Insurance Refusals

Re: Insurance Refusals

toby travis — Tue, 27 Apr 2010 09:24:39 GMT

We promote PetPlan within our practice (I've got a badge but I don't wear it) but recently have had a few claims which they have declined to pay in spite of supporting letters. The one that I was involved in was a severely pruritic dog that was diagnosed with food intolerance dermatitis (took 3 monhts to diagnose, but definite in the diagnosis), but the owners had one of the older 12 month Petplan policies (which they had taken out when the dog was a puppy and renewed annually). 3 years previously the dog had had an episode of FAD at their previous practice which hadn't been claimed for, yet they have refused to pay out.

We also have found they have added sneaky excesses such as for a course of hydrotherapy post-cruciate repair - there is now a separate complimentary therapy excess as well as the excess for the surgery itself, and strct limits on the course of the treatment - eg for hydrotherapy there is a maximum of 10 sessions.

My 2 young dogs are with PetPlan but I'm thinking of possibly switching to Sainsburys - £7500 per condition in total for life, only 1 excess, and a £75per dog per year cheaper.

Re: Insurance Refusals

Michael Woodhouse — Tue, 27 Apr 2010 00:36:40 GMT

Many equine insurance policies will exclude ANY condition in an entire limb if they have paid a claim on it already!

Re: Insurance Refusals

Alex Gough — Mon, 26 Apr 2010 13:54:13 GMT

The lumps thing isn't new. I think 10 years ago I had a client's 2 year old Labrador have an exclusion put on it for all masses, lumps, tumours and cancers, because I had removed a histiocytoma. When I wrote to the company and pointed out that histiocytomas are always benign and never recur, they removed the exclusion.

Re: Insurance Refusals

Amie Glaves — Sun, 25 Apr 2010 20:13:58 GMT

I thought that insurance companies had 'qualified' staff as claims handlers therefore can suss out whether a llipoma is related to an osteosarc etc.

I remember a lovely 6y Boxer who was rehomed about a year previously. It was noted on rehoming that he had a lipoma in his L axilla. The dog then went on to have an odontogenic cyst that required a rostral hemimandibulectomy. The owner informed me that an exclusion had been put on any abscess, mass, lump, bump and so on.

After a strongly worded, but polite letter to the 'gold standard insurance provider' explaining that there was no way these 2 were related and therefore it was grossly unfair to not pay out for this, they did a pre-authorisation for the surgery. RESULT!

Re: Insurance Refusals

Hanna Bennett — Sun, 25 Apr 2010 12:11:26 GMT

which is fine for the little things, but when the bills add up (and this one is in excess of £500 due to complications) it seems unfair not to treat the dog just because the client cannot afford it up front.

Re: Insurance Refusals

Robert Wilson — Sun, 25 Apr 2010 00:55:36 GMT

Our practice policy regarding insurance is that it is most definitely a contract between the client and the insurance company. We have a policy of never doing direct claims, because of being stung previously. Clients seem to understand and accept this without complaint.

Re: Insurance Refusals

Sean Dunne — Sat, 24 Apr 2010 16:16:23 GMT

Hanna,

I didn't think about it much till I read your post but I do think I'm getting involved in more insurance claims than I used too. Most as another poster has mentioned are sorted out with a phonecall or a letter. I find that most companies are happy to pay out once they can tcik whatever boxes they need to tick their end.

On the "lumps" front I never used to have this before but recently had to explain to an insurer ( Tesco I think but not 100% sure) that a MCT removed three years ago from a boxer was not the same as a myosarcoma we took off a couple of weeks ago. I wonder are many others having this issue.

I wonder what will happen when I remove two anatomically distinct lipomas from the same dog with a bit of time in between ?

Re: Insurance Refusals

Hanna Bennett — Sat, 24 Apr 2010 14:52:18 GMT

the arthritic client is arguing the point for sure. Insurance company have not helped themselves by sending a cheque for the cost of the joint supplement despite no claim having been made for it, and their statement that they 'do not pay for preventative treatments'. Quite looking forward to hearing more for sure.

As you mention that story, Clive, i was starting to see Tesco's heading down similar lines to the old E&L which is a disappointing sign as many more people are insured with tesco than ever were with E&L, and this has put me off direct claims once again.

I completely agree that a good service should be charged for, and insurance can help clients get a level of service they would otherwise be unable to afford. The problem is, and always has been, the wrong insurance.

Re: Insurance Refusals

Clive Ansell — Sat, 24 Apr 2010 12:28:58 GMT

[quote user="Rudolph"]

[quote user="Hanna Bennett"]One was a dog that used to get some herbal joint supplement from their vets - not having a history of arthritis, was actually an agility dog, but more as a preventative - and now the dog has arthritis and they are refusing to pay[/quote]

If there's no note of the clinical records of the dog being stiff or slow then there are no grounds for refusal. You should contest this. It can only be pre-existing if there have been associated clinical signs.

[/quote]

Actually, the client should contest it. Insurance is a contractual arrangement between a client and insurance company. The veterinary practice or veterinary surgeon are not party to it. Of course, we can always support our clients claims and offer help where possible.

Ths case of the arthritic dog should be contested, with the client taking it through the small claims court if necessary.

I once had a case where an owner, a policeman, took his insurer to court and won his case over a refusal to pay out over a claim for prostate disease in his dog because the original diagnosis and treatment was based around a provisional diagnosis of bph, where in fact it was discovered eventually that he had prostatic carcinoma and was pts. I forget the insurer, something like horse and farm animals I think ???????

Re: Insurance Refusals

Clive Ansell — Sat, 24 Apr 2010 12:08:00 GMT

[quote user="Vikki Halliday"]

Whilst I always try to do my best for the animals concerned, and offer every level of treatment with approximate costings, and then obtain informed consent , I am frustrated constantly that we are more and more providing high standards of practices and equipment for the minority, and the majority think that a £20 consultation and a couple of injections will fix most illnesses.

That is why I object to some private practices opting out of the PSS, and only carrying out the bare minimum treatment and undercharging for procedures to keep themselves in business.

[/quote]

As a locum I work in five practices on a fairly regular basis, as well as many others. I have found most clients want a cheap service, the primary driving force is usually costs. I think as a profession, we need to get the message out that we can provide a cheap lower standard of service at a budget price, or we can provide a higher quality service at a high price . What is not sustainable is providing a high quality, ER style, bupa hospital style, full on 24/7 service at a low price.

A paper in the JSAP in I think September or October 2009 highlighted the void between what clients expect and what actually happens; it seems they would like a cat spey carried out with gown, mask, gloves, specialised operating rooms and new packets of suture materials etc etc - all for 20 quid.

I am not persuaded that the PSS scheme will make any difference really; one of the worst practices I have worked in is a tier 2 practice within the scheme, and conversely 2 of the best ones I know are not within the scheme, because they don't have the time or the inclination to tick the boxes and jump through the hoops.

Re: Insurance Refusals

Vikki Halliday LLB — Sat, 24 Apr 2010 10:59:44 GMT

Have had a few problems with Tesco for similar things, especially when they phone up and I'm not available, then ask me to retun the call with the answer to a leading question which is not as clear cut as they would like!

I personally think we need a concerted effort to educate the public on several points.

1. Keeping an animal is a priviledge not a right.

2. The cost of not only keeping the animal but considerations of potential complications should be pointed out, and if clients can't even afford to neuter, they should be prevented from obtaining the animal in the first place. Don't know how you can implement this one, but if you adopt children you go through a screening process, if you buy a house your credit is checked, yet we are prepared to accept that cats and dogs can change hands in the pub for the cost of a few pints. How about making animal sale or adoption a legal process, where the onus falls on the purchaser to prove their ability to care for and fund the animal?

3. Compulsory third party insurance and microchipping.

4. A concerted national press campaign to improve insurance takeup rates and a clear message that clients are responsible for funding the cost of veterinary attention, not charities and certainly not private practices. Clients should also be educated to look for insurance that will cover the life of the animal, not just the first 7 years.

I am constantly amazed by the number of clients I get in a day who cannot afford to pay for even simple intervention and treatment. And also those who moan that they wish they should have insured the animal, and is there any way they could do it now, i.e. after the event!

That is why I object to some private practices opting out of the PSS, and only carrying out the bare minimum treatment and undercharging for procedures to keep themselves in business.

Re: Insurance Refusals

Adi Nell — Fri, 23 Apr 2010 17:41:01 GMT

Hi, Hannah,

I had an exclusion put on my left knee when I took out health cover because of an incident years earlier, so this applies to humans as well as animals. And any insurer can refuse a claim based on previous history if they feel there was a related problem, whether it was excluded initially or not. Your client can challenge their ruling or threaten legal action if they feel strongly enough, but if there's a record of meds to prevent some joint disorder then there's cause to think the client suspected somehting was on the go.

As far as the bill is concerned, you are within your rights to reduce it if you feel inclined to do so. That's a private matter and doesn't affect the insurer, or your general pricing policy.

And, by the way, I've ended up having two cartilage ops on that knee - so far!

All best,

Adi

Re: Insurance Refusals

Rudolph — Fri, 23 Apr 2010 16:54:34 GMT

[quote user="Hanna Bennett"]The other is a dog which had a different lump noted on history a couple of years ago, nothing done with it so no claim submitted, and now we have removed another lump and they are refusing to pay as it may be associated. [/quote]

No proof at all that the lump is related, especially given that the one claimed for is a de novo lump and there is no histopath to support them being related. I would contest this also - I find a well written letter usually does the trick. I had a similar battle with Petplan a year or so ago (policy from another company that was bought over by Petplan then retrospective exclusions applied!) and they eventually paid in full.

I know that doesn't really help in the wider scheme of things but I don't think either of these cases should be given up without a fight!