How would your clinic price this work up?

Re: How would your clinic price this work up?

Martin Jones — Tue, 03 Nov 2009 09:09:42 GMT

Interesting. For the record, I don't ever tell people NOT to make a claim - it is, after all, why they pay for their insurance. But I am convinced of a couple of things: random claiming for small amounts will almost certainly drive everybody's premiums up; I'm also sure that in the past I have come across claim capping. It also depends on whether someone has, say, a lifetime policy with petplan or a yearly budget policy with Tescos.

I'm also not referring to, say, a heart condition coming through, which is likely to be ongoing and therefore expensive. I was really talking about this case in particular, which is an eyelid tear.

Must work - only came on here to pick up a particular piece of advice

Martin

Re: How would your clinic price this work up?

Ian Mostyn — Mon, 02 Nov 2009 22:38:03 GMT

Making a claim or not has no influence on whether it is a pre-existing condition and will get an exclusion slapped on just as quick as making a claim. As for the thimblettes, don't keep them somewhere warm. I had some in a cupboard with a laser printer, it gets a bit warm in summer and two of the blue ones melted!! Why it was just the blue ones, don't know???//

Ian

Re: How would your clinic price this work up?

Hannah Wynne Richards — Mon, 02 Nov 2009 09:08:21 GMT

I agree with Gillian Every 12 month policy I've ever come across dates the 12 months from when the problem was 1st noticed-so no point in not claimimg

Wynne

Re: How would your clinic price this work up?

Gillian Mostyn — Sun, 01 Nov 2009 10:33:39 GMT

[quote user="Martin Jones"]

[quote user="Gillian Mostyn"] But that is fraud.....

[/quote]

Yes, it is. Which is why we don't do it, and advise the owners that smaller claims that aren't perhaps entirely necessary could lead to them having issues in the future.

[/quote]

Sorry if I'm being daft - it is sunday morning afterall - but I still don't understand what you mean. You're saying that you advise the client not to make a claim because it will influence what may be excluded in the future? But I assume you still treat the problem? Therefore your clinical notes will clearly state that there will be a previous related problem..so a future claim will still be affected.

For example, we saw a puppy with typical puppy diarhoea a few days after purchase - treated easily with changed diet and probiotics. Obviously no claim made. However, a few months later when it developed a more serious GI upset the insurance company refused to pay when they requested previous clinical notes. We fought the case, and won if I remember correctly, but what I am saying is that any previous history will be taken into account. Regardless of claims being made or not.

I actually advise our clients to claim for everything they can - they pay the premiums, so why not? Unlike with cars, there is no 'no claims discount' - people who haven't ever made a claim still get a massive premium hike when their pet reaches its senior years. Seems very unfair to me.

Re: How would your clinic price this work up?

Rob Loxley — Sun, 01 Nov 2009 10:11:25 GMT

[quote user="Martin Jones"]Which is why we don't do it, and advise the owners that smaller claims that aren't perhaps entirely necessary could lead to them having issues in the future[/quote]

However, taking Tesco's 12month policy for example, the 12 months runs from the date of 1st treatment (and many policies count xrays, and even advice, as treatment), not the date of 1st making a claim. I seem to remember other policy T&Cs specifying 12 months as being from when the problem was 1st noted on the records.

As for how many excesses, at the end of the day the insurance company will decide, and they will quite happily request the notes to decide this; we advise the clients of this, regardless of whether we/they think it is all one claim.

Also be careful that if clients request extra tests above what is advised by us and this is recorded in the notes, the insurance company is often well within their rights to decline to pay out.

Re: How would your clinic price this work up?

Martin Jones — Sun, 01 Nov 2009 09:18:21 GMT

[quote user="Gillian Mostyn"] But that is fraud.....

[/quote]

Yes, it is. Which is why we don't do it, and advise the owners that smaller claims that aren't perhaps entirely necessary could lead to them having issues in the future. It's also not unknown for policies to have a cap on number of separate claims made per year, although to be fair I haven't seen this one rear its head for a few years.

As an aside, I had someone in the other week, who when asked if she was insured, said 'Yes, but it doesn't matter because it's with [rhymes with Pee & Smell], so they won't pay anyway'. Yet she was still paying premiums. Er, why?

Martin

Re: How would your clinic price this work up?

Gillian Mostyn — Sat, 31 Oct 2009 20:25:50 GMT

[quote user="Martin Jones"]

Not sure what part of the country you are, as that can make a difference to fees, but in our place it probably wouldn't be worth claiming for this against insurance; the rads will probably come out just over the excess, and the surgery probably won't be more than a hundred quid over (apologies if I'm out of touch with fees in your area, I do live in Cornwall after all). In both cases, there is the potential for exclusions to start appearing at next renewal, particularly if you shop around.

We do try to get our insured owners to be reasonably sensible with claims, and to wait for those that really need it. It MAY be that lots of owners making small claims is one reason why underlying premiums are getting bigger; it also exposes you to sharp practice from some companies in terms of future claims.

[/quote]

Exclusions are based on conditions the dog has had - not what has been claimed for. Therefore, if there is mention of eyelid surgery on a record then future conditions in that eye MAY be excluded, regardless of whether you have claimed or not. Unless you don't write clinical notes about it and then lie on the part of the form where it asks if you have seen a related condition before. But that is fraud.....

Re: How would your clinic price this work up?

Clive Ansell — Sat, 31 Oct 2009 07:18:25 GMT

[quote user="Martin Jones"]

[quote user="Clive Ansell"]

I thought it was a wind up too, but no worries !

Martin, your fees must be cheap. where I am working at the moment, very approximate fees would be. ......... if doing the pre op bloods the bill for the suturing could be £220-£250

[/quote]

Yikes. Closer to half that; xrays at the same time would be £25 for the first film, and half that for subsequent exposures. Charity fees would be around half of the above again. Interestingly, I bet we wouldn't be that far different when pricing up neutering - for us, it tends to fit into existing scales of fees, but it's apparent that many up-country practices are running these ops at significantly lower fees than for other procedures - if you're doing eyelid sutures at £250 - and I have no opinion either way on this - are your bitch spays higher or lower fee?

Martin

[/quote]

The practice I am locuming at the moment charge between £180 and £300 for bitch speys, in 4 tiers depending upon weight. That is a full inclusive price, including i'v catheter if used, all drugs, buster collar, vicryl and/or pds as prefered by the surgeon, 4 days additional post op analgesia with an nsaid, and 2 post op checks inc suture removal if thee are any - I usually do s/c ones. Too cheap I would say, but people still whinge about it.

some of my other regular practices charge less, one charges only £90 inclusive for bithes < 10kg - as I found out from one client, less than her hair do (£110)! guess which she complained about.

Hint - it wasn't the hair do

Re: How would your clinic price this work up?

Evelyn Barbour-Hill — Sat, 31 Oct 2009 00:16:53 GMT

[quote user="Martin Jones"]Tongue in cheek, Evelyn - hence the prefaced apology. But I do find that many owners get better results with a thimblette than the slightly cantilevered finger brushes that we can get from the wholesalers; use of paste aside, have you tried these (also much cheaper, as they can be got for around £2-3 for 12)?[/quote]

Hmmm, tongue in cheek disease, definitely a case for the oral surgeon

The thimblettes (don't you find it interesting that you can still get these in these electronic, paperless automatic-counting-machine days?) are a nice idea.

Those finger brushes they sell in my opinion are utterly useless; they just make brushing difficult and risk the owner getting a bitten finger.

There are two problems in introducing brushing (in a wide sense) for a grown dog. One is persuading the dog to accept it (not a big problem except with a stubborn minority). The other is persuading the owner that they can do it.... usually the bigger problem. You have to give them confidence and a long handled brush helps!

The Virbac double-ended brushes are the best I've found. The angle of the handle is excessive, but the shape and consistency of the head are just right. And I do think you need paste.

Sorry, I think I'm getting boring. Time to sign off and reach for that glass of malt.

Re: How would your clinic price this work up?

Martin Jones — Fri, 30 Oct 2009 23:32:19 GMT

[quote user="Clive Ansell"]

I thought it was a wind up too, but no worries !

Martin, your fees must be cheap. where I am working at the moment, very approximate fees would be. ......... if doing the pre op bloods the bill for the suturing could be £220-£250

[/quote]

Martin

Re: How would your clinic price this work up?

Martin Jones — Fri, 30 Oct 2009 23:25:39 GMT

[quote user="Evelyn Barbour-Hill"]

Indeed, why not. But why not get a proper toothbrush and proper paste and brush 'em every day?

[/quote]

Tongue in cheek, Evelyn - hence the prefaced apology. But I do find that many owners get better results with a thimblette than the slightly cantilevered finger brushes that we can get from the wholesalers; use of paste aside, have you tried these (also much cheaper, as they can be got for around £2-3 for 12)?

Martin

Re: How would your clinic price this work up?

Clive Ansell — Fri, 30 Oct 2009 23:02:06 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Clive Ansell"]I can't stand dental work. Seriously, I would do the suturing and book for dental work when I'm off! [/quote]

Each to their own.

[quote user="Clive Ansell"]In fact in this practice dental scale and polish is carried out by vn's[/quote]

But the veterinary surgeon is there to supervise the anaesthesia and do the periodontal examination........ he is, isn't he?

[/quote]

Each to their own - yes, it doesn't bite my biscuit I have to say.

There would of course always be a vet in attendance to examine, supervise and carry out any extractions that are needed.

Re: How would your clinic price this work up?

Evelyn Barbour-Hill — Fri, 30 Oct 2009 22:26:59 GMT

[quote user="Clive Ansell"]I can't stand dental work. Seriously, I would do the suturing and book for dental work when I'm off! [/quote]

Each to their own.

[quote user="Clive Ansell"]In fact in this practice dental scale and polish is carried out by vn's[/quote]

But the veterinary surgeon is there to supervise the anaesthesia and do the periodontal examination........ he is, isn't he?

Re: How would your clinic price this work up?

Evelyn Barbour-Hill — Fri, 30 Oct 2009 22:20:47 GMT

[quote user="Martin Jones"] I'd say get yourself a pack of a dozen bookkeepers' thimblettes and squeak the teeth every day.[/quote]

Indeed, why not. But why not get a proper toothbrush and proper paste and brush 'em every day?

She did say, originally, that they needed a scale and polish. If they need a scale and polish (which would of course include a proper periodontal examination, which is only possible under GA) then that's what they need.

Re: How would your clinic price this work up?

Jacquin Mitchell — Fri, 30 Oct 2009 18:18:10 GMT

Thanks everyone. He's back home and stitched up. The wound looks great- very nice and the rads showed some OA changes in one of his hips- nothing on the carpus though, which surprises me. The bill came to just under £300. We will have to pay 2 excesses of £60 ea on that but should get the rest back.

He didn't need a scale at all in the end. He used to have a lot more tartar but a change of diet has really helped with this.

Yes, Tesco only pays for a year but I figured that as a vet, most of the cost of any condition for my pets will be diagnosis. I wouldn't recommend them for a client!

I've only used them a couple of times and we've had 3-5 pets insured over the last 8 years.

Re: How would your clinic price this work up?

Clive Ansell — Fri, 30 Oct 2009 15:31:41 GMT

I thought it was a wind up too, but no worries !

Martin, your fees must be cheap. where I am working at the moment, very approximate fees would be.

consultation £28.50

bloods: x12 biochem, electrolytes, haematology £60 or just x6 biochem and electrolytes £32

IVFT if indicated by bloods, but probably not needed in this case, £60-£70

Ga: £70, plus drugs used: lets say acp/vetergesic/propofol another £10- £15, plus about £0.80 per minute for iso/02 usage. includes i/v catheter, and ecg/pulse ox monitoring.

Minimum of 2 rads: 1st £70, subsequent ones £35 each plus ongoing ga time iso/02

surgery: about £6 per minute, minimum of £30, plus £10 sterile pack, plus any consumables, vicryl etc at cost price plus vat.

basic scale and polish teeth about £40. plus ongoing ga time iso/02

1/2 day hospitalisation: about £20

so, if doing the pre op bloods the bill for the suturing could be £220-£250, so a claim may well be worthwhile depending on the excess. Wouldn't be worth it for the rads alone though I guess, unless there is ongoing treatment with nsaids and/or cartrophen and it forms part of ongoing treatment and eventual claim.

I'm with you on the dentistry and the bookkeepers' thimblettes, I can't stand dental work. Seriously, I would do the suturing and book for dental work when I'm off! In fact in this practice dental scale and polish is carried out by vn's

Re: How would your clinic price this work up?

Hannah Wynne Richards — Fri, 30 Oct 2009 15:13:51 GMT

Tescos are one of the policies where they stop paying after a year !!!!!

Wynne

Re: How would your clinic price this work up?

Martin Jones — Fri, 30 Oct 2009 14:50:35 GMT

In a slightly different slant....

Regarding all of the clinical arguments, I suspect that as you're a vet there may be some winding-up going on. Just to add some more (and with due apologies to Evelyn), I'd say get yourself a pack of a dozen bookkeepers' thimblettes and squeak the teeth every day.

Martin

Re: How would your clinic price this work up?

Clive Ansell — Fri, 30 Oct 2009 12:41:07 GMT

He is only 8, and if he is healthy, appetite and thirst are normal, weight is stable and nad on exam, I would offer the bloods as an option, but would not insist on them - if he needs the procedure anyway they are probably not going to make any difference.

Regarding the dentistry, I can see the arguments for and against doing at the same time as sterile surgery, i.e. 2 ga's etc, but I would always advise rebooking and doing on another occasion.

Re: How would your clinic price this work up?

Evelyn Barbour-Hill — Fri, 30 Oct 2009 11:59:55 GMT

[quote user="Jacquin Mitchell"] I meant he's having a GA and is older, [/quote]

He's only 8!

[quote user="Jacquin Mitchell"]just need a quick scale and polish[/quote]

Still should not be done at the same time as sterile surgery.

Re: How would your clinic price this work up?

Jacquin Mitchell — Fri, 30 Oct 2009 09:19:18 GMT

Fair enough re the seperate claims for the xrays.

We'll have to see what they show, I guess.

As to the eyelid, I'm a bad owner and I'm guessing the injury was at least 24 hours old before I ( my daughter) noticed it. I'm not sure an extra 12 hours will make that much difference to it at this stage but if it had been fresh I would have had him seen immediately.

Re: How would your clinic price this work up?

Hannah Wynne Richards — Fri, 30 Oct 2009 09:07:16 GMT

I would agree with Clive I certainly wouldn't commit myself to a client that hips and carpus would be one claim without 1st seeing the rads.It's this sort of overhelpfulness to the client , as opposed to being strictly neutral, doing the job, and leaving all else between the client and the insurence company that will sooner or later land a veterinary surgeon in very serious trouble I agree with the comments re dentistry, but think an eyelid needing suturing should be an OOH emergency-the longer it's left, the more debridement may be necessary, and the greater likelihood of the eyelid ending up rubbing the cornea, or an ectropion

Wynne

Re: How would your clinic price this work up?

Jacquin Mitchell — Fri, 30 Oct 2009 08:38:40 GMT

I'm sure this vet is competent ! LOL.

Re the bloods, I meant he's having a GA and is older, I'm assuming it's sensible to do a pre op blood on a otherwise healthy dog of this age. He last had bloods done when I removed a shopping trolley wheel from his gut about 6 years ago Thankfully he's a much more sensible dog these days.

Fair point re the dental. His teeth have improved so much since changing from Hills that he really would just need a quick scale and polish They used to have a fair amount of tartar on them..

Jacq

Re: How would your clinic price this work up?

Clive Ansell — Thu, 29 Oct 2009 21:52:23 GMT

I guess you are a vet?, but assuming you are not I would start with a full history, clinical exam and discussion. As your dog has not been seen by a vet for 5 years there could be many other health issues too.

Any recommendation for blood tests and/or radiography would be based on the history and the clinical exam, and not on whether or not the dog is insured. why do you particularly want blood tests, and what would you like to test for? same is true for the rads. I would happily carry out both, but could not guarantee that insurance would pay, that is an arrangement between you the client and the insurance company, but they usual do. The 2 rads may or may not relate to the same condition, it would depend on the findings. If there is hip dysplasia and a fractured carpus for example then clearly 2 different conditions and 2 excesses I guess.

I would usually advise against dental work at the same time as sterile surgery, and would prefer to schedule for another occasion. If teeth were bad I would normally advise pre op antibiosis for 5-7 days

Re: How would your clinic price this work up?

Noweia — Thu, 29 Oct 2009 21:20:34 GMT

The two x-rays could be lumped together in our practice, and the bloods as a pre-anaesthetic health screen for the anaesthetic.