e.g. "if Fluffy is insured then you may be able to claim for this on insurance", without asking this question directly.[/quote]

Which is often how I approach things. I don't literally say 'so, before I start, is your pooch insured?' I just make an effort to find out, diplomatically, during the initial discussion of options.

I got the impression that some vets don't mention insurance at all until the client brings it up - whereas I do include it in the discussion. That does not mean, however, that I am too blunt!

RE: Should we ask clients if they are insured?

Diana Kennedy — Thu, 22 Sep 2016 14:56:39 GMT

[quote user="Gillian Mostyn"]

[quote user="Diana Kennedy"]I personally don't ask about insurance from the outset - what difference does it make? [/quote]

In my experience, speaking generally, there are less financial restraints when pets are insured. I guess that hasn't been your experience.

[/quote]

Obviously it means there are fewer restraints in general. I meant that it makes no different to what we should be offering owners. I've had uninsured clients go for referral, how they paid the bill isn't my business. For all I know they could be earning a lot more than I do or have a lot of savings.

[quote user="Gillian Mostyn"]

[quote user="Diana Kennedy"] One person I was chatting to asked me, "Why do vets ask if I insure my dog? Do I get second class treatment because he isn't insured?". [/quote]

Seems to be to be a perfect opportunity to explain that the vet is simply asking who will be paying their bill, without making any judgement on the client.

[/quote]

They do interpret it as a judgement or might query whether we purposefully rack up huge bills to get insurance money.

[quote user="Gillian Mostyn"]

[quote user="Diana Kennedy"]The only time this has back fired [/quote]

The only time you are aware of. As you found, no system is foolproof.

[/quote]

You're right. I now mention insurance at the end after discussing all options e.g. "if Fluffy is insured then you may be able to claim for this on insurance", without asking this question directly.

RE: Should we ask clients if they are insured?

Robert Lowe — Mon, 19 Sep 2016 21:31:06 GMT

Interesting thread. Has made me review how I approach this as I had not given it much thought. I am with Arlo's volte face in that I prefer to mention insurance after discussion of options and prices and tend to run through everything from do nothing to top end with a discussion of benefits and costs along the way. I would feel uncomfortable asking for insurance details first as part of the consult BUT our client terms and conditions, that all new clients complete, asks the very same question. I just don't get to see it until after the consult as it goes straight to reception to cross check all the details with that provided by the referring vet.

On the flip side there would have been a number of animals that wouldn't have had surgery if I hadn't asked the question as either they didn't think referral work was covered or did not realise they had puppy insurance from the breeder.

Finally also noted one or two comments about referral centres using the insurance limit as a target. We only do this to make up for when the referring practices have used up insurance limits trying unsuccessfully to treat the animal and then expect the referral centre to do it for a discount as the clients no longer have cover and any more money

RE: Should we ask clients if they are insured?

Thomas Johnson — Mon, 19 Sep 2016 16:32:10 GMT

[quote user="Arlo Guthrie"]And as regards discussing treatment options, I (n=1) think it would be better NOT to begin with the gold-standard option, but to start with the minimum that can and should be done. Then to progress to the gold standard options explaining how the additional cost will (or might) increase the chance of a favourable outcome. So it comes across as 'this is good, this is better and this is best', rather than 'this is the best; anything else is worse and represents a failure on your part, Mr Owner').[/quote]

There is a risk of assuming that the best treatment is the most expensive treatment. We should always offer what we think is the best treatment, in some cases that will mean running a lot of expensive diagnostic tests or referring for expensive surgery; in other cases it may be a staged approach where you test for the most likely cause of the clinical signs, and then move on from there if you don't get a positive result; and in others it may be to give symptomatic treatment and assess the response.

As for 'gold standard', who knows what that means? Does it mean, for example, referring any animal diagnosed with neoplasia to an oncologist? I hope not, but you could argue that it's in the animal's best interests.

RE: Should we ask clients if they are insured?

Bob Russell — Mon, 19 Sep 2016 15:55:33 GMT

It still remains the case that it is more how do you ask if they are insured rather than if you ask!

I have seen occasions where referral centres seem to use the insurance limit as a target!

RE: Should we ask clients if they are insured?

Virginia Campbell — Mon, 19 Sep 2016 15:39:07 GMT

I like this idea. I already use it in some cases and might start to use it as my default setting. I think Noel Fitzpatrick uses this method- he seems to go through the options quite quickly but very clearly and in the episodes I've seen has included "Option 1: Do nothing. In Fluffy's case that's not an option, he's in too much pain." I still think talking about "do nothing" is valid even -or especially- to explain why it is unfair in those cases where it's not an option.

Mind you, you know anyone going to Supervet already has the readies for the last option so that makes the choice a bit simpler

But in general I like idea of not starting off with the "here's what you could've won..." feeling

RE: Should we ask clients if they are insured?

J G Wray — Mon, 19 Sep 2016 15:35:10 GMT

This cropped up this am with someone wanting a price for a cryptorchid castration in a GSD

My colleague reminded me to give an estimate which is higher than the one their own vet gave them

RE: Should we ask clients if they are insured?

Hannah Wynne Richards — Mon, 19 Sep 2016 15:29:29 GMT

I've lost count of the number of times I've had a phone call "What do you charge for a dental?"

Answer along the line of "How long is a piece of string?"

I'm sure Evelyn will back me up in stating that before you've started, you don't know if it's a scale and polish, or major jaw bone surgery.

Wynne

RE: Should we ask clients if they are insured?

Anthony Dennison — Mon, 19 Sep 2016 15:28:23 GMT

[quote user="Michael Woodhouse"]I've had that bite me on the arse before now. They latch on to the figure. Only when dog is asleep do you find you need to collect more images, do an ultrasound etc and it's 50% over the figure plucked out of the air[/quote]

Why you give an estimate range rather than a quote. On our consent form it also mentions 'any additional procedures after discussion with the veterinary surgeon', meaning that if we need to do more we ring the owners and discuss it before proceeding.

RE: Should we ask clients if they are insured?

Virginia Campbell — Mon, 19 Sep 2016 15:25:12 GMT

[quote user="Michael Woodhouse"]They latch on to the figure. [/quote]

Yep. If you give a range say £300-450 and explain that it is an estimate not a quote, they will still latch onto the lower figure and after the work is done the "I Was Told..." phrase comes out.. " I was told it would be £300". Which is why our practice is getting more and more hot on written signed estimates for everything. It's easier when it's TTA vs lateral suture, but when it's "investigate weight loss" in an older animal it's tough. I tend to do stepwise investigations but sometimes that feels like death by a thousand cuts for the owner.

RE: Should we ask clients if they are insured?

Michael Woodhouse — Mon, 19 Sep 2016 14:58:42 GMT

[quote user="Arlo Guthrie"]Surely if I came to you, you'd normally be able to give me a really rough idea of cost implications are for, say, 2 or 3 different options without having to go and estimates for referrals (i.e. a few hundred quid if we do something in-house. A few more hundred if we run these tests to help us narrow it down. Normally a few thousand if we refer to these guys).[/quote]

I've had that bite me on the arse before now. They latch on to the figure. Only when dog is asleep do you find you need to collect more images, do an ultrasound etc and it's 50% over the figure plucked out of the air.

RE: Should we ask clients if they are insured?

Arlo Guthrie — Mon, 19 Sep 2016 14:17:45 GMT

When this thread started, I was of the opinion that it's fine - actually, important - to ask whether an animal is insured or not, and it doesn't matter all that much when you pose the question. But I'm going to do a complete volte-face.

Forget the question of insurance for a moment. That's not really the issue.

The problem seems to me to be that with advances in veterinary science has come an ever widening gulf between the maximum and minimum cost of treating a given illness.

Not being a veterinary surgeon myself, it's hard to illustrate what I mean, but I have this sense that where in the past, everyone would rely on the same stethoscope, x-ray and thermometer, nowadays there's a BARRAGE of diagnostic tests that can be used for just about anything, not to mention the vastly more sophisticated surgical techniques available at your local 'Supervet'.

That's the real problem.

It's a problem because 'gold standard' has become so much more expensive (so you find yourselves offering a Rolls Royce to someone who can't afford it, but unlike the Rolls Royce, they feel guilty - sometimes desperately - for not being able to).

It's a problem because presumably, there are plenty of situations where the 'stethoscope and thermometer' outcome is the same as the platinum-plated Rolls Royce (the animal was going to regress to the mean regardless ).

It's a problem because veterinary surgeons want to offer the best for the animal. But the best is now beyond the means of many, unless they are insured.

Last weekend, I went to meet some friends for a drink and was introduced to a man who, it transpired, is involved in pet insurance at a senior level.

He (not me) raised the subject of when veterinary surgeons should ask if an animal is insured. He said he had been asked whether his animal was insured before advice was given and he found that infuriating, because of the implication that the advice would be different if the animal was uninsured.

I made the point that in human healthcare, the same question is often asked before treatment. He said that whilst that's true, there isn't a sense that treatment advice would be any different either way (the point being that a human Dr is going to tell you what needs to be done - whether you are insured or not doesn't affect what the treatment will be, just how long you will have to wait!).

I thought about it some more, and thought maybe he was just acutely sensitive because he is involved in that business, then again I think many people are actually quite protective about their insurance. I know I am.

A couple of people have mentioned in this thread about how it is all to do with perceptions. I think that's right, and it is at the heart of this issue.

I'm now firmly in EBH's camp. I think that if for no other reason than the risk of your motives being called into question, insurance cover for a specific case should never, never, never be discussed until after the treatment options (and their cost) have been discussed.

And as regards discussing treatment options, I (n=1) think it would be better NOT to begin with the gold-standard option, but to start with the minimum that can and should be done. Then to progress to the gold standard options explaining how the additional cost will (or might) increase the chance of a favourable outcome. So it comes across as 'this is good, this is better and this is best', rather than 'this is the best; anything else is worse and represents a failure on your part, Mr Owner').

[quote user="David Mills"]I've lost count of the number of clients, private and charity, who've said they want to explore options and make you do leg work for estimates for referral to turn round and say no, we've decided to have the lateral suture for £200 thanks. It's a waste of their and your time to go through all the options without mentioning cost, and, ergo, whether they can afford that.[/quote]

Surely if I came to you, you'd normally be able to give me a really rough idea of cost implications are for, say, 2 or 3 different options without having to go and estimates for referrals (i.e. a few hundred quid if we do something in-house. A few more hundred if we run these tests to help us narrow it down. Normally a few thousand if we refer to these guys).

That, surely, is all you need to do in order to be able to judge what the realistic options are. And if you do that BEFORE asking about insurance (or the client proffers the insurance information as a result of this discussion), then nobody can ever accuse you of trying to milk the insurance company.

Sorry for essay. Probably a load of rubbish I've written, but it's an interesting conundrum.

RE: Should we ask clients if they are insured?

Wren — Mon, 19 Sep 2016 09:57:48 GMT

I haven't read all the replies yet, but for anything that is likely to come in at more than the excess on the average policy, I always ask - almost all equine policies have a clause which requires the policy holder to notify them at the beginning of a course of treatment and/or before extensive investigations/surgery. So I say 'are you insured for this? If so you need to notify your insurance company that you may be claiming'.

RE: Should we ask clients if they are insured?

James Dunne — Sat, 17 Sep 2016 09:25:12 GMT

I've come in to this discussion late, but it seems to me that many of us still have problems dealing with what is a professional obligation: discussion of fees. It is in the RCVS Guide to professional conduct. I agree that the proposed treatment path should be outlined in every case before discussion of fees. I tend to state 'If your pet is insured they may reimburse you for some or all of the treatment costs - check it out with them'. It is a safer way for me of phrasing things and has been deliberately developed to avoid vexatious accusations from similar clients to the one in the original thread! It also implies that the client pays rather than direct claiming, which we still do in our practice but prefer to avoid for obvious reasons. Last thing: while it can be a pain in the behind to do the run-around for clients wanting to hear all the options when they have no capability to pay for advanced treatments, it is a necessary nuisance. Occasionally, they will initially state they have no funds only to find it somewhere and then complain when they weren't given all the options at the start. While discussing money can be embarrassing or awkward for us all on occasion (why???), it is easier than dealing with a complaint.

RE: Should we ask clients if they are insured?

Hannah Wynne Richards — Sat, 17 Sep 2016 08:01:45 GMT

Most insurence forms ask you to sign that the prices are those you normally charge. If you sign this, and then have a differential charge, you're liable for a criminal prosecution..................and all prisons are full of people who thought they wouldn't be found out. Some of those are professional people, who thought crimes committed in the course of work would never be found out....................including a former solicitor of mine ( and also former Carmarthenshire coroner ) who is currently a "guest of the taxpayer"

Wynne

RE: Should we ask clients if they are insured?

Francisco Gomez — Sat, 17 Sep 2016 07:33:24 GMT

[quote user="Clive Ansell"]

post op checks for insured animals are charged as a full consultation, whereas they are free for uninsured animals - written in stone in the practice manual too.

[/quote]

Rewarding uninsured clients while pressing insurance companies to put up prices, close down or refuse claims to the minimum detail to continue in business... then I complain when I'm forced to write a letter to an insured client in my own time because I feel the exclusion is unfair...

An ethical dilemma or an expected consequence of the capitalist state: the free market?

RE: Should we ask clients if they are insured?

Clive Ansell — Sat, 17 Sep 2016 07:14:23 GMT

[quote user="Neil Wheadon"]

[quote user="Michael Woodhouse"]I'm sure differential pricing for the same thing is an absolute no no[/quote]

Really?

Vaccination prices for breeders

Negotiating an ex lap for a client with less money

Dental special offers

Need I go on?

[/quote]

Differential pricing happens all the time, and we are free to quote and charge for work as we feel fit; if I want to do a Bulldog C-section for £10, or charge £3000 for a nail clip I can do.

One of my regular practices will do bitch spays for a local small charity for £65 on quiet days when there are no ops booked in, on the basis that if it gets busy or an emergency presents they may not get done, and that they may be booked in or cancelled at short notice.

I think what is an absolute no no is differential pricing primarily because an animal is insured. some insurance forms specifically ask if prices charged are the same. Unfortunately, it does go on in some practices - I recently came across a practice where post op checks for insured animals are charged as a full consultation, whereas they are free for uninsured animals - written in stone in the practice manual too.

RE: Should we ask clients if they are insured?

Braden Collins — Sat, 17 Sep 2016 04:41:42 GMT

[quote user="Neil Wheadon"]

[quote user="Martin Atkinson"]If I go to the doctor I make damn sure that he knows I've got private medical insurance! Does that count?[/quote]

A clinic near us will do operations such as hip replacements etc at a reduced fee if you aren't insured and are prepared to simply pay for it. In effect they are open to negotiation. It keeps the theatre list full, why have the surgeon twiddling his thumbs? now there's a thought...

Neil

[/quote]

And then specialist centres complain when insurance companies set up preferred referral networks......

This sort of price changes between insured and not insured patients is what is creating the "need" for referral networks. People who do this differential pricing or standards of care for insured patients are the guys who are killing their own golden goose.

Prises should stay the same. What is offered as first-line should stay the same. The only thing that insurance should change is the discussion about what the client can afford if they are unable to pay for the recommended options and the consequences of any compromises.

RE: Should we ask clients if they are insured?

Neil Wheadon — Sat, 17 Sep 2016 03:47:01 GMT

[quote user="Michael Woodhouse"]The only fair way would be to negotiate first and reveal you were insured after agreeing a price?[/quote]

Agreed

[quote user="Michael Woodhouse"]I'm sure differential pricing for the same thing is an absolute no no[/quote]

Really?

Vaccination prices for breeders

Negotiating an ex lap for a client with less money

Dental special offers

Need I go on?

Neil

RE: Should we ask clients if they are insured?

Michael Woodhouse — Sat, 17 Sep 2016 00:11:28 GMT

[quote user="Neil Wheadon"]A clinic near us will do operations such as hip replacements etc at a reduced fee if you aren't insured and are prepared to simply pay for it. In effect they are open to negotiation. It keeps the theatre list full, why have the surgeon twiddling his thumbs? now there's a thought...[/quote]

Dodgy ground I'd have thought. The only fair way would be to negotiate first and reveal you were insured after agreeing a price? I'm sure differential pricing for the same thing is an absolute no no