Pet health insurance: What we're learning from ObamaCare - DVM
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Pet health insurance: What we're learning from ObamaCare
Veterinarians—not insurance companies—may be in charge now and in the future when it comes to pet insurance.


DVM360 MAGAZINE


The similarities

The two biggest similarities I see between the human medicine world and the veterinary world are these:

  • First, the technology, innovation and availability of diagnostic and therapeutic modalities (the things we doctors offer) is expanding at breakneck speed.
  • Second, everybody wants access to all the great new stuff, but those innovations are becoming so expensive it is unrealistic to expect the average person to be able to subsidize that level of care out of pocket.

But since we cannot finance pet-cancer therapy any more realistically than we can put Grandma to sleep, we as a profession must look to third-party financing to permit us to do what we are capable of doing for our patients.

And it wouldn't kill any of us to start being able to charge something approaching what our skill is worth, either.

Keys to pet health insurance

Assume for a moment that I am correct in my assertion that the primary-care veterinarian is the person most likely to convince a pet owner that insurance is a wise decision. (Some would say that a receptionist or office manager can accomplish this, but the jury is way, way out on that point.) If we doctors believe in a product, our sincerity and our credibility will carry the day. These qualities will help us avoid the hard sell and the need to spend a lot of time convincing clients.

However, you can't be sincere in your support of a product unless you have one or two favorites and have learned enough about the pet insurance companies and their policies to make an informed recommendation. To assist in that regard, I will lay out the qualities I believe are most important to veterinarians and clients to consider.

Remember, insurance is not an investment. It is a tool to manage risk. Clients deserve — and you should endorse — a tool that, very simply, works well for the money.

And a caveat: If I were you, I would check first and foremost into how quickly and effectively clients get reimbursed. Good coverage is not worth much if it is awkward and full of hassles when it is used.

Coverage issue No. 1: The percentage

Each pet-insurance program generally agrees to cover a certain percentage of the "veterinary bill" (definition of which may vary; see below) for covered accidents and/or illnesses. I think coverage percentage is important because, when the surgeon says the procedure will cost $2,000, clients may be able to come up with $200, but not $400.

Coverage issue No. 2: What is excluded?

Clients are no different from us. They don't want smoke-and-mirrors or bait-and-switch. Most pet-health policies exclude many or all pre-existing conditions, as do many human policies.

Pet health-insurance companies also are likely to limit or exclude hip dysplasia coverage while occasionally a company will offer hip dysplasia coverage at extra cost. Some companies do not cover any congenital or hereditary disorders.

The best approach is to contact the major insurers and compare exclusions. Generally, the fewer restrictions, the better.

Coverage issue No. 3: What is a veterinary bill?

Human HMOs have a list of care providers. Medicare tells MDs what they can charge if they expect the government to pay. The pet health-insurance version of this phenomenon is the definition of "covered veterinary fees."

The long and the short of it is that, when the company says it will pay a percentage of the fee, the fee that really counts to the client is the actual fee charged by you or the specialist to whom you refer.

I suggest that before you recommend policies that have an insurer-established schedule of how much a certain procedure (such as a catheterization) should cost, you should make sure the schedule is realistic.

It's one thing to decide to set your fees based in part on insurance reimbursement. It's quite another to send a client to a terrific specialist on referral only to find that his fees are, effectively, only 50 or 60 percent reimbursable.

Two things to note: First, all the companies have a maximum payment for any given policy, like human insurance. Second, most pet-insurance policies have a per-claim deductible.

Coverage issue No. 4: Premiums rise with pet age

Each of the plans I looked at had different pricing systems for aging pets. The difference can be analogized, I suppose, to the difference between term insurance and whole life.

Trend can't be ignored

I have to believe that if we want to be able to practice our profession to the best of our abilities and offer all that we can, we must get out in front of the problem.

Wages are not going to increase as quickly as our invoices. Consequently, we must embrace third-party payment. We need to be proactive in our patients' health-care insurance, or our voices will be drowned out.

Dr. Allen is president of the Associates in Veterinary Law P.C., which provides legal and consulting services to veterinarians. Call (607) 754-1510 or e-mail


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Source: DVM360 MAGAZINE,
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