Last week our hospital received a terse letter from a client complaining about her $600 dentistry bill. “Outrageous,” she wrote. The owner had left in a rush without picking up her estimate, waving it off with an “I’m sure anything you need to be done will be fine with me. I trust you.”
So much for trust. Our fault, of course, for allowing her the privilege of running away without an estimate. But still…
The charges included full mouth dental X-rays, IV catheter, fluids, continuous EKG, eight extractions, 90 minutes of anesthesia, pain relievers and antibiotics. Did I mention eight extractions? With gum flap surgeries on most of them?
My colleague, one of the two practice owners, had been the one to receive the complaint against him. He took it well. He handled the issue by sending a friendly-toned, 500-word letter explaining the services provided in detail along with the price list for our local dentistry practice so the disgruntled owner could compare our prices with theirs.
Ours was 1/3 the price of the dentist’s—without adding in any of the incidental costs such as anesthetics, monitoring and other drugs.
So there.
This situation was not dissimilar to a New York City-residing family member’s. His two dogs had been seen by his regular vet for routine, six-month tick titers (his dogs hike the nearby woods every week). The upshot? $1200. Really. He showed me the bill. The bloodwork was $800 of it.
I’d never seen such a thing. The invoice was a shock to me. $200 exam fees and $400 of bloodwork on each dog? “Omigod!” I said. “And you pay this much regularly?”
Apparently.
Granted, this is a Manhattan vet in a fancy neighborhood. But for that price it seemed to me he could have taken his dog anywhere else and seen a 50% reduction in prices. I had no idea anyone would charge that much. That anyone would pay so much.
“So I’m getting ripped off?” he asked. I swallowed hard and explained I didn’t have any experience with NYC prices but that the same work at my place would’ve run him $200 tops—for both dogs. And I probably wouldn’t have charged an exam fee for simple six-month bloodwork. After all, his dogs weren’t examined. It seems the exam fee is part of every visit for his dogs, regardless of whether they’re actually examined or not.
Ouch! I’d never even heard of a $200 exam fee.
Recently, we’ve been re-thinking our prices at the place that I work. It’s a forty year-old hospital with great doctors (I think), low staff turnover and excellent equipment. But our basic costs are rising so rapidly that we’re having trouble staying solvent. Nonetheless, we have a healthy clientele that reflects forty years of wonderful care.
We’re proud of the fact that we offer our clients value, above all. We’re proud that we’re fair with our clients and work with them so that when they hit hard times their pets still get the care they need.
Unfortunately, that also means we carry a lot of clients who haven’t been able to pay us back. We barter with clients so that their dog’s heartworm treatment means five auto details instead of $500. But that don’t pay the bills. Still, we do it because it’s the right thing to do.
Other hospitals take our position, too. I know this because even the specialty hospital across the street prices itself so that clients can still afford their care. A typical back surgery (disc decompression) there costs $3,500. The specialists in the neighboring county charge $6,000. A cat scan across the street costs $750—nuts to bolts. The other place? $2,800. (I know because my Frenchie, Sophie Sue, had one there. I had no idea the price differential would be so high.)
Taking care of clients is so basic. But at what cost? As we struggle to deal with our receivables (I haven’t yet been paid for about $3,000 of work I did last month) and help our clients out, it somehow hurts to see that clients will pay more when they assume they should…when they don’t know the difference.
Perusing the invoice my relative presented me, examining dentist’s price list, hearing clients complain about our prices, I can’t help contemplating the inequity. I’m only human.
Add Comment57 Comments
Surprisingly, that's about what I would expect to pay at MY vet's... and he's the lowest price around. Old, country vet running a state of the art clinic, but with enough clientele that he can keep the prices low.
Basic dental runs about $300 - other clinics around here run $700-1000. So for what your client received and what you charged her... quite frankly I think it was YOU who got robbed.. and it's not often I side with the vet on account of the bill, particularly in regards to dentistry (I know soooo many people who have walked out with $1500-2000 bills for what accounts to nothing... the upcharges are because the dogs are so old - the procedures amounted only to scaling, no extractions, and the dogs were well above the age that I would have put them through GA for such a procedure, opting instead for a product like LebaIII or something like it.) So I'm a bit touchy about dentals, and generally steer people towards my guy.
This woman is just a case of buyer's remorse. It's easy to say "do whatever is best for Fifi!!!" and another to have to open your wallet. ;O)
You will always have clients like this, and it's HER problem for not reading the estimate that you RIGHTLY provided her. Maybe SHE has learned her lesson... read the paperwork.
Kim December 17th, 2008 11:48:16 AM
I hear you loud and clear.
My husband and I are lawyers and we really bend over backwards to help clients who don't have $20,000 in the bank to put in our retainer account. Our hourly fees are comparitively low and we try to keep costs down. But all too often we get bitten in the butt. The client who insists on spending hours talking about the same thing over and over every day is the one who is shocked when he gets his bill, and then doesn't pay it. We work out payment plans and people disappear. In the meantime, we have to pay the bills for the out of pocket costs and our overhead. It makes you bitter after awhile.
Susan December 17th, 2008 11:50:06 AM
The only thing I can think about the Manhattan vet's prices that your family member pays is that the overhead there must be absolutely astronomical. Think about it - this is an area where people pay 2,000 or 3,000 or more per month to live in a studio apartment that is 200 or 300 sq. ft.
It's still a ripoff - especially in the sense of paying a full office fee/exam fee every time you walk in the door whether you get an exam or not - but they probably have to do that to stay solvent.
I love Manhattan, but I'm SURE glad I don't live there!!
Barb December 17th, 2008 12:09:31 PM
With vet care, quality and price are not always correlated. See vet prices in the Washington DC metro area (PDF) at >> http://www.terrierman.com/dcvets.pdf If you fail to shop, you shop to fail. Patrick
PBurns December 17th, 2008 12:14:22 PM
Just to compare, my current dog's last dental was about $800 (I can't remember if it was $795 or $895). I didn't ask how much it would be, nor did I really care. But I remember wondering how "regular folks" can afford those kinds of fees. (I guess they just don't get dentals, or they save-up for 'em.)
Marjorie December 17th, 2008 12:40:53 PM
The clinic I work at has a very strict policy of always drawing up estimates on paper and having them signed if a pet is dropped off. If diagnostics are considered in the exam room, same thing - our computer system allows anyone to easily search for and add diagnostics or diagnostic packages and then click over to the client's invoice to see total cost. We do accept verbal authorization over the phone or in person if someone has discussed the estimate and the cost directly with the owner. So, we figure we usually have our bases covered. Nope - not always! I swear, we get people calling every week demanding to speak with the office manager so they can rant about how unfair the prices were - AFTER THEY SIGNED THE ESTIMATE! For what it's worth, a "standard" dental at our practice is $220 - this includes an exam, preanesthetic CBC/chem12, i.v. catheter and fluids during, premedicants and propofol/sevofluorane anesthetic, continuous ECG/pulse ox/blood pressure/temperature/CO2 monitoring, ultrasonic scaling w/hand tools where needed, polishing, a topical fluoride gel, a ketoprofen injection (for gum sensitivity), cefazolin or ampicillin IV, and recovery care...! I think it's pretty reasonable. Extractions, extra pain medication, extra antibiotics to go home, suture or sterile instruments used for extractions, etc., are all obviously extra. So, while I'd wince, if my pet needed EIGHT extractions w/gum flap surgeries (and I've seen how long those can take), I wouldn't consider that cost unfair, and that's probably what they would end up paying at my practice, too, with dental radiographs (which we don't really perform that much, unfortunately).
anna December 17th, 2008 01:43:01 PM
My fifteen-year-old cat's dental earlier this year, with a mere two extractions, was just shy of $600, including pre-op bloodwork. This was painful, but not a surprise, because they just won't do procedures without a signature on the estimate/agreement to pay. I cannot imagine that your client had any realistic basis for complaint, with EIGHT extractions.
Lis December 17th, 2008 03:54:42 PM
I think my cats' last dentals each cost somewhere in the $175 range.. but they were uncomplicated (no extractions) and relatively quick (particularly- and intentionally- in the case of the cat with HCM). In-house preanesthetic bloodwork was performed on both cats pre-dental, and this is included in the cost.
I probably could have been charged an extraction fee for HCM kitty, as he kind of did have one taken out ... but they didn't charge me for it because the tooth was so loose, it fell out mid-dental. (This would be *why* HCM kitty was subjected to said dental. They also neglected to charge for the additional fluids and such the other cat received to safeguard his kidneys (thank you, Menu Foods!).. but, even if they had, the dentals still would have been astronomically cheaper than some of the other local clinics'. Same protocols and everything.
I suspect the difference usually boils down, in large part, to operating costs. There is a hospital I'm familiar with in a considerably wealthier locale nearby. Their expenses are horrendous, and their client base is much smaller, in part because they chose a relatively out-of-the way location located in the general vicinity of another much more advantageously positioned clinic. You could easily drop $700+ on a dental there, and you're not getting anything extra for that additional $4-500.
Whenever I encounter people lamenting their ability to foot their veterinary bills (particularly elderly persons on a fixed income who may be forgoing some of their own much needed medical care in order to fund their pets') I always suggest shopping around, particularly if they're using a clinic in a pricey area. There is an enormous amount of variability out here, and sometimes just driving a few extra miles could easily save you thousands- without compromising your pets' well-being.
It's also sad how many lower-income individuals intentionally go out of their way to patronize some of the pricey clinics, on the assumption that simply because they're more costly, they must be delivering a higher standard of care. Alas, this is not always true. I've encountered exceptional (and pretty abysmal) veterinary care throughout the spectrum... (and, incidentally, the most talented, thorough, compassionate professional I've ever encountered easily ranks among the most affordable).
Ramen Connoisseur December 17th, 2008 04:22:44 PM
I'd just like to add: $600 for a 90-minute procedure including x-rays, meds, IV catheterization, and all that good stuff = no basis for complaint in my book. Nada.
Not sure about where you're located, but that's probably fairly standard around here.. unless you have it done at the specialty practice, in which case, you could easily drop $1K+.
She should have bothered to read the estimate before okaying the dental.
Ramen Connoisseur December 17th, 2008 04:51:04 PM
Wow. That's not too much. Mine had pretty much the same drill with far fewer extractions (1 or 2 for each of two cats) and the bill was about $500 ea. So you are inline with that if not cheaper.
OK, so my vet uses licensed techs, though, and I think you don't, right? I'm not going to complain if some of the extra is associated with that because I am a stickler now for licensed techs.
Stefani December 17th, 2008 06:34:13 PM
Oh, and PS . . . I'll add two perhaps seemingly contradictory comments.
When it comes to vet care, so many owners just assume that if their neighbor or friend says they got it for less, they paid too much. Too willing to switch vets on price alone. I almost always assume that low price = many things NOT being done that I'd want. Although I don't believe the converse is necessarily true (high price = good care), I think it's almost impossible for low price to equal good care when it comes to more than the basics. I never look at price alone. But then -- I've been burned so I have learned something about quality.
On the other hand, in spite of the fact that I go out of my way to go to a vet that uses licensed techs, intubates, monitors, uses pain control, explains her anesthetic protocol, does x-rays if needed (all that for dentals), I still don't think you can reasonably or rationally compare the cost+services of a veterinarian to the cost+services for a dental facility without proving first that all things are equivalent.
For one thing, dental hygenists have to have specified training don't they? And even though I insist on LVTs, lots of vets don't have them. When you've got unlicensed staff without credentials assisting, you can't compare that to a human medicine/dentistry situation. Also, what training and special certification is required for dentists that practice "sedation dentistry" or perform major extractions (like wisdom teeth) -- don't they have to have an anesthesiologist on staff? Or special training in this?
Isn't the equipment (for those bite-wing xrays and stuff) in a human dental setting more complex and expensive?
So I'm saying, the lower costs may be appropriate for all those reasons.
Stefani December 17th, 2008 06:45:20 PM
The owner had left in a rush without picking up her estimate, waving it off with an “I’m sure anything you need to be done will be fine with me. I trust you.”
Sorry, but she pretty much waived her whining perogative from where I'm sitting.
I admire how your colleague handled it. I'm no vet, but if I were one, I'd have been tempted to reply to her with my above comment. Perhaps not the most professional response in the world, but I'd have been darn tempted.
I trust my vet. But that doesn't mean I'm going to run off without an estimate, or knowing what the plan is. If I EVER told her to just do whatever, I'm sure whatever she wanted to do would be fine, then I certainly wouldn't complain after the fact. Wouldn't be her fault if I'm in too much of a rush to deal with it.
Michigan Pet Lover December 17th, 2008 07:36:38 PM
my vet just charged me $36 for a followup visit on a minor condition; he spent at most 2 minutes examining my dog. The first visit he had charged me $42 for an "exam" consisting of nothing that I could see, as well as the charges for the actual procedure and meds.
EmilyS December 17th, 2008 08:09:57 PM
To make you feel a bit better, the standard exam fee at my vet's is $165. Nothing is included in the cost of the exams, we're even charged for blood draws separately from the bloodwork. I hate to say it, but one of the reasons that I finally settled on this practice is because I have four dogs, and their costs are significantly lower than the other vets in town. (Other reasons are that they use licensed vet techs, and that I really like the rescue/volunteer work that the practice owners avidly support.) But then, I live in Alaska and nearly all costs are inflated here, due to the cost of living. Sadly, my paycheck is decidedly uninflated.
I think that your practice is absolutely in the right here, and I wouldn't feel a bit guilty about your policies nor your prices. In fact, if anything, I'd say that perhaps you need to research your market and find out if you're undervaluing your services.
Erin December 17th, 2008 08:19:43 PM
WOW!!!! I always thought I had a good thing with my vet; now I'm absolutely certain. Granted, this is suburban/semi-rural western PA; not L.A., Manhattan, or Miami. I go to a 4-vet practice with a new, state-of-the-art facility. The techs are licensed, but they do have some "veterinary assistants" who are not. Yesterday, my 9 year-old Lab Sadie had a mass removed from her right hip/thigh area, and a needed dental while under anesthesia. (The mass turned out to be a large sebaceous cyst/abscess, but a tumor was suspected initially, and it wasn't known how extensive the surgery would be; had it been very involved the dental would have been postponed until a later date. Also, despite the send-out biopsy tissue sample, both the vet who did the surgery and another vet in the practice examined a slide in-house, for which there was no additional charge; it was included in the surgery fee. And, the bill I received afterward was actually about $150 LESS than the estimate I signed when I dropped my dog off in the morning, since the surgery turned out to be less involved than expected!
Here is the itemized bill I received when I picked her up last night:
Pre-anesthesia lab panel $ 42.00
Chest x-ray $ 60.00
Atropine injection $ 12.00
Penicillin injection $ 12.00
Anesthesia-isoflurane (extra large) $ 47.00
Anesthesia IV (large) $ 30.00
Ultrasonic dental cleaning $ 37.00
Tooth polishing $ 20.00
IV catheter 18g x 1-1/4" $ 5.00
IV set/tubing $ 10.00
IV fluids $ 10.00
Surgery--removal mass right leg $ 160.00
Pathology--send-out to XYZ Lab $ 95.00
_______________________________ ________
My total bill $ 540.00After reading the above comments, your client certainly has no cause to complain about the cost of your services. I would gladly pay whatever it takes to keep my animals healthy. I'm just glad that I don't have to pay big-city prices here!
Shellie December 17th, 2008 11:46:11 PM
The above post was originally set up in nice, neat columns....don't know what happened there.
Shellie December 17th, 2008 11:48:52 PM
Dang! Anna and Shellie, I wanna know where you live! While I work at a good vet's and get a discount (so price would be mostly in line with yours), there are a lot of vets in Cleveland who charge a lot more (and some give less care). Sometimes it's really hard to deal with clients foregoing dentals because of price (and very often those "I'm-afraid-he'll-die-under-anesthesia" fears), when their pet has a mouthful of problems that aren't going to get better without help, and that our prices are less than many other places, with decent care and concern for the pet.
KateH December 18th, 2008 09:56:00 AM
The dental charge seems perfectly reasonable to me. One of my cat has dentals every 6-9 months (chronic dental/gum problems) and the basic cost is around $200 for pretests, cleaning & pain medication. The one X-ray they took last time was about $50 and the extractions run from about $25 to $45 depending on whether they are simple or not. So the average total runs me around $300-$350. I thought this was high - but considering I live in Chicago, I think I have a real bargain.
2CatMom December 18th, 2008 10:52:58 AM
KateH - you could definitely find a Banfield in Cleveland, OH! :)
anna December 18th, 2008 10:02:16 PM
There seems to be a overflow of passive / aggressive behavior going on. It's not limited to vets though, it's everywhere. I'm not sure if it's because of the economy, the upcoming holidays, people tipping the bottle to much or what but whatever it is, I don't see it going away anytime soon. I'd say don't take this client's nonsense seriously. If she can't be bothered to atleast look at a estimate and ask questions regarding her possible upcoming bill, she can take a big girl pill and deal with it.
Stacy December 19th, 2008 07:16:23 AM
For the most part, I am pleased with the services of my vet. The one thing I find disconcerting is that I am not offered an estimate - verbal or written. I have had to request an estimate for the past 2 procedures performed by the vet. The staff acts mildly put out that I request an estimate. I have been told that I will have to call or come back because the vet will have to write something up for me. It would seem that an estimate would be standard procedure, especially for surgeries. I have no way of knowing if I will have to pay $100 or $1000. I would think the vet would want to minimize the above senario as much as possible!
Susan G. December 19th, 2008 09:47:27 PM
Susan: It's pretty standard to offer estimates now. But it's true that some hosptals aren't in the swing of it yet. Their computer programs may not be set up for this?
For my part, I force my clients to wait for the estimate. Or I fax it to them. Or I make sure the receptionist lets them know how much it'll be. Even when clients say, "just doi it, I'll have to pay it anyway, right?" I still make sure they get an estimate one way or another. OK, sometimes I get busy and I let things go in the case of very good clients but it's pretty easy to get into the swing of an estimate every time we hospitalize a case.
Dr. Patty Khuly December 20th, 2008 07:10:44 AM
His two dogs had been seen by his regular vet for routine, six-month tick titers (his dogs hike the nearby woods every week). The upshot? $1200. Really. He showed me the bill. The bloodwork was $800 of it.
A TWELVE HUNDRED DOLLAR bill for bloodwork and a non-exam exam fee?? Both your relative and the dogs should have received some sort of "happy ending" for that price!
Sabrina December 21st, 2008 05:31:10 PM
Wonder what auto mechanics, or plumbers, or electricians charge in the Manhattan area? Still, $1200 sounds crazy to me---an awfully huge markup for the price of real estate.
Pocket's Story from NH December 21st, 2008 08:45:26 PM
Wow - it just goes to show - you gotta shop around. I used the same vet for 20!! years, but one day they quoted me $3000 for a procedure that my dog desperately needed. It was either $3000 or put her down, and when you don't have the money, it's like being stuck between a rock and a hard place. My friend recommended her vet (my new vet, btw) who was a bit of a drive, but much less expensive. He was nice, came highly recommended, and did the procedure for no more than $380.24. A 10th of the original estimate! Why the big difference? I have no idea. Maybe it's the difference in city vet vs. country vet, but my new country vet is well worth the drive. Not only are his prices right, but he takes his time, answers ALL my questions, and his home phone and pager number are listed on the answering machine. Excellent service is still out there...you just have to look for it. I wish I had been smart enough to look years ago!
Heather December 30th, 2008 01:50:57 PM
After my personal experience today, I am DISGUSTED with vets and their blatant price-gauging. I just came back from dropping off my 8 year-old cat at the vet for a dental cleaning. His gums were really red/irritated; no extractions are expected. Wanna know the estimate?? Ready for it...?? $940!! Plus, $74 for a 1 night stay. Disgusted is the only word I have right now. $128 for IV? $208 for head/chest/abdomen xrays? AND $110 for the radiologist's consultation AND, the best part, I was charged $25 for an "office visit" and $25 for "re: check" - Soooo, I was charged $50 for just dropping off the cat, because that's all I did today, drop him off. ALL the fat, money-hungry vet did was open the cat's mouth and look at his gums. 1 second, I kid you not. I live in Queens, about 20 minutes from NYC, so that maybe explains some of the cost difference with a vet, in say, Oregon?? I don't know, I am making myself believe that so that this $1,012 pill goes down easier. CAN SOMEONE PLEASE write me back, letting me know if these charges are average/standard procedure?? PLEASE. thank you.
Ines December 30th, 2008 04:33:39 PM
I too am at a loss. We recently rescued an older dog and he went in for a cleaning with several extractions today. We walked out with a $1000 bill. Yes, ONE THOUSAND. I actually started crying in the lobby because I had no idea how to pay for it and ended up spreading it on several credit cards. Our other dog had several dentals at our previous vet before we moved so I had a number in my head. His last dental at our old vet was around $350 with 8 extractions. (In 2007) Our new vet did not give us a written estimate but she did give us an oral one when we were in for an exam several weeks ago. It seemed in-line with what I paid at our previous vet. I mentally added a bit to the estimate she gave me just to give myself a buffer. But in my wildest dreams I never expected such a bill! And as best I can tell, looking at the itemized bills for Buddy (new senior dog) and Larry (our other dog who has been with us for ten years)... well, the major difference seems to be the "surgeon's fee"... our old vet charged $45 for eight extractions; the new vet charged for 84 minutes of surgical time, to the tune of $400 plus the cleaning itself at $120 plus anesthesia and the various other items.
This will cause tremendous financial burden for our family. (I have my own medical bills for surgery two months ago!) But more than the financial burden, I worry that it will really compromise our ability to provide essential, emergency care for our dogs. I feel like I've been blind-sided and I feel I ought to speak to our vet but am unsure how to address it. Our new dog is elderly and as I said, we rescued him. His teeth were in bad shape and both my husband and I agree that the dental extractions were not really optional. If we had known the cost up front, I am not sure what we would have chosen to do but we would have been able to make that decision with eyes open. We might have put it off a while to save up the money or we might have asked about other options to manage his periodontal condition or we might have applied for care-credit. I don't know. But we weren't given that courtesy. If anyone has advice about how to politely express my distress, please, please let me know! I don't begrudge vets for their fees. I just wish I had been told in advance what to expect.
Nichole January 8th, 2009 10:04:09 PM
Shellie's itemized bill was actually very helpful so I thought I'd add ours:
Pre-surgical blood work 98.00
Torbugesic (Anesthetic) 11.00
Propofol (Anesthetic) 11.00
General Anesthesia, Isolurane 193.00
Ampicillin injection 22.50
Dental Ultrasonic Scaling/ Polishing 118.00
**Surgeons time 392.00
IV Catheter 35.00
Buprenorphine (Analgesic) 11.00
Local anesthetic ? about that? 28.00
2 Dental x-rays 34.00
TOTAL: 953.5
plus meds for home (Rimdadyl & Tramadol) 28.50
plus Clavamox pre and post surgery 150
= $1132 (if I'm doing my math correctly!?)
Now, this is a matter for a different post, but this is almost as much as I've spent at the vet in the TEN years we've had our other dog, Larry. He was expensive, from a very good breeder but he is healthy as a horse and has only needed vaccinations, annual exams and couple of (what now seem very inexpensive) dental cleanings. This makes rescue a very expensive route for adoption.
Nichole January 8th, 2009 10:33:08 PM
I am in a similar spot. Just took my cat to a highly recommended Vet in Brooklyn, NY. Vet and staff was very nice and we had a good visit. Yet the estimate for the dental my cat needs shocked me:
IV/fluids/meds $130
insolflurane/min$2 estm 60 min $120
Dental Scaling and Polishing $95
Fluroid treat / Sbgigival Nerve Block and other meds $130
estractions $35 per tooth
cleaning the gaps $15
full mouth radiograph $200
this adds up to about $700 (could go up to $1000)
I also paid $100 for bloodwork.
I was told that the ASPCA on 92nd is considerably cheaper. Has anyone an idea how much cheaper for such procedure? Has anyone been there?
Reading the above posts it seems that this is an average price for such procedure in cities. What about pet insurance? Do people do that? does that make sense? does that include dental?
Any advise very much appreciated!
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