Direct Claims

Re: Direct Claims

An On MRCVS — Wed, 05 Oct 2011 19:09:39 GMT

I do see your point.

Re: Direct Claims

Evelyn Barbour-Hill — Wed, 05 Oct 2011 18:40:16 GMT

[quote user="An On MRCVS"]Just because you have a credit card doesn't mean you have any credit available on it at that time. I have insurance for my cats because I wouldn't always have the amount that might be needed in my bank account or on my credit card, but would happily give over my credit card details with the understanding that it was 'insurance' on the insurance!

[/quote]

That just makes my point: if you can't pay by credit card because you've no credit left on it ("maxed out") then you probably won't have any credit on it when the veterinary practice demands payment because the insurance didn't pay up. So it's no guarantee at all, unless the practice can actually use your card to "reserve credit" as hotels do.

Re: Direct Claims

An On MRCVS — Wed, 05 Oct 2011 17:59:13 GMT

Just because you have a credit card doesn't mean you have any credit available on it at that time. I have insurance for my cats because I wouldn't always have the amount that might be needed in my bank account or on my credit card, but would happily give over my credit card details with the understanding that it was 'insurance' on the insurance!

Re: Direct Claims

Laurence Webb — Wed, 05 Oct 2011 16:47:22 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Laurence Webb"]and also take credit card details so that, if we are not paid within a month, we can take payment directly from the client -[/quote]

Not a bad idea - but if they have a credit card, why can they not just pay you with it and make their own claim? With a bit of luck they might even get the cheque before the card bill arrives.

[/quote]Good point! As direct claims are generally for those that don't have access to credit but have the foresight to plan ahead for this by getting insurance it often ends up as a debit card, which will cause them immediate cash flow problems or a post dated cheque. Obviously that can be cancelled by the owner so isn't safe, but it both gives us a bit of security and again helps to reinforce the message that an outstanding debt is the client's responsibility, not ours.

Re: Direct Claims

Martin Atkinson — Wed, 05 Oct 2011 16:14:32 GMT

[quote user="Bob Russell"]

At the moment we have withdrawn all Pet Plan literature and ceased issuing cover notes until they have sorted out what I consider is a perfectly fair claim for dental treatment.

My nurse wrote 'routine scale and polish' on the history, meaning the procedure was routine but PetPlan decided this was not covered because they did not pay for 'precautionary' scaling and polishing on a routine basis. I wrote to them clarifying this but they decided that they still would not pay because treatment was for gingivitis! I admit I had not noted gingivitis on the record previously but it had been there and was discussed with the owner. I had recorded 'worsening gingivitis' in the consultation prior to the procedure. The procedure was carried out to treat a medical problem and this should be covered by the type of policy the owner took out. A mild condition that was worsening seems a fairly good reason to intervene!

[/quote]

I struggle to see why this is Pet Plan's fault: they will understandably not cover routine dentistry, if you then change the claim to gingivitis that may sound to them like you are making a fraudulent claim. I would kiss and make up on this one and put the Pet Plan proposal forms back on the shelf, they may have the odd hiccup but compared with all the others they still win hands down and IME will happily honour claims for gingivo-stomatitis. Pet Plan and Marks & Spencer are the only companies I will make direct claims with I got fed up with waiting 6 weeks or more for Direct Line and E&L, but even then I'd rather not unless its no claim - no treatment..

Re: Direct Claims

Evelyn Barbour-Hill — Wed, 05 Oct 2011 15:00:49 GMT

[quote user="Laurence Webb"]and also take credit card details so that, if we are not paid within a month, we can take payment directly from the client -[/quote]

Not a bad idea - but if they have a credit card, why can they not just pay you with it and make their own claim? With a bit of luck they might even get the cheque before the card bill arrives.

Re: Direct Claims

Hannah Wynne Richards — Wed, 05 Oct 2011 12:23:01 GMT

I suppose I'm lucky that having a small practice, I know my clients, so am not often let down,and the money I lose is outweighed by what I gain from clients who would not otherwise be able to afford gold-standard treatment

Wynne

Re: Direct Claims

Laurence Webb — Wed, 05 Oct 2011 11:14:49 GMT

We do allow them, but we aim to get payment from the client at the time of treatment if at all possible.

Before allowing a direct claim we check the certificate of insurance to ensure they are covered (make sure it is for the current year - we've had certificates from 2 years ago presented to us, which isn't much good!) and require a signed claim form at the time of treatment. We ask the client to pay the excess before treatment and also take credit card details so that, if we are not paid within a month, we can take payment directly from the client - it certainly encourages the client to be on the back of their insurance company if we haven't been paid. So far we haven't had to resort to this - we don't do direct claims for E&L otherwise I expect this would be a common occurence.

We also make to clients sign a form detailing all of this, including the estimated (before treatment) and actual (post treatment) balance, including the phrase "it is your responsibility to cover any shortfall in the cost of treatment which is not covered by your insurance company", I think this helps to reinforce that the contract is between the client and their insurance compnay, not between us and the insurer to sort out.

Re: Direct Claims

Stephen Courtney — Tue, 04 Oct 2011 20:51:56 GMT

I think ultimately a good client with insurance is valuable to the practice. they need to be cherished, and for every slimeball who cons you, there will be a lot of others who are honest and appreciative and sing your praises.

I do what i have to to get a good night's sleep!

Re: Direct Claims

Utlendigur — Tue, 04 Oct 2011 14:35:08 GMT

[quote user="Stephen Courtney"]the biggest problems i get are when a client has paid as they go then run out of cash - what do you do[/quote]

I'd generally send in two claim forms - one payable to the client for the dates when they paid us, and then a second "continuation" payable to us for the remainder of the treatment. Sometimes it's also if a problem seems minor initially so the client pays as usual, then the animal turns out to need expensive treatment. The last one was a dog with mild lameness which worsened - client paid for initial consults, nsaids and xray, but couldn't afford to pay for the cruciate op that it subsequently needed. Seems to work so far....

Re: Direct Claims

Stephen Courtney — Tue, 04 Oct 2011 13:48:20 GMT

We don't do direct claims happily, the official line is No, but of course we will do themif a claim is going to be large or in special circumstances eg cash flow issues. I have a branch in a working class area, with a high uptake of insurance, and I feel very uneasy refusing direct claims when i know people have taken out policies for just the eventuality they are facing.If the client is known to me in my own little branch where i have some discretion, I'm happy to do the claims direct, but at our main hospital we usually require pre-authorisation. But these can be for major ops and investigations, rather than simple things i take care of in my little branch.

Generally I ask the client to show me their insurance documents, and to call their insurer, give them authority to discuss their policy with me, and i will phone and ask about the policy - is it valid, any exclusions, any limits on the policy and any time constraints that may apply. Usually they won't admit liability and promise a condition is covered unless you do a formal preauthorisation which takes time.

I also make it clear that it is their insurance policy, not mine, and if there are any problems with payment they will have to find the money. Of course we have been stung from time to time, memorably in the odd circumstance, and this is bad for all the honest clients we have.

the biggest problems i get are when a client has paid as they go then run out of cash - what do you do, claim directly and refund them, or trust the client to pay us when their cheque comes in? I've only once had a client spend the money instead of paying us ( at my branch) but I did have a client pass away once, leaving a large claim in limbo - which was subsequently declined anyway...never saw a penny from that one

On the whole I think you have to judge each case as it comes in, and make the decision that best fits the situation and your own conscience.

Re: Direct Claims

Bob Russell — Tue, 04 Oct 2011 12:18:23 GMT

[quote user="Mark Rowland"]

Thanks

What is your protocol then when a claim is refused?

[/quote]

I get progressively more pushy with the insurance company until we come to an agreement or we find out who is most bloody-minded. At the moment we have withdrawn all Pet Plan literature and ceased issuing cover notes until they have sorted out what I consider is a perfectly fair claim for dental treatment.

I had recorded 'worsening gingivitis' in the consultation prior to the procedure. The procedure was carried out to treat a medical problem and this should be covered by the type of policy the owner took out. A mild condition that was worsening seems a fairly good reason to intervene!

We do not send in claims that we consider dubious in any way so when I submit a claim I do rather expect it to be paid unless there is some sort of exclusion on the policy that I am unaware of!

Re: Direct Claims

Mark Rowland — Tue, 04 Oct 2011 11:04:08 GMT

Thanks

What is your protocol then when a claim is refused?

Re: Direct Claims

Hannah Wynne Richards — Tue, 04 Oct 2011 10:45:50 GMT

I do them It means a delay in payment but at least I'm allowed to treat by the book, instead of having to fit treatment to owners budgets-which I hate

Wynne