Retrospective weight exclusions by insurance companies

RE: Retrospective weight exclusions by insurance companies

Allison Gleadhill — Tue, 12 Sep 2017 15:20:08 GMT

A lot of our time & involvemen by the Ombudsman & Petplans head of complaints has decided to approve the claim for cruciate surgery!

RE: Retrospective weight exclusions by insurance companies

Martin Atkinson — Tue, 05 Sep 2017 13:55:16 GMT

[quote user="Anthony Dennison"]In defence of the referral centre, the clients are incredibly high maintenance, and when things were mentioned to them they may have asked for it all to have been done...[/quote]A fool and his money are soon parted!

RE: Retrospective weight exclusions by insurance companies

Anthony Dennison — Tue, 05 Sep 2017 13:48:11 GMT

[quote user="Linda Filshie"]And did all this CT and MRI give any useful information that influenced treatment or management??![/quote]

If I remember rightly the cervical MRI did, but not really anything else. In defence of the referral centre, the clients are incredibly high maintenance, and when things were mentioned to them they may have asked for it all to have been done...

RE: Retrospective weight exclusions by insurance companies

Linda Filshie — Tue, 05 Sep 2017 13:11:24 GMT

[quote user="Anthony Dennison"]

[quote user="Malcolm Ness"]I am increasingly unsettled by how often MRI is being used in veterinary orthopaedics and neurology.[/quote]

One of our clients self-referred themselves to a certain referral centre down south (from Lancashire!) for a chronic left fore issue. The dog has xrays and CTs of both elbows, then on clinical exam they noted hindlimb lameness so did xrays and Cts of both stifles, then thought the left forelimb lameness was neurological so did a cervical and thoracic MRI.

Talk about taking the mick. Clients aren't insured and agreed to it all thinking they were getting the 'gold standard' of treatment rather than realising they were being fleeced.

[/quote]

And did all this CT and MRI give any useful information that influenced treatment or management??!

RE: Retrospective weight exclusions by insurance companies

Anthony Dennison — Mon, 04 Sep 2017 15:28:33 GMT

[quote user="Malcolm Ness"]I am increasingly unsettled by how often MRI is being used in veterinary orthopaedics and neurology.[/quote]

Talk about taking the mick. Clients aren't insured and agreed to it all thinking they were getting the 'gold standard' of treatment rather than realising they were being fleeced.

RE: Retrospective weight exclusions by insurance companies

James Dunne — Sat, 02 Sep 2017 14:54:20 GMT

[quote user="Malcolm Ness"]I am increasingly unsettled by how often MRI is being used in veterinary orthopaedics and neurology. Very rarely in SA orthopaedics and only occasionally in SA spinal neurology does MRI provide any significant information, especially if a clinically competent examination has been performed and interpreted first. (By significant information, I mean something that has the potential to change treatment and/or outcome). Too often there is a knee-jerk, "it looks like a neurological case, refer if for MRI". Unsurprisingly, some have seen the opportunity and are happy to feed the demand for scans no matter how large the cost-benefit disparity might be. [/quote]

Interesting comment. I have had experience of people advising MRI being substantially safer than, say, myelography, for the investigation of disc disease and then others indicating that in smaller patients, myelography may yield as much relevant information. How much of it is genuinely to offer a safer, better service to the patient and how much of it is trying to gain market share by exaggerating the benefits of advanced imaging?

RE: Retrospective weight exclusions by insurance companies

Allison Gleadhill — Thu, 31 Aug 2017 20:27:23 GMT

It's pet plan.

I can understand 'weighting' a premium or even refusing to insure an animal if there are risk factors but this should be up front & not retrospective as this dog is effectively uninsured for most health problems & given the level of exclusions the policy isn't worth having. The owner wouldn't have taken it out if he knew this. Perhaps weight should be declared when insurance taken out /renewed.

RE: Retrospective weight exclusions by insurance companies

Clare Tapsfield-Wright — Thu, 31 Aug 2017 19:19:01 GMT

[quote user="Bob Russell"]

From memory not far off £2000 for MRI and not much less for CT!

Elsewhere CT is in hundreds and I bet a lot more use for veterinary diagnosis.

[/quote]my recent private MRI scan was £800 , brain and spine. I didn't need sedation, didn't bite and lay still . I assume the higher cost of vet MRI is to get the return on investment in the equipment but it seems a bit steep.

RE: Retrospective weight exclusions by insurance companies

Glenn Hodgson — Thu, 31 Aug 2017 19:09:46 GMT

Please can someone say which ins company? Nothing liable about stating a fact.

RE: Retrospective weight exclusions by insurance companies

Chris Milligan — Thu, 31 Aug 2017 18:46:53 GMT

[quote user="Malcolm Ness"]I am increasingly unsettled by how often MRI is being used in veterinary orthopaedics and neurology. [/quote]

Interesting you should say this - I've been thinking recently how impressed I am at the reduction in the frequency with which MRI seems to be performed on referred cases and instead they've reached a diagnosis through said neuro exam competency rather than just doing it for the sake of it or because the referring vet requested it (or...dare I say it, the moneys...) . Maybe we're seeing a different spectrum of case management though I have generally tended to send things to the university hospitals rather than private referral centres so maybe they have an interest in keeping their costs down?

RE: Retrospective weight exclusions by insurance companies

Martin Atkinson — Thu, 31 Aug 2017 18:26:02 GMT

[quote user="robloxley"]Do you think that neurologists MRI everything that comes in to justify the clinic's investment in the scanner and their own pay?
[/quote]I suspect they want it to genuinely enhance their diagnostic ability to the maximum but the bean counters want to see a return on their investment so this sentence then becomes a truism.

RE: Retrospective weight exclusions by insurance companies

Rob Loxley — Thu, 31 Aug 2017 16:49:51 GMT

[quote user="Malcolm Ness"]Unsurprisingly, some have seen the opportunity and are happy to feed the demand for scans no matter how large the cost-benefit disparity might be[/quote]

How much MRI-ing of these patients is driven by pet insurance?; do you think pet insurance feeds the clinician's desire to rule out the minority with any changes?; does pet insurance feed the owner's ability to afford 'gold standard' (maybe 'gold-plated' is better?) investigations. Do you think that neurologists MRI everything that comes in to justify the clinic's investment in the scanner and their own pay?

RE: Retrospective weight exclusions by insurance companies

Bob Russell — Thu, 31 Aug 2017 15:52:28 GMT

From memory not far off £2000 for MRI and not much less for CT!

Elsewhere CT is in hundreds and I bet a lot more use for veterinary diagnosis.

RE: Retrospective weight exclusions by insurance companies

Malcolm Ness — Thu, 31 Aug 2017 14:37:07 GMT

[quote user="Bob Russell"]but CT/MRI scans are coming in at stupid money.[/quote]

What do you call stupid money?

I am increasingly unsettled by how often MRI is being used in veterinary orthopaedics and neurology. Very rarely in SA orthopaedics and only occasionally in SA spinal neurology does MRI provide any significant information, especially if a clinically competent examination has been performed and interpreted first. (By significant information, I mean something that has the potential to change treatment and/or outcome). Too often there is a knee-jerk, "it looks like a neurological case, refer if for MRI". Unsurprisingly, some have seen the opportunity and are happy to feed the demand for scans no matter how large the cost-benefit disparity might be.

An acquaintance of mine was relating a tale of their two Spaniels treated at a well-known referral centre "down-South". The first had a cruciate failure and they were persuaded to have the "gold-standard" pre-surgery examination which included MRI examination of the stifle. The subsequent TPLO procedure went as well as any competently executed TPLO can be expected to and the dog returned to full activity. Very soon after, the other spaniel went "off its legs". A T-L disc extrusion was diagnosed by the referring vet on the basis of signalment, progression, a neurological examination and the radiographic evidence of extruded, calcified disc material in the vertebral canal. Despite this, a "Multi-site" MRI scan was perfumed (at a cost of more than £1500.00) before the dog went to surgery and the calcified disc material - mentioned above - as removed via hemilaminectomy. Again, the dog recovered well as could have been expected.

Together, the client was separated from more than £11,000.00, of which £2,500.00 was spent on MRI scans which were of little or no worth and could have been predicted to be so. Fortunately, they are wealthy enough to afford such bills but they now regard vets as money-grabbing barstewards.

RE: Retrospective weight exclusions by insurance companies

Martin Atkinson — Thu, 31 Aug 2017 14:34:50 GMT

[quote user="Anthony Todd"]What about cyclists with head injuries and were not wearing a helmet?[/quote]There is no legal requirement to wear a helmet and given the vast majority of serious head injuries are as the result of incidents involving vehicles where the driver is at fault and in which a helmet would offer little protection (most are only certified up to 20 mph) that argument is a non-starter.

RE: Retrospective weight exclusions by insurance companies

Anthony Todd — Thu, 31 Aug 2017 13:47:29 GMT

What about cyclists with head injuries and were not wearing a helmet?

[quote user="Martin Atkinson"]I was waiting for that[/quote]

RE: Retrospective weight exclusions by insurance companies

Bob Russell — Thu, 31 Aug 2017 12:53:25 GMT

Approved Referral Centre restrictions have caused us little grief. In emergency they can go pretty much anywhere we consider most appropriate.

Two out of the three centres around here are on the list and others seem to offer a 'discount' equivalent to the penalty charge.

I have to say that at least one centre is charging eye-watering fees, not sure if this is different for practices belonging to the same corporate but CT/MRI scans are coming in at stupid money.

Thankfully one centre is much more realistic in its charges so most patients go there even if it is a bit more of a trek!

RE: Retrospective weight exclusions by insurance companies

Malcolm Ness — Thu, 31 Aug 2017 11:14:42 GMT

There are two aspect to this - if the question of obesity as a possible modifier to the terms of the policy was written into the policy as purchased, then the owners have little to bitch about. If not, it is a matter for the Ombudsman.

The second relates to "tailoring" of health insurance policies to fit the individual. This is commonplace in humans as anyone who has taken out life/health (or should that be death/illness) insurance will know - you are subjected to a medical examination, the complexity of which reflects the amount insured, and the cost of the policy, along with any exclusions, are determined on the basis of your health and a raft of population data. In dogs, the pre-insurance examination does not (?? yet) exist and the risk data is not reliable though, interestingly, the cruciate information is rather better researched than most.

There have been several good papers over the years looking at risk factors for cruciate failure. There is some inconsistency between papers, for example, while Rottweilers are consistently reported at increased risk, the other breeds on the at-risk list vary considerably. Obesity, when considered, has consistently appeared as a significant risk factor but so has being female - bitches seem to be almost twice as likely to suffer as dogs. Similarly, most papers show that neutering (dogs or bitches) increases the risk.

More questions than answers!! It seems to me that the vet insurance market is not thriving and we should expect some changes as companies struggle to find an offering that is perceived as valuable to the pet-owner while at the same time proving sufficiently profitable for the companies.On a closely related topic, what effect has the "Approved Referral Centre" restriction that had people jumping up and down a year or more ago had on the handling of cruciate surgery?

RE: Retrospective weight exclusions by insurance companies

Bob Russell — Thu, 31 Aug 2017 11:07:28 GMT

Unless there is a clause in the insurance documentation that allows this type of exclusion then I would be going with the Insurance Ombudsman route.

They are perfectly entitled to adjust the premium at renewal to reflect any additional risk. The owner really should expect to be informed about the reasons.

RE: Retrospective weight exclusions by insurance companies

Martin Atkinson — Thu, 31 Aug 2017 10:58:00 GMT

[quote user="Anthony Todd"]Don't fall off your bike then......[/quote]I was waiting for that so the answer was ready: the few times I trouble the NHS for cycling/sports related injuries are infinitely outweighed by being fit and healthy and very rarely needing treatment for anything else so I'm saving them money!

RE: Retrospective weight exclusions by insurance companies

Nicola Lawlor — Thu, 31 Aug 2017 10:53:18 GMT

I see you haven't named them but please would you do so because the rest of us need to be aware of this in more detail if this is going to be a more regular thing being dealt with in practice with this company. If we are recommending this company I feel we should know that this is something they are now doing because I won't be happy to continue to do so.

RE: Retrospective weight exclusions by insurance companies

Anthony Todd — Thu, 31 Aug 2017 10:37:26 GMT

[quote user="Martin Atkinson"]Same as with the NHS why should it fund treatment for people whose problems are almost entirely lifestyle induced?: sedentary, dietary, obesity, alcohol, smoking....just for starters.[/quote]

Don't fall off your bike then......

RE: Retrospective weight exclusions by insurance companies

Martin Atkinson — Thu, 31 Aug 2017 10:28:14 GMT

Quite frankly I have sympathy with the insurance company so long as it is made clear in the policy ts&cs. That said, Rotties ACLs have been excluded for some time not just for obesity.

Same as with the NHS why should it fund treatment for people whose problems are almost entirely lifestyle induced?: sedentary, dietary, obesity, alcohol, smoking....just for starters.

RE: Retrospective weight exclusions by insurance companies

Jill Butterworth — Thu, 31 Aug 2017 10:22:55 GMT

They'll be excluding passive smoking pets next... ;)

RE: Retrospective weight exclusions by insurance companies

Edward Jones — Thu, 31 Aug 2017 08:38:23 GMT

Which insurer?

I'd not heard of exclusions on the basis of weight before.