Thanks for posting this. It's clear to see the advantages from a patient's perspective -- I wish that I had known about insurance before my dog was diagnosed with diabetes, although it's not entirely clear how care for long-term, chronic conditions is handled by many insurance plans. But, because of the silence you mention -- except for some veterinary websites that shall remain nameless and (ditto) some vets whom I suspected  of getting kickbacks for pushing a particular insurance plan -- I was left wondering what most vets think of insurance. I think it's a great time for patients to get in on plans -- i.e., before that old genie is unleashed. How nice to be able to take finances out of the equation when making stressful decisions about a pet's medical care.

Edie February 16th, 2009 01:03:19 PM

I don't understand the concern about "managed care." Are you saying that people will make decisions about health care for their dogs based on whether it's covered by insurance or not? But how is that different from people who don't have insurance and have to make decisions based on what they can afford?

Or are you concerned that all vets will have to work for one big HMO organization? That doesn't seem realistic.

I hate dealing with insurance companies, either human or animal. One of the reasons I belong to Kaiser is to avoid having to deal with insurance headaches. I think many (most?) insurance companies do their darndest to avoid paying claims, even veering into illegal territory (in California, for example, the insurance commissioner has been fining a number of companies and making them agree to stop dropping people and refusing to pay claims due to supposed pre-existing conditions, long after those people signed up for insurance). I also have a theory that insurance companies automatically reject most claims, figuring that a certain percentage of people won't bother to appeal.

I had pet insurance way back in the early days. My dog broke a tooth. Rather than having the tooth removed, I had it repaired. I submitted a claim, asking only for the same amount they would have paid to have the tooth removed, not the additional amount I paid to have it repaired. The claim was rejected. because repairs were not covered. I eventually ended up speaking with the owner of the company, who agreed the claim should have been paid, but it should not have had to get to that point.

I could understand vets being concerned about insurance companies not paying claims, especially due to so-called pre-existing or congenital conditions, and about having to fill out the paperwork, but what is the concern about managed care that you say has veterinarians "wringing their hands with angst"?

Mary Straus February 16th, 2009 01:28:53 PM

The National Library of Medicine defines managed care as:

"health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary costs sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high cost health care cases. "

In other words, the veterinarian would no longer become the gatekeeper of the patient's care. This convoluted system whereby insurance companies make decisions on pet health care--taking the medical decision making out of the provider's hands and leaving to those to make decisions in the best interest of the company or its collective population of insured--is very unlikely to evolve in veterinary medicine.

But you can clearly see why veterinarians would not want to be part of that system. Once a company starts telling us what kind of care a patient can or can't receive based on their cost-saving systems (none of which are necessarily in the best interest of the patient), we lose the very personal dialogue that we believe is essential for practicing medicine to our best ability.

Dr. Patty Khuly February 16th, 2009 01:54:52 PM

I have looked into pet health insurance several times.

my reasons for rejecting it, were all the same each time I considered it. They are as follows

1. preexisitng conditional and/or genetic exclusions

2. multipet costs are high

3. payout/submit then everntually get reimbursed

4. possibility of denied claims. (then if I have paid all this premuim money I could have been saving instead of having someone else making a treamtent choice while paying premium money).

5. general support of another "managed" type big business program.

having given these reasons to not get pet health insurance, I think if I had a kitten or puppy that I had just gotten and only had 1 possibly two very young animals, I might be more inclined.

However, I have in the past taken the ill, the injured and the otherwise unadoptable, so that hardly makes me personally the type of customer those insurance companies are looking for. I'm the one who will take the diabetic cat brought to the vet to be euthanized, or the FIV cat no one wants.

LorriM February 16th, 2009 02:23:47 PM

Lorri your #s 3 and #4 are my reasons, too. I also take in those types, plus I choose to maintain pets with chronic age-related conditions as long as I can prop up their Quality of Life, and those kinds of things like you said, aren't usu. covered or are capped. Then there is the fact that I eat costs sometimes because I don't submit receipts for reimbursement for other things, so why would I be any better about it with pet insurance?

I've yet to be unable to pay for needed care, although at times, I've had to delay optional procedures or tests for financial reasons.

Stefani February 16th, 2009 02:34:12 PM

Ditto to the above 2 comments. I maintain a savings for my animals'care, and keep a balance of $10,000- 15,000 in it. So far I have been able to meet all their needs, but if more than one would have come catastrophic event....well, I don't know. But it's the age thing, and the "pre-existing" clause. If I should have young pets with no issues, I may look into one of the high-deductible plans, but for now we're uninsured.

Shellie February 16th, 2009 02:51:35 PM

Personally, I think health insurance is a no-brainer for those who have a single dog, or perhaps a pair of indoor cats.  I push it at my place of business, even though I will NEVER profit from it in any fashion (aside from perhaps a grateful owner should something go horribly wrong and they partook of my advice...).

However, for those of us with multiple pets (like my three dog, two cat household) or those of us with multiples of "high risk" breeds, the cost is prohibitive.  In this case I suggest taking a small amount each month ($50-100 depending on the situation) and setting it aside for emergencies.  It can even gain interest while waiting to be used (and yes, eventually, it will be used... thems the breaks).  In addition, it's wise to get a credit card (or two, or three) to keep on hand just for medical emergencies.  We have a few that we just charge doggy/kitty items on every month, and pay off at the end of every month to keep the accounts active and in good standing (your credit score also benefits from this - although this is a POOR idea if you're credit-crazy).

This way if you find yourself in need of a larger chunk of money than you have on hand, you have the credit space to charge it.  Our past experience has taught us that if the bill is significant enough that you can't pay it off within three or four months, it's a wise move to then visit your bank about taking out a personal loan at a lower interest rate to get the balance off your interest-crazy credit cards.

Generally, right around the time we've got the loan paid off and the savings account built back up is right around the time that one of our rescues has another disaster and wipes us out again <shrug>.  But we've done the math a hundred times, and it's STILL far cheaper than purchasing insurance for all of them.  In addition, you need to have the money up front ANYWAYS... so either way you need those accounts available.

Our savings account gets $150 every month and we have $5000 in credit open for the dogs.  To insure our guys, it would be $218 a month, and we'd still be on the hook for 20% of the bill, plus the first $150 for every pet every year.  And of course, regular expenses are not covered.  Then it gets REALLY crazy - our monthly insurance bill would be $401 with a $250 deductible per pet per annum plus a 20% co-pay.

Sooo, I'd be spending $4800 on insurance and I'd have to spend $250 on any of them before the insurance would even kick in.  After a year or two, one can imagine how much money would be wasted.

Now, if I had one dog and wanted to go full tilt with the coverage, I could probably accept paying $82 a month without an issue - but I'd still be putting money away and stashing those credit cards....

Kim February 16th, 2009 02:53:22 PM

I sincerely hope we don't evolve into a situation where Vets stop treating pets because they don't have "insurance" or look at you strange when you say no big deal we'll pay cash.

I also don't want to see insurance executives telling Vets how to practice medicine.

Evet February 16th, 2009 06:29:35 PM

Maybe I am misunderstanding, but dental insurance is like a HMO or PPO. I have BCBS with a measly dental reimbursement that isn't PPO, but a good plan or better coverage does have that. My Dad is looking into a plan that only has 3 providers within comfortable driving distance, none in the same large town he resides in.

I also wonder, if this country turns to nationalized or socialized medical care, if this may change people's perception of pet insurance. I was surprised on the link, how rapidly the industry has grown without much advertisement or exposure.

Barbara A. Albright/NH

Pocket's Story from NH February 16th, 2009 07:12:47 PM

Barbara: Most dental insurance plans are not like an HMO or PPO. They're more like car insurance. That's the indemnity model pet insurance follows. In these cases, your dentist/vet remains the gatekeeper for any specialty care. Your choice of services is not questioned. 

Dr. Patty Khuly February 16th, 2009 07:50:21 PM

I'm with LorriM, for the very same reasons. I've looked into insurance, and, for me, the benefits just aren't there. Uninsurable kitties aside, frankly, I'm just not very impressed with what the insurance companies are offering at this point.

Ramen Connoisseur February 16th, 2009 09:28:32 PM

I looked into pet health insurance after one of my dogs had to have some major surgeries (carnassial abcess and retrobulbar abcess - required 2 surgeries, MRI, hospitalization, etc).  The final bill was close to $3000.  Pet insurance would have covered about $400.  I decided it wasn't worth it. 

Nita February 17th, 2009 06:39:44 AM

Nita: Why not? I don't understand this. What kind of insurance only covers $400 out of $3,000 for a non-routine procedure? Answers...anyone?

Dr. Patty Khuly February 17th, 2009 08:27:54 AM

Over here in Ireland (and also in the UK), around one in three of my patients are insured pets. This fact makes my working life so much more satisfying. I have the freedom to do exactly as my training tells me to do, without first having to clear the hurdle of making sure that the pet owner is able to afford my recommendations. There have been mutterings about "managed care" over the years, but these have only been minor issues (such as putting a ceiling on the amounts vets charge for histopathology) and they seem to have been sorted out with local discussions. As long as vets "behave themselves" (i.e. no blatant over-charging, over-investigating or over-treating) there is a comfortable symbiosis between vets and insurers.

As for the query re: $400 out of $3000 - well, "routine dentistry" is excluded (i.e. scale and polish), as are pre-existing conditions (before the insurance was taken out) but otherwise with our insurers, $2920 of the $3000 would have been covered. Much depends on the individual insurer, and in the UK, cheap insurance often goes hand in hand with poor coverage.

There is a website ( http://www.insureyourpet.co.uk/) that helps folk in the UK choose which package offers the best deal. Is there such a site in the USA? It's very helpful.

Pete

www.petethevet.com

pete the vet February 17th, 2009 09:23:48 AM

I can't speak for Nita, but when I last had pet insurance (in the dark ages, but I think some companies still work this way), they paid a set amount per diagnosis, regardless of the amount of the bill. Thus I'm assuming that the insurance Nita talked about paid around $400 for dental abscess and wouldn't have covered the MRI, second surgery, etc.

Mary Straus February 17th, 2009 12:03:48 PM

Pete, thanks for the UK web site. There is a site that reviews insurance companies in the US: http://www.petinsurancereview.com/

Mary Straus February 17th, 2009 12:21:00 PM

I had pet insurance for 6 years for my Doxie/Min Pin, Hanna Banana, Hannah Pyrannah (like all of us she was not perfect all the time.  Anyway I hardly ever used it.  In the fall, I noticed that Hanna the most ball obssessive dog that I have ever met was not fighting for her ball anymore.  Just a few months earlier she would get "her" ball back no matter what.

My daughter, a vet, recommended a blood test just to check.  Off the wal result, went to U C Davis where she was diagnosed with a liver shunt at age 6.  I scheduled the operation after appropriate tests.  She did not come through whole, kept seizuring and I had her euthanized while in my lap.

VPI said, "Oh did you not notice, we do not cover liver shunts"  You know I had never heard of a liver shunt and even after educating myself, it was a couple of years before I heard about adult dogs being diagnosed. Hanna was one of those once in a life time dogs.  I will always miss her and I think that VPI could have offered to pay part of it.  I will never use them again and now I do not trust other companies.  I have no way of knowing what they cover even if I read the list.

Eliza Wingate February 17th, 2009 12:46:23 PM

I'm sure all are aware of the long history of battles between the dentists and other human medical professionals.  However, now that this is being overwhelmed by the scientific facts that dental and mouth care are essential to overall healthcare, dental care is becoming incorporated.  I expect it will be fully so within a decade (probably much sooner since it appears it will be part and parcel of the Obama overhaul).  Basically, we were all sold our current health care system in the US in the exact same way this is being sold.  "Pish, tosh, don't you worry, it will never come to that!  Traditional insurance will always be there as an affordable alternative.  We'll never be entirely subject to gatekeepers", blah, blah...  Well, I've watched the deterioration of human health care during my adult years and I'm not THAT old.

PBS did a wonderful comparative show of American healthcare to 5 other nations recently.  We have third world country healthcare.  (IMO, largely because we Americans are selfish and have give little or no thought to the system and society like members of other nations.)  American insurance is a for profit, big money SCAM IMO.  I'm not signing on for one more bit of it until we make some changes that make us more like those other 5 countries because I think this will indeed become just like human health insurance AND I think there will be a tipping point where Vets will say things like "no insurance, you need to go elsewhere" and that will be because they no longer make decisions but just do what the insurance companies mandate by rote.  This is what happened with human medical providers (yes, I've been denied care with greenback cash in my hand by a doctor who wouldn't take any patients who didn't have insurance and he was the first of several) and I believe it will be inevitable with Vets too.

I wish I were in Ireland or the UK because I think they have a more realistic perspective on both human and pet care.

PJBoosinger February 17th, 2009 12:55:15 PM

Dr. K: Must be a fluke about the dental ins., I am very ignorant on the whole system and find that people that have utilized insurance, really know there around. I think I am still the "good risk" that has years of paid premiums...glad I have it, and glad not to need it!!

Eliza W: I am really surprised that the liver shunt at age 6 was not covered. Was it because of the type or number of (mini shunts)? Was it claimed to be hereditary vs. acquired? Just doesn't seem right to have excluded it from the policy, although success rate isn't too high.

Barbara A./NH

Pocket's Story from NH February 17th, 2009 05:34:54 PM

Barbara: Many policies specifically exclude genetic or congenital diseases. I'm guessing that was the issue with the shunt.

Dr. Patty Khuly February 18th, 2009 05:41:54 AM

I am so glad to see that you also support the discussion of pet health insurance. I speak to each client at their first puppy visit and we distribute a "generic" insurance brochure from AAHA that doesn't endorse any specific company or plan. I feel like the clients we have who already have insurance are more prepared to do what their pets need, and in these uncertain economic times, any feeling of security is a good thing. Insurance may help prevent euthanasia due to economic reasons.

Lisa February 18th, 2009 08:03:42 PM

I have a plan through PetSmart that provides virtually everything except Heart Worm and Flea/Tick medications.  All vaccinations are included, liver and kidney evaluations, 1 dental cleaning, and other things too numerous to mention.  There is also a discount on "non covered" charges up to 30% based on the level of coverage you carry.  I have been a customer of Banfield (PetSmart) for over 15 years, and would not consider a private vet with no "HMO" plan.

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bnt aboha May 22nd, 2009 12:51:43 PM

As long as pet owners are aware of what they are purchasing (exclusions, maximums, etc), pet insurance can be a positive experience. When reading reviews, many of the people who have had negative experiences with pet insurance didn't do enough research before their purchase and some will admit it. 

Pet insurance can be expensive for multi-pet households and i can see how it is hard for pet owners to justify the costs. One company, PetFirst, offers family plans that will insure up to 3 pets per policy. The pet owner can file claims on all 3 pets up to the annual, and per-incident maximums for that one policy. At the same time, all 3 pets have their own individual wellness care included.

Unfortunately, PetFirst doesn't cover hereditary or chronic conditions in this basic policy, but offers coverage for these as an add-on rider for an additional premium that would for most pet owners push the cost beyond reach. If purchasing a family plan policy from PetFirst, you just need to be aware of these exclusions.

By the way, that's the way it is with any pet insurance company or policy. There aren't any that are perfect. Some are better than others - you just have to know exactly what you are getting when you purchase a policy. Otherwise, surprises down the road will disappoint you.

I have published a book written from a veterinarian's perspective for pet owners to help them understand how pet insurance works. It provides details about each company that sells policies in the U.S and their policies (some of which aren't readily apparent on company websites or in the fine print.) It also helps pet owners narrow down their search for the right company and policy for their pet. I also author a blog on pet insurance.

I received my Veterinary Practice News today and found an article on Pet Insurance by Dr. K. I was so impressed by what she said that I came to her blog and i've been reading various posts all evening. With current veterinary attitudes toward pet insurance, it took guts to say what she did and the way she said it!

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