Comments on: Pet Insurance as an HMO?

By: Josh

Josh — Wed, 05 Aug 2009 00:59:43 +0000

We had a “scheduled” plan before and it was terrible — VPI Pet Insurance. I prefer the way Go Pet Plan works in which they just cover 80% of the charges. This is fair. I haven’t submitted a claim yet to review their claims payment service.

By: Melissa Kowalchuk

Melissa Kowalchuk — Thu, 16 Jul 2009 19:17:08 +0000

Dr. Kenney,

Thank you so much for your post, as I’m sure everyone else appreciates, as much as I do, the veterinarian perspective. Your point about the leg fracture is one that I wasn’t even aware of, but makes total sense. I had the basic knowledge that “chemo treatment”, for example, could vary tremendously from patient to patient costing the pet owner any range of money. Making the benefit fee schedules incredibly irrelevant.

Again, thank you so much for jumping in here!

By: Dr. Doug Kenney

Dr. Doug Kenney — Thu, 16 Jul 2009 03:01:07 +0000

Melissa,
Great topic! As you know, virtually every pet insurance policy from every company has “reasonable and customary” printed in their policies. Each company has a fee schedule of some kind (most use the AAHA Fee Reference Guide that is published every 2 years) that they can use to determine if what a veterinarian charges is more than the usual for any given geographical region of the country.
There are several companies that actually strictly apply these fees when they calculate reimbursements to pet owners. Most of the newer companies like Trupanion, however, usually pay according to whatever the pet owner’s veterinarian charges. I have been told by executives of these newer companies that the fee schedule (reasonable and customary) would only come into play if a certain fee seemed extremely inappropriate (out of line). Even then, they are likely to contact the veterinarian to determine if there were circumstances that would justify the higher fee. Therefore, you are indeed right to advise the pet owner to ask how a company calculates benefits because it will definitely make a difference in how much they get reimbursed.

But, it is important for pet owners to understand why fee schedules can be misleading. In fact, fees not only vary from one region of the country to another, but from one hospital to another in the same city.

For example, we have two specialty/emergency hospitals in Memphis. If a pet is treated at one of these facilities, the fees will be higher because specialists have more training, use higher technology e.g. CT scans, MRIs, solve more difficult problems and usually the pet receives treatment around the clock.

Also, the costs of repairing a fractured femur will vary greatly depending on whether the bone is in 2 pieces or 10 pieces and whether it was repaired by the pet owner’s regular veterinarian or referred to a specialist. So, fee schedules may not account for these variables.

I think that the newer companies are aware of the criticisms that some of the older companies have gotten over the years from pet owner when their reimbursements didn’t match their expectations because the company paid benefits based on a benefit or fee schedule. Therefore, they have decided to pay benefits based on what the veterinarian charges.

From my research, it appears that the newer companies that pay according to what the veterinarian charges have premiums that are very competitive with and sometimes even less than those who pay strictly according to a benefit or fee schedule.

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By: Melissa Kowalchuk

Melissa Kowalchuk — Mon, 22 Jun 2009 17:04:45 +0000

Thanks for your comment and sharing your experience. Many policies do have the “reasonable cost” wording, and that is exactly what veterinarians are afraid of. It is possible that some vets overcharge for their residential area, but why should an insurance company get to determine what that “reasonable” amount should be?

By: Summer's Momma

Summer's Momma — Mon, 22 Jun 2009 11:46:50 +0000

I have saved thousands with pet insurance. It is not cheap, but either is veterinary care. It works like a PPO. Ours through Pet’s Best pays 80/20…but for recurrent illnesses, 100% is covered, for life!
Here is the thing. I am not the one sitting in the vet’s office having to make the heartbreaking decision, because I cannot afford lifesaving care. Pet’s Best will elven send reimbursement directly to the vet. If you have a relationship with your vet, and you are strapped, I cannot imagine him not working with you and the insurance.

As as aside. I have known vets that overcharged. I have known human doctors that have done the same. Just because someone is in the medical field, does not automatically mean they have integrity.

Most insurance, human or pet pays “reasonable cost”…it is right in the policy.