Maybe you’re not aware of this but some vets are scared of pet insurance. All that paperwork, red tape and the fear of something even more sinister: the specter of managed care that lurks behind every policy.
Me? I’m not so worried that one day how I practice will be altered by my patients’ policies. I’m more worried that my cases won’t get the benefit of the care I can provide. The way I see it, I’d rather risk losing out on the “old ways” of veterinary practice, especially if it means that fewer patients will forgo the therapies available to them.
Case in point: The number five. That’s how many knee injuries I’ve seen forgo the specialist this month. It’s understandable. $2,500 is just too much money for the average American family to fork over to a surgeon in this withering economy.
Yet after working on one special case over the course of the last week I had cause to consider that number in a more positive light. $2,500 is what it’s going to cost to bring off one dog’s strange neuter scenario (yes, as in castration). And without insurance it wouldn’t have happened. Here’s the unlikely story:
A two year-old Dane comes in with a huge, swollen scrotum (I mean ginormous!). This thing’s in the melon family by the time I behold it.
It had started to swell overnight but his owners decided to wait to see their regular vet (us) instead of surrendering their dog’s care to the unknown emergency hospital. Needless to say, they awoke to wish they hadn’t waited.
Because 150 pounds of Great Dane in the prime of his life is not worth messing around with—especially if he’s painful, scared and deaf, to boot—we sedated him with a micro-dose of medetomidine (Domitor) delivered along with a pain-relieving dose of buprenorphine. Immediately afterward we flicked in our biggest IV catheter and called in a specialist for an ultrasound look-see.
Feverish and still somewhat uncomfortable, but quiet now, this Dane settled in for a gentle ultrasound probing of a scrotum accompanied by several “oh my God’s” on the part of the board-certified internist we use for procedures like this.
“I’m a little out of my depth,” he demurred, explaining that this was NOT his usual case, “but I’ll give it a go.”
Indeed, I don’t know who wouldn’t feel a bit cowed by this monster scrotum. But by this time I was no longer so impressed as the males in the room seemed to be. I mean, the damn thing wasn’t going to explode, much though it appeared to threaten otherwise. I was more anxious to rule out some of the more life-threatening conditions likely to afflict a young, intact male dog’s testes.
My biggest fear was the possibility that one of the testicles had become twisted, a painful emergency condition that leads to a lack of blood supply to the gonad and always necessitates emergency surgery (called "testicular torsion").
Thankfully, the ultrasound confirmed normal testicles in the house. Instead, several huge pockets of fluid dotted the landscape, interspersed with severe swelling of the tissues in between. Poking them with a sterile needle, we discovered rivers of bloody pus in every one. I don’t think I’ve ever been so pleased to diagnose abscesses (likely arising from deep pustules many dogs will harbor on the surface of their scrotums).
Seeing the writing on the wall, the owners had asked me to simply neuter him and get the whole thing over with. Yeah, right. That’s exactly what I need right now—a feverish, unstable patient under the knife at the exact time that his scrotum boasts more blood vessels than a bull elephant’s. No thank you…not unless you really want to risk his life and the success of the procedure.
Instead, I fully anesthetized him to drain each zone in a painstaking procedure that involved placing drains at the site of each of many abscesses. Yes, gross—but immensely rewarding, nonetheless.
My patient was going to be fine. Though his labwork was reflective of a severe infection, appropriate antibiotics (I’d cultured the sites, of course) virtually promised eventual success. In the end, he went home a couple of days later feeling much better, his condition now downgraded from melon to citrus.
A week later, if all goes well, he’ll come in for the neuter he requires to complete the cure. Ultimately, the condition that created the abscesses will persist. Therefore, a special variety of the standard castration procedure called a scrotal ablation is planned. In this surgical approach the whole scrotum is removed along with the testicles, leaving a sizable incision in a dog this large.
It’s not my favorite surgery but it’s one I can handle well. No need to see the boarded surgeon for this one. Ultimately, this dog will go from A to Z without having to leave the hospital for more expensive, specialized care—thanks to my friend the traveling internist and his trusty ultrasound technique.
Nonetheless the bill won’t be a small one. Before all’s said and done this strange case will end up costing the owner about $2,500. Well, actually, it’ll end up costing the owner about $500 once the insurance company’s paid their fair share. And that’s the real point of this post.
Sure, in the end it’s just a neuter (usually valued at just over one-tenth of this price in a dog so large), but it’s a rare neuter indeed that makes for an exciting emergency like this one. I know I’ve never seen a case like this Dane’s (nor have my in-hospital colleagues, despite their eighty years of combined experience). And that’s when insurance works best—for treating the unforeseen conditions our animal patients will occasionally manifest in ways that make routine care seem cheap by comparison.
When vets balk at the concept of insurance I have many cases like this to point to. After all, where would this patient be without it? He’d either have undergone risky surgery that could have led to sepsis (a whole body infection) and death or he’d have seen the business end of a syringe loaded with pink poison. That’s no choice. Not when we can do so much better.
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Thank you for waiting and stabilizing the patient rather than going ahead with the neuter. I know it might seem like a no-brainer to you, but not all vets are as careful, and if asked by the owners to just go ahead with it, some might have.
On the topic of insurance, your example is a good one. But most financial advisers tell us owners that we are better off putting money aside on a regular basis than buying into insurance -- I've never head a bona fide financial analyst/advisor say otherwise, have you? Of course that begs the very obvious question -- yeh, but most people DON'T set money aside regularly (myself included -- I'm still in crisis mode from years of critically ill pets one after the other). After I get out of this hole, I plan to start such a savings regimen for future problems (my cats are all 8 years old now, it won't be long till bad stuff starts happening). But my primary concern is not the unforeseen emergency, but rather old-age chronic diseases, and I doubt most insurance plans are very generous on that score. Am I wrong?
Stefani September 1st, 2008 10:32:00 AM
You know, Stefani. I used to recommend that approach. The problem is that most of us truly need to do both: save and keep insurance. Financial advisers are working on information five to more years old when they recommend this. Many of them base their recommendation on a 5-plus year-old Consumer Reports study that I believe was flawed in its design and focus (i.e., saving money). Pet insurance is NOT for saving money. It's paying for peace of mind should the worst occur.
The problem is that medical treatment for the worst is now much more available and doable--which means that the average pet owner will be offered choices they never before had access to. Radiation, chemotherapy, more appropriate (safer) management of surgical cases like this one. The high end of vet medicine is more available--but it's not getting any cheaper. THAT's why insurance is becoming more of an imperative.
If I see one more dog with a knee that needs repair this month (and can't afford surgery) I think I'm going to scream. How long would it take you to save for $2500? Can a saving's plan really cut it in the face of those kind of expenses?
Dr. Patty Khuly September 1st, 2008 10:43:00 AM
That's a scary situation. Poor dog!
We're getting the chance to see if our pet insurance does its job this week. It seems Lilly tangled with a rattlesnake Saturday night ... 24-hours at the emergency/critical care hospital to the tune of about $1,000 later, she's home ... still somewhat swollen, still feeling a bit cruddy. But, she seems to be on the mend.
When we first saw the fat lip, we assumed bee sting, but an hour later, when the swelling had more than quadrupled ... off we went to the ER ... on a Saturday night ... on a holiday weekend.
The swelling moved up her face and down her neck, and I was terrified she wasn't going to be able to breathe.
Based on blood tests, it looks like it might have been a dry bite or a very low venom one, so we're lucky ... especially since there is virtually NO anti-venom in CO right now.
It's NOT how I hoped to spend the last weekend of summer, but I'm beyond grateful she's going to be OK.
Roxanne September 1st, 2008 11:48:00 AM
For those of us who can't save... how are we supposed to find the money for pet insurance? I can't even pay for my own right now.
Perhaps a new job soon will help me start putting that emergency money away (here's hoping). But pet insurance comes with the same pitfalls that human insurance does. What if my cat has another urinary blockage? Insurance wouldn't cover a cent as his crystals are a pre-existing condition. What if my sister's vomity, farty cat suddenly develops a disease of the digestive tract? An insurance company could easily claim his sensitive tummy was indicative of pre-existing problems (even if vets have found nothing) and deny coverage. If I don't have money one month and the coverage lapses, my pets may get sick and I won't get a dime. Why risk throwing my money down the toilet when I can save on my own schedule, when funds are available, instead?
Nena September 1st, 2008 02:50:00 PM
Pet insurance for my 5 (3 relatively young cats and 2 Labs who are 6 and 9 years) would be prohibitively expensive, and exclude hip issues (both dogs have dysplasia of varying degrees). For years, I've been putting $50-75 per month (insurance quote was $80-90 per month for all 5)into my money-market "pet account", which tends to have a balance of between $10,000 and $15,000. I figure in most cases, that should cover whatever unexpected expenses they might incur, unless they all had simultaneous catastrophes. It may not be for everyone, but works for me.
Shellie September 1st, 2008 03:38:00 PM
@Nena: I don't agree, pet insurance does not come with the same pitflals as human medicine. In human health insurance obtained through a group, coverage for pre-existing conditions exists. Pet health insurance on the other hand is much more like individual health insurance where pre-existing conditions are excluded. Also whereas health insurance for an individual can cost $200 - 500 per month, pet insurance is around $25 - 30 per month, roughly 10 times cheaper.
The posts on your cat's urinary blockage, your sister's farty cat, and Shellie's Labs with hip dysplasia all point out a major shortcoming of pet insurance: it doesn't cover pre-existing conditions. However this should not surprise anyone: you can't get home insurance after your house has burned down or been flooded either. If insurance companies covered pre-existing conditions then there'd be no need for insurance. True insurance is for unexpected events only.
Pet insurance has a place alongside dedicated savings accounts and credit cards but it requires planning. The best time to get pet insurance is when your pet is young (ideally no older than 5) and healthy. Older pets usually have pre-existing conditions of one kind or another and this can lead to a poor experience when claiming. You can always request the pet insurance company review your pet's health history prior to signing up. We do it quite a lot and it gives peace of mind to know exactly what might be excluded up front, if anything.
Pet insurance companies also vary widely in how they handle pre-existing conditions that are curable (like broken limbs and prior episodes of UTI). Always get an answer in writing before you sign up - any reputable company will gladly do this for you.
@Shellie: You look like you're on a solid path with your savings account. Patty's comment from 10:43AM asks a question to which you already have an answer: how long would it take you to save $2,500? You've already got money in the bank and in your case you could contemplate a high-deductible pet insurance plan (say, with a $500 or $1,000 deductible, comapnies like Embrace, Trupanion, and Purinacare offer them) that would be very cheap and would kick in to protect your nest egg. Unfortunately as you point out your Labs' hips would not be covered.
Alex September 1st, 2008 07:31:00 PM
This question is for Alex.
So, Alex, question:
Hypothetical.
Let's say that tomorrow I iinsured my 3 female, 8-year old cats with your company.
2 of these cats were born into a colony with herpes virus, and have viral flareups (URIs) periodically.
Other than that, there have been no major health issues.
If I were to insure them, and say in 4 years, one gets diabetes, another gets cancer, and the third goes into CRF (wow, that would suck) . . .
Would the policy pay for frequent visits for the diabetes, insulin, test strips, etc? And if the cat went into diabetic ketoacidosis, would it pay for the 3+ day ER hospitalization?
And would it pay for cancer kitty's ultrasound, surgery and chemo?
And kidney kitty's subqs and frequent bloodwork and urine?
I'm clear on no coverage for URIs on the herpes kitties. But my biggest concern is not the very occasional large outlay -- like surgery to remove a foreign body that was ingested, which I gather your policy would pay for. I'm more concerned about the chronic diseases of old age that make maintaining the pets life expensive in a very routine and relentless way.
In one case, you have a several thou outlay once.
In the latter, you are spending hundreds and hundreds each month and thousands other months, so that over time, we are into double-digit thousands.
Stefani September 1st, 2008 08:48:00 PM
I've noticed on the last couple of clinic visits, seeing pet insurance brochures. If I were starting out with a couple of young pets, w/o pre-existing conditions, I think I would compare companies and choose a plan, for catastrophic events---not necessarily a wellness plan.
And I can't help wondering as a side note, if clinics promoting insurance, just may be governed a bit, as in human care, for prevention of fraud & abuse. Are pet insurance companies ready to tackle that aspect, as private & Medicare insurance companies look into "red flags" such as unusual, excessive charges or double billings?
Barbara A. Albright/New Hampshire September 1st, 2008 10:32:00 PM
As a financial advisor, I was not aware that financial advisors generally recoemmend against pet insurance, and doubt that is the case. I read lots of comments bemoaning the ineffectiveness of pet insurance, and advocating instead for savings accounts, but I doubt a quality financial advisor would make such a generalized, uninformed comment. Obviously, insurance and savings accounts are two different things. Insurance should be for expenses one could not, or would not want to, cover out of savings.
Dr. Kuhly, it would be helpful if you could disclose the insurance policy covering this case. I doubt it would be well covered by the oldest and most prolific pet insurer.
Petinsurancereview.com is a good place to start to learn about pet insurance from a factual perspective, rather than from the bland perspective that all pet insurance is overly expensive and restrictive.
Erich Riesenberg September 2nd, 2008 06:55:00 AM
Stefani - Your point about chronic conditions is well taken, they can be nightmarish. There are really two things going on in the scenario you outlined: the first is whether the pet insurance plan would consider the herpes to be a primary contributing factor to any of the subsequent chronic illnesses you list, the second is whether there is chronic condition coverage would pay.
It is my opinion that the biggest differences between pet insurance plans are largely invisible to the majority of pet parents because what the plan says and how a claim is handled are often dissociated. In other words, you're sold the promise, you get the reality afterwards. Thus when it comes to pre-existing conditions, some companies will find any reason under the sun to deny a claim by linking it to a prior condition that even a non-DVM would find incredulous (contact us for examples). We actively avoid doing this.
The upside to this is that most plans (with an exception or two) cover chronic conditions. But having to fight with a pet insurance company to prove that herpes virus is not the causative agent of subsequent chronic diabetes is not anyone's idea of a good time.
I don't mean to sound like a broken record but I'll say it again: until the pet insurance industry learns to follow through on the promises it makes and earn your trust, get everything in writing. And as one of the other posters here mentioned, visit PetInsuranceReview.com - other companies might decry their low scores but they've sure earned them.
I hope this helps!
Alex September 2nd, 2008 08:28:00 AM
@Barbara - You raise a good point when talking about fraud. Believe it or not, we are finding the majority of fraud is related to pre-existing conditions, although my use of the word fraud in this case does not necessarily imply deliberate, for I do think that pet parents often just think that something that's been diagnosed will be covered.
For example, we've had a number of claims for hip dysplasia where the medical records clearly indicated that, prior to enrollment, the vet suspected hip laxity and wrote it down. Then the pet parent goes and gets a policy expecting that it will cover their pet's newly diagnosed orthopedic problem that costs $2,000+ to fix. We get a claim and the pet parent is upset when it's quickly denied.
We have had some cases where medical records (typically a date) were altered by the pet parent. And we've had a couple of cases where charges were over the top (being charged $600+ for a $40 medicine). But we have never yet, despite thousands of claims, had need to question the charges for a veterinarian's services.
Many vets have told me that they receive requests to insert a certain diagnosis code for claims lodged with VPI. Fortunately for everybody they reject such requests.
Because pet insurance in this country does not really have a third-party payment system as human health insurance has, companies that handle claims are eating their own cooking, so to speak, and there have not been any problems I'm aware of with duplicate claims, certainly not from our perspective.
Alex September 2nd, 2008 08:41:00 AM
I followed the 'put aside' advice and now have a $5000 pillow on top of whatever the credit card would allow. I did another round of the insurance offerings at the AVMA convention and have yet to see one that offers more than my than my Dog CD in terms of fees, caps and exemptions (e.g. doesn't cover breed-specific disease, really? Doesn't pay up front etc). If there really has been a dramatic shift in offerings I still haven't quite got the message,
emily September 2nd, 2008 09:11:00 AM
Emily: Plans that cover breed-specific conditions are Embrace, Petplan, Purinacare, and Trupanion )although I believe with Trupanion you need an endorsement for hip dysplasia coverage).
So long as your pet is not exhibiting symptoms of or was not diagnosed with a breed-specific condition prior to enrolling, you're in good shape. But please do confirm with the other plans, I can't speak directly for them.
Alex September 2nd, 2008 10:48:00 AM
Patty,
That is a crazy story! Thanks for NOT providing video... I'm sure you've seen some of the unusual claims we've received recently. Truly bizarre. Even so, people continue to tell us that their pets don't need health insurance because they're young or they've had a history of good health. Insurance or not, I think everyone should know by now that some sort of plan (savings, credit card, all of the above) has to be place for the unexpected.
Grant at VPI September 2nd, 2008 06:21:00 PM
Apart from the insurance issue, this case points up another item - that being that many pet owners, including myself, do not like going to a strange emergency vet clinic when they have an emergency.
I'm fortunate to live in a small town where my vet does his own emergency calls. Sure I pay an extra charge for afte-hours, but I am able to see the vet I know and trust, and that has seen my animal before & has their history in his files.
To me it's not the difference in cost but the fact that I see my own trusted vet in an emergency.
Mary September 3rd, 2008 01:26:00 AM
Mary, you are very wise to hold that feeling. No doubt I learned that in the most horrific way. I have been left in the lurch with 3 departing vets in a 30 year time frame, and it is scary to say the least.
Offering 24 hour emergency service is somewhat of a safeguard, being able to look personell in the eye following any suggestion of diagnostics or treatment.
No doubt, promoting pet insurance, may also be interpreted as a safeguard, though perhaps unintentional. I highly doubt insurance would cover the fraud and abuse that my own Scottie "Pocket" endured in this non-consumer friendly state of New Hampshire
Barbara A. Albright/New Hampshire September 3rd, 2008 09:54:00 AM
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