Audits, fraud and other vet issues in the Wild West of pet insurance (Veterinary pet insurance Part
You didn’t think there’d be a part 3, did you? But pet health insurance is a near-and-dear-to-my-heart issue—so why not?
Remember when I mentioned all the exclusions and small print issues in the pet insurance industry? It’s no surprise that insurance for pets has all the same trappings of its human counterpart.
Funny, though, that vets are just now starting to take notice of some of the more i-dotting and t-crossing aspects of billing, claims eligibility and reimbursement for our pet health insurance users.
If vets want to reap the benefits of our freedom to independently set our prices (knowing someone other than our clients will pay for them) then we need to keep in mind that there might be some follow-up consequences should the insurance company have questions about the care we provide.
And here comes the slippery-slope we’ve all been warned about by our human medical brethren. Sure, we don’t have “managed care” for pets—yet—but we may be on our way (despite the low market penetration of insurance in the pet sector).
Here are a few issues sourced from a recent multi-vet conversation:
∑ How about the client who asks you to change the date on a procedure? (Umm…we call that fraud in my part of the world…)
∑ Another vet’s client who wonders how he should list his cat’s breed? (If the pet look predominantly anything but is clearly a “mix,” owners should know that they’re at a financial disadvantage to label their pet a purebred. Much as they’d like to think Fluffy is an Angora cat, truth is, she’s really a “domestic shorthair,” and to call her anything in particular undeservedly raises his premiums.
∑ When records get “audited” by a company trying to determine if a claim should be paid, how should vets respond? Some vets write lengthy letters detailing the case or ask receptionists to do so. Others just copy records or print out a skeleton of invoice items with their dates. Some even throw away any insurance correspondence, thereby limiting their clients’ ability to get reimbursed. Did you know that?
Increasingly, vets are being asked to work for their clients, much like the human medical establishment, now rife with billing specialists who handle claims for doctors, thus raising our healthcare costs. Even at this early stage where so few pet owners carry insurance, it’s an issue. Where will we be in five years? Or ten?
It’s still the Wild West in the pet insurance game, except in Great Britain where 40% of the pet-owing public carries it. Maybe they have the right idea and perhaps they’re better off because they sign up in big numbers. But I wonder…
I guess that’s my next pet insurance post. But I promise to give you a break—for now. Still, if any of you GB residents care to weigh in, it’ll be much appreciated on this side of the pond.