I wanted to bring up an important topic, and one that most of you fellow pet owners probably aren’t aware of – or you are, but don’t realize it. What?! Let me explain…

HMO. Managed care. Human healthcare system (US). Sound familiar?

As most of you are aware of, human health insurance companies in the US like to dictate to doctors/hospitals/clinics what they are allowed to charge and subsequently, what the insurance company will pay out.

For example, if you go see a shrink through your healthcare provider, and that shrink usually charges $250 an hour (hmm maybe I’m in the wrong line of business…nevermind.) but the health insurance company says “to get our clients, join our network, but we will only pay you $75 an hour”. The same goes for regular doctor check-ups, emergency room visits, hospital stays, etc.

Ok now that you know what I’m talking about; let’s touch on our veterinary healthcare system. Oh wait, there’s isn’t one…yet.

As pet insurance becomes more popular in the US, many veterinarians are becoming worried that pet insurance will start dictating their prices. That is, the more that people buy into pet insurance to cover their pets, then their pet insurance company says “we will only reimburse you up to $200 for that knee surgery because that is a ‘reasonable cost’”. Well, when you get your veterinary bill for $1,000, what would you do in that situation? I know what I would do “hey veterinarian, why are you overcharging me?” It turns into a debate over who should you trust, veterinarian or pet insurance company? Well, as a representative of a pet insurance company, let me give you what I think is the correct answer: YOUR VETERINARIAN.

There is a reason why they went to school for many years and decided to go into veterinary medicine. They truly like pets. They want to make them healthy. They want to take care of their clients (your pets) and their owners (you).

I’ve seen many comments over the past few months on this blog about benefit fee schedules and people getting upset that their pet insurance didn’t pay out enough, or didn’t pay as much as they were expecting.

By now you’re probably thinking “ok, Melissa, get to the point already”.

Here it is: make sure you understand what your pet insurance company is paying out on. Most pet insurance companies do have some sort of reimbursement schedule or fee guide, whether or not they clearly market it. If you’re okay with getting about 50% of your claim reimbursed, then maybe that’s ok with you. But for most of us, we’re expecting to get the advertised “90% of your costs” or “80% of your veterinary bill” back.

Be wary of things like “usual and customary fees” or “reasonable costs”. Ask the question “Do you pay out based on what my veterinarian actually charges?”

Now, for those readers who haven’t yet gotten pet insurance or ran into the problem above, could the rest of you please share your horror stories? Did you think you would get $700 back but actually ended up only getting $300?