More Insurance Dilemmas

Re: More Insurance Dilemmas

Kate Richardson — Mon, 12 Jul 2010 12:16:54 GMT

[quote user="salome2001"]

[quote]

its not the poor animals fault they have an a**hole for an owner!, but would I go out of my way to give that extra 10% to them? Probably not.

[/quote]

But you can always add that 10% "a**hole surcharge" on the bill somewhere if you think about it...

[/quote]

Could do, but sadly think it probably backfires on the animal as a**hole then either complains or just thinks 'bloody expensive vet bill' and less likely to take poor pet to vets in future (unless dying at 4am after 5 days of being ill...)

Re: More Insurance Dilemmas

salome2001 — Mon, 12 Jul 2010 12:07:28 GMT

[quote]

its not the poor animals fault they have an a**hole for an owner!, but would I go out of my way to give that extra 10% to them? Probably not.

[/quote]

But you can always add that 10% "a**hole surcharge" on the bill somewhere if you think about it...

Re: More Insurance Dilemmas

Hannah Wynne Richards — Tue, 06 Jul 2010 09:34:12 GMT

Well said Kate

Wynne

Re: More Insurance Dilemmas

Utlendigur — Mon, 05 Jul 2010 15:19:28 GMT

We had one client who regularly called OOH wanting a home visit to his insured obese (65kg) youngish labrador that was "off his legs". Every single time the door would be opened to the dog leaping around, just a bit stiff. Any advice on diet was met with denial and much hand feeding of digestives. On one occasion I suggested that he might leave the call out until the next day and was told that he knew his rights and any refusal to attend would be followed by a complaint. Strangely when the claim form started asking whether the OOH treatment was necessary (I ticked no and sent the history as requested) the call outs stopped and he even brought the dog down to the surgery during normal hours

Re: More Insurance Dilemmas

Kate Richardson — Mon, 05 Jul 2010 14:49:55 GMT

[quote user="Hannah Wynne Richards"]

I agree that when one is on call (as opposed to working for a supposedly dedicated OOH provider, and sleeping during the day ), the clients attitude can alter one's perception . Someone who starts off with "I'm not sure if this is an emergency " will always have a more sympathetic response than the aggressive "I know my rights " type

[/quote]

Absolutely! I guess those 'aggressive' clients may have had a bad experience elsewhere, hence their attitude, although there are some genuinely aggressive types out there who think that being rude and demanding gets results. Maybe it does, but in my book, all animals get the treatment they need and when they need it, be it 3am or 3pm, as its not the poor animals fault they have an a**hole for an owner!, but would I go out of my way to give that extra 10% to them? Probably not. But some people, once they realise that you do genuinely care about what you are doing will mellow and lose that tone. Hopefully they then realise that we are not all tarred with the same brush! And hopefully you gain a client, and get some free PR.

Re: More Insurance Dilemmas

Evelyn Barbour-Hill — Fri, 02 Jul 2010 16:50:26 GMT

[quote user="Bob Russell"]The client was a little embarassed and said 'I am not sure if this is an emergency or not but....' My bosses reply was 'If you are worried enough to phone is an emergency to you'[/quote]

That's very true; but, on the other hand, among my clients anyway, they really are phoning up just for advice on whether it's an emergency or not. They want to talk it over and if I assure them it's not an emergency, and suggest what they can do while waiting for the next regular surgery, that's all they want.

As for the demanding client, I have a good friend who set up his own singlehanded practice a little before I did. The principle he adopted was: "Have your dog's toenails clipped at midnight? Yes, sure, as long as you don't mind paying midnight rates".

As for filling in the insurance claim, you may find it useful to have a non-veterinary spouse who can advise you. "Evelyn, don't agonise over it. Just fill it in truthfully. It is NOT YOUR PROBLEM"

Re: More Insurance Dilemmas

Hannah Wynne Richards — Fri, 02 Jul 2010 16:00:10 GMT

Back to original question

Go on your initial feelings. If you felt at the time that the animal wasn't an emergency, then don't put your MRCVS at risk by signing a false certificate- the owner won't support you financially until retirement age !!!!!!!!!!!!!!

Also remember insurence fraud isn't a victimless crime-the victims are every one of us who wants something more than a basic old-age pension when we grow old-most pension funds invest heavily in insurence companies-that is unless we are DEFRA or Uni employees on tax-payer funded final salary schemes

Wynne

Re: More Insurance Dilemmas

Hannah Wynne Richards — Fri, 02 Jul 2010 15:54:20 GMT

Vikki I only wish all OOH providers were willing to see any client who was worried enough to call !!!!!!!!!!

I've had someone with a genuine emergency fobbed off with telephone advice-very unsatisfactory-especially as the veterinary surgeon was in work and should be waiting for them

Being a practice owner, the thoughts of the extra money reconciles me to most things

Wynne

Re: More Insurance Dilemmas

Wren — Fri, 02 Jul 2010 15:37:33 GMT

Sort of leading away from the original query I find it interesting to hear people's opinions of what constitues an emergency. There aren't that many things that need to be seen at 7.30am when the surgery will open in an hour, but perhaps more that need to be seen on a Saturday evening when normal veterinary care is 36hrs away.

I feel that after so many years in the job I am reasonably good at judging over the phone how urgent cases are (I was quite happy that the aforementioned cat didn't have a melting ulcer or glaucoma, and when I saw it it did indeed only have mild conjunctivitis). I think it is true that you see a lot of non-emergencies when owners are worried and most of these I am totally happy to see (GI upsets, small nicks and wounds, minor lamenesses, 'sudden onset' otitis) as it keeps the client happy, is a useful money-spinner and is good PR.

I do have a problem with the people who think that they have a 'right' to have a vet attend whenever they demand and often find that these people have no idea that we work in the daytime as well - they tend to assume that the on-call vet is only working nights.

I remember a letter of complaint I received after being mildly put out at having to empty a dog's anal glands at 11.30pm one Saturday night having worked pretty much solidly from Friday morning. Doubly annoyed as we had had a Saturday afternoon surgery that the owner could have attended. Trebly annoyed as I had just crawled into bed after nearly 36 hours on the go. The owners stated that they had a right to see the vet when and where they chose regardless of what the problem was or how busy we were and if the vet in question couldn't stand the heat...... There's heat and there's unnecessary heat! The boss made me phone and apologise and this I did, though given the same situation again I'm sure I would be reluctant to see their dog at midnight solely to squeeze its behind!

Mostly our clients are reasonably good and I always let them know that I am happy to talk to them over the phone any time if they are worried, even if it's only for advice and peace of mind and not necessarily for a call out. Client 1 in the above scenario wasn't registered with any vet, it was just pure (bad?) luck that they picked our name out of the phone book. We're not even the first listed alphabetically!

Re: More Insurance Dilemmas

Bob Russell — Fri, 02 Jul 2010 14:07:39 GMT

My first boss (many years ago) was phoned up by a client out of hours. The client was a little embarassed and said 'I am not sure if this is an emergency or not but....' My bosses reply was 'If you are worried enough to phone is an emergency to you'

These cases do not appear to fall into that category as both have admitted it is not worry but convenience. It is always appropriate to warn an insured client that the insurance company may not pay or may not pay the out of hours rate. Insurance is to cover health costs not to pay for convenience.

Re: More Insurance Dilemmas

Vikki Halliday LLB — Fri, 02 Jul 2010 14:03:36 GMT

I think this is symtomaptic of an increasing problem as client expectations are that they WILL be seen if they request OOH, partly because there is more awareness that it is a requirement of RCVS membership, and also because the advent of litigation, OOH centres and general extension of working hours to suit the clients mean that they have much more choice, and expect more from their practices.

Personally I think this makes it difficult where some practices work hard and do their own OOH, where they will generally have a larger staff rota, (but not always), and where spending time on call is compensated by time off.

This puts pressure on the smaller practices to provide the same level of service, with no regard to working time regs, and also in the face of the larger OOH service providers, who will generally always see every client that calls.

Personally I think there is a balance, if the client is a long standing loyal one, who genuinely will find it very difficult to get to the surgery during opening hours, then perhaps we should try to accommodate within the bounds of reasonable hours. However those who abuse the facility should be politely told that it is an emergency service, not an at your convenience service.

I realise the difficulty comes in deciding what are true emergencies, but I think they fall into categories of Breathing, Bleeding, Fractures, GI emergencies such as GDV/obstruction where pain and depression are obvious, acute ocular emergencies such as Glaucoma, which are generally also accompanied by depression and lethargy, and pregnancy emergencies / dystocia.

I've probably missed something off that list, but the important thing is we are not the animal A&E if we are a normal Mon-Sat practice providing emergency cover. If you do what you can and charge appropriately for those cases you do see, then there should not be a huge issue.

Regarding the original question, I would most definately tick the boxes for not necessary, and include a full report with details of the conversation which led up to the decision to see the animal OOH.

Re: More Insurance Dilemmas

Nixthevet — Fri, 02 Jul 2010 10:49:35 GMT

As an vet working for an independant ooh service it's important for us to get it right too....we want to protect the clients of our member practices.

I woudl always warn the owners that if they choose to be seen-rather than it being advised or necessary then they must expect to pay the fees themselves and not expect the insurance company to pay out. If they do then contribute then the clients happy. Always be accurate and say that treatemnt was not necessary out of hours if it wasn't.

Of course a cat described as having conjunctivitis for 5 days and not getting better could be hiding a FB- or be the decemetocoele that you'd never expect to see........

Re: More Insurance Dilemmas

Michael Woodhouse — Fri, 02 Jul 2010 01:09:03 GMT

NHS Direct rely on telephone triage whether you can see a GP OOH. I wouldn't have seen either case. Frequently I tell people the OOH service not there for their convenience. I would tick the OOH visit not required box, as I have in the past when asked about home visits for PTS.

Re: More Insurance Dilemmas

Gareth C. — Thu, 01 Jul 2010 20:40:37 GMT

[quote user="Wren"]

A bog standard good ol' fashioned mixed practice providing our own emergency cover when the surgery is closed.

[/quote]

that makes it more important to get it right. If you were just working at an annonymous ooh clinc then client loyalty satisfaction etc are not so important and you can just say it wasnt nec. anyway the most they can refuse i would imagine = ooh fee-normal consult fee.

as previous post said- never sign aything you are not 100% happy with and if nec just leave boxes blank or write in your answer. I recently did an NFU one which i could hardly tick any boxes. Not sure what will happen to that one, and the owner had also put int he section "occupation" - "SLAVE (housewife)"...

Re: More Insurance Dilemmas

Wren — Thu, 01 Jul 2010 17:25:59 GMT

[quote user="Gareth C."]

Do you work for an emergency clinic or a 24hour provider? What is the difference? Maybe your employer and you have a different answer to that one!

[/quote]

A bog standard good ol' fashioned mixed practice providing our own emergency cover when the surgery is closed.

As it happens I have ticked the box to say that it wasn't a genuine emergency and we have got the money so I shall wait and see what develops. In future I will make a policy of informing people that their insurers are unlikely to pay for a 2am mild pruritis consultation though.....

Re: More Insurance Dilemmas

Rob Davis — Thu, 01 Jul 2010 17:16:55 GMT

I think Rob's is a very sensible answer. I often leave boxes blank on insurance forms (eg is this condition likely to recur.....) if I don't feel I can put my signature to the answer. It will sometimes delay claims while they request more information, but NEVER put your signature to anything which you are not completely happy to back up should it be questioned in the future. As stated above, the contract is between the owner and the insurance company, and it is not your problem if they don't pay, particularly if the owner has insisted on the emergency consultation at their convenience.

Re: More Insurance Dilemmas

Rob Loxley — Thu, 01 Jul 2010 17:09:36 GMT

Hmm, not so easy I'd suggest. Some cases will be clear cut - cat with RTA vs cat with fleas - and easy to decide which box to tick, but many will be in a grey area e.g. the lame puppy could have a fracture or just a soft tissue sprain; the sore eye cat could have simple conjunctivitis or a deep ulcer just about to rupture the globe; it would be reasonable to say each needs seeing to assess which is the case. Can you rely on the owner to diagnose mild conjunctivitis vs. acute uveitis/deep ulceration/FB in eye over the phone?

I'd maybe tick neither box and write a brief summary of the owner's description of the problem over the phone and your assessment of whether it should be seen or not, which can be explained further by reference to the clinical notes if needed?

Re: More Insurance Dilemmas

Rob Reid — Thu, 01 Jul 2010 16:51:28 GMT

Tick the 'No it wasn't necessary' box and don't feel guilty! Neither of these cases is a genuine emergency.

It is the owner's who have the contract with their insurance company not you - they should be aware of the terms and conditions. If they kick up a fuss just state that you do not wish to be party to insurance fraud!!!

One of the things that really gets my goat is the client that rings out of hours with an animal that has been ill for 5 days that suddenly needs to be seen at 11pm on a Sunday night. Most of these people who claim they can't get in during hours can, and just use it as an excuse.

Sorry if you think I am a bit harsh!!

Re: More Insurance Dilemmas

Martin Atkinson — Thu, 01 Jul 2010 16:39:52 GMT

[quote user="Wren"]

I have Client 1's insurance form in front of me and am dithering over the 'if you provided out-of-hours treatment was this necessary?' box which I know I shouldn't really be ticking. Thoughts?

[/quote]

I trust the client paid up front and you're not making a direct claim, otherwise a white lie may be in order if you want to see your money

Re: More Insurance Dilemmas

Gareth C. — Thu, 01 Jul 2010 16:31:42 GMT

its an interesting question to raise and I think Gillian's point is a good one: if you had a clear policy of informing people before they came in that only genuine "blue flashing light" emergency fees would be covered by insurance and they should therefore consider whether they would be prepared to pay the extra. In any event the insurers would pay for a consult fee of some sort so I don't think the insurers could refuse to pay anything. Do you work for an emergency clinic or a 24hour provider? What is the difference? Maybe your employer and you have a different answer to that one!

Re: More Insurance Dilemmas

Gillian Mostyn — Thu, 01 Jul 2010 15:45:33 GMT

It sounds like you ascertained during the phonecalls that these weren't emergencies for the animals involved. The OOH consultations were for convenience to the owner. So I would therefore have to tell the truth on the form and say so.

However, I would have told the client over the phone that OOH fees will not be covered under their insurance if it isn't actually an emergency. If you didn't warn them, I'm not sure if that may cause problems for you or not.