In what universe is it professionally ethical for a doctor to pimp for a specific gambling establishment, in this case, a pet insurance company?

A specific company is different than for the concept as a whole. I agree with you that "pimping" out a company in particular could be construed as questionable. I tend to offer a selection of brochures for just that reason (and also because different people have different needs).

Oh, and I don't view pet insurance on the same footing as gambling. Sure, the odds are stacked in favor of the house but that's not why I buy insurance.

Dr. Khuly is correct, insurance of any kind is not gambling. Gambling increases your risk of a payout but at the risk that you will lose a lot of money. Insurance is designed to "make you whole" following a loss and your downside is limited to the premium you pay. So gambling INCREASES your risk and insurance DECREASES your risk.

No, it is NOT a veterinarian's responsibility to "push" pet insurance. MD's do not. In the human world, it is the responsibility of the person themselves, or a benefit of employment. To some extent, I see it as a bit of a conflict of interest for vets to actually act as an insurance "source" of information or "sales", other than making brochures available or perhaps insurance company business cards. And pet insurance is not necessarily "cheap" either. And there is good and bad...and what fits your situation. I've also run into clients and friends that have been burned by "insurance" and "healthcare" packages...certainly by the Banfield variety.

Animal health care and human health care share some similarities, but are also profoundly different. While private doctors can certainly "choose" to not accept patients without insurance, public emergency rooms cannot turn them away. The same does NOT apply for animals. Whereas there are options for humans to find care, especially emergency care, if they cannot pay, that option does NOT exist for animals. There isn't a veterinary emergency clinic anywhere that will treat an injured or sick/compromised animal without a credit card with an available line, or a call to the bank. People cannot be euthanized for lack of funds. Animals can. And for an animal that is in distress, from an accident, or poisoning, or in seizure, or some other acute situation, and is suffering,there is no other option but to euthanize...because vets will NOT treat without payment. Our kennel club learned that last summer when an exhibitor's dog overheated and was rushed to the emergency clinic by the site. The owner was not immediately available, and trying to find someone that could make payment before treatment was about impossible. During this time, the dog is seizing. And finally goes unconscious.

Our ability to make such giant leaps forward in our knowledge of animal health care is a two-edged sword. On the one hand, we have the technology to diagnose and treat just about every disease, including cancer, with decent outcomes with good quality of life. We can perform heart surgery, hip replacement surgery, and just about any other kind of surgery on our animal companions, and yes, at a much lesser cost than what those same surgeries would cost a human patient. But at prohibitively high costs, nonetheless, to the average owner. Anesthetics continue to be developed which are quicker, cleaner, safer...but more expensive. Much of this great technology is still prohibitively expensive. And as veterinarians are able to offer more in-house diagnostic and testing equipment, the higher the fees to help pay for the additional space and the hardware...which is, of course, passed on to the client.

The real question becomes, just because something is "available", does that make it necessary? Does that make an owner more responsible or less responsible for accessing or NOT accessing an "available" procedure or treatment, even if prohibitively expensive?

Once upon a time, families brought the family pet to the vet one a year, or every couple of years as a general rule, for shots...and for euthanasia at the end of life. Pretty basic stuff, and not too terribly expensive. We didn't spend a lot on preventative care, and we didn't spend a lot when they became sick or when issues arose. We did not have all the diagnostic and veterinary specialist hospitals that NOW exist. Nor treatments. We had a dog, we fed it, it lived in the house, or in the yard with a doghouse...and it lived, and it died. Usually with a relatively happy life. At least the dogs I knew seemed happy.

Now, veterinary practices have split into very specialized fields themselves. But as with human medicine, not all people can afford it. And not all people can afford insurance either. And unlike human medicine, veterinarians have no legal directive to provide care, regardless of ability to pay. So financial euthanasia will always remain a fact of life.
Costs continue to rise...and greater and greater services are available...but in many cases, the general public cannot afford to access them. That does not make them "less" compassionate. It is simply indicative of a society that puts great value on having the best, but strangely, not having it "realistically" available to the majority of the public. So yes, we can treat your dog's cancer, but the protocol is twelve weeks, and costs between $5,000 and $7,000. Yes, we can do a hip replacement for $2500. You get the picture. Just about any procedure or treatment that is available for humans, is available somewhere for animals. But for a cost. And not everyone will be able to afford either insurance, or the procedure. At least until legislation is written that mandates all pet owners have insurance...(probably have to show proof of insurance to be able to register your animal) But that's a double-edged sword as well. As long as we keep mandating more and more restrictions and requirements for pet ownership and breeding, at some point these questions will become moot, because only the very rich will be owning animals, and most vets will be out of business.

I totally agree with Rosebud.

Technology costs of veterinary medicine have essentially outpaced what people will be able to spend. With the post recession economic climate where consumers are more careful with discretionary spending, specialists may no longer be a ticket to the big salaries from expensive treatment. Potential treatment options will more and more be subject to a cost-benefit decision as to how much it will improve the quality of the pet's life and for how long. Insurance may be an option for some but many will revert to doing what can be done within a certain dollar range and hoping for the best.

Joe

"I've also run into clients and friends that have been burned by "insurance" and "healthcare" packages...certainly by the Banfield variety."

Just want to step in here that the "Banfield variety" is not insurance. It's a preventive care package. The items included are clearly stated at the time of signup, all of which are geared towards routine preventive care. My own pets went to Banfield for most of my childhood, as they were the closest vet to us. My own cat was signed up for a plan when I first got her, and everything was crystal-clear when I did that. Never claimed to be insurance, the paperwork I signed included a list of what was included and the terms of payment. The only way someone could really get "burned" is if they are not reading what they are signing, because even if it is not explained to them well verbally I have seen the contract and it is laid out pretty plainly.

Later on in this discussion TheOldBroad asks for exactly this - a package to cover wellness exams and vaccines. This sort of thing is starting to be offered by a few independent places but is easiest to implement in a large corporate practice. It is not, however, the same thing as insurance - insurance is designed to protect against large unpredictable expenses. Wellness packages and preventive care plans are designed to spread out the cost of preventive care and give a discount to the pet owner while basically giving them strong motivation to come back. The practice is almost guaranteed continued business from this person as the preventive care is already paid for, while the client gets a discount compared to paying full price for the services.

I am leery of any insurance that includes wellness care (for people, too!) as the insurance company is not charity, it is there to make money. It is essentially a gambling game rigged to favor the company since they arrange premiums so on average most people don't get enough payout to offset the premiums, otherwise it would not work as a business. If routine preventive care that is sure to be needed is included in an insurance plan you can get they have raised the price of the plan by more than the cost of the wellness care ad it would be cheaper to carry insurance for illness and injury while paying out of pocket for wellness. Completely different beasts.

Two words:

Exclusion clauses.

A lot of pet insurance policies are full of them.

Still worth considering if the guard against that big one off event, but unlikely to help with ongoing issues.

Insurance companies are not in the business to lose money and have no legal reason to act in the best interests of the animal. The largest insurance company is Petplan (Allianz Global group) so I doubt they are in it because they love pets. They are in it because it is a profitable business segment.

Which it wouldn’t be if they spent all the money they took in, of course if they did that they would be a charity and not a business.

Here is a review of Petplan written by an owner in the UK:

http://www.ciao.co.uk/Pet_Plan_Insurance__Review_5861191

I think insurance is a great idea but they would need to start providing comprehensive cover and actually pay out when needed.

I would love to insure my animals, one would never get insurance in a million years, the company simply wouldn’t insure her and the only thing likely to wrong with the other one would be counted as a pre-existing condition, so it would be pointless.

Unless the front desk has brochures from every pet insurance company, it might backfire if the clinic seems to be supporting one particular company.

Even though the clinic would have no financial interest, if a client bought pet insurance from a particular company based on a seeming endorsement from that clinic and was subsequently unhappy with the insurance, it reflects on the clinic and staff.

Human clinics have had to assure they have insurance experts on staff and most are members of a health care network so that limits the number of companies with which they will deal. Is that something that is in the future of pet clinics perhaps?

I also wonder if it's something in the future where clinics might have the equivalent of a monthly payment plan that would cover wellness exams and routine vax.

It's a shame that most pet owners don't save something every payday in an emergency fund for their own "pet insurance"

I don't see there being a broad movement to offer monthly payments on wellness plans because the possibility that a clinic will get burned is just too high. Imagine a wellness package offered by your local hospital costing $25/mo that provides 12 months of flea-and-tick meds worth $140 in total over the year. If some unscrupulous individual signed up for a monthly wellness plan and got $140 worth of meds after just one month of payments then the clinic will incur a loss.

Hi Dr. Khuly,

This discussion has made me wonder if a vet would ever waive all costs for a procedure if the pet owners couldn't afford it and the life of the pet depended upon it?

Jennifer

It happens all the time. But unless it's a well-known client, the hospital will typically want to take possession of the animal for re-homing unless temporary extenuating circumstances are obvious.

Am I reading your comment correctly? Are you saying that if the (unknown)owners can’t afford the treatment in a life/death situation, then the vet will treat the animal but keep it for rehoming? If so, I would question whether that’s legal. Pets are considered property in most states, and you can’t take property without a court judgment against the owners.

I've seen it done, but the owner must sign the pet over to the clinic like a legal transfer of property. It's much the same as the legality of signing a form to allow your pet to be euthanized.

My Ivy Elizabeth (RIP) was one such kitty. She had terrible allergies and licked herself bald. The owners didn't want to treat and took her to the clinic to be euthanized. She was such a great cat and only 4 1/2 years old so the vet asked if she could rehome her. They happily signed the paper. I adopted her not too long afterward.

We tested her for allergens, got her on injections and she was a happy pet for many years. Her only other medical problem years later was to become hyperthyroid - so off she went to "Camp Iodine". She lived to be 18 1/2 and I confess that I was really surprised that she didn't make the Magic 20.

I'm sorry she had a couple of really bad years with allergies (and fie on her previous owners for not treating her), but so grateful she came to live with me.

Sorry let me explain: This is called a "sign-over." It usually happens when owners cannot pay for services and opt for euthanasia. Sometimes the staff and veterinarian then get all upset about this (happens a lot) and want to save the animal (particularly if he or she is adoptable) so they ask the owner to sign over ownership while they scrape up the funds to either get a discounted surgery at the specialist's place or do it themselves.

I don't deny it's a tricky business but it's commonly done. More common is to offer the owner a deep discount but sign-overs are usually situations where people cannot. pay. anything.

I would view this as a "value-added" discussion with your patients. Whereas pet parents are accustomed to having health insurance for themselves, pet insurance is still somewhat unknown to the majority. Your office doesn't have to promote or endorse a company to endorse the concept (or just introduce the concept). I would be surprised if one of the veterinary professional associations doesn't have an informational piece on pet insurance designed for display/distribution in clinics. Regardless, informing your clients about the availability of pet insurance may encourage them to maintain their wellness visits and soften the financial impact of major veterinary treatments may increase your patient volume. Then, just like any product or service, it's up to the consumer to make the purchasing decision.

I, personally, feel like if I buy a car the dealor isnt going to tell me to get insurance for it (or what type to get), and if my car needs fixed the repair shop isnt going to tell me to get insurance; it is my responsibility to know that car repairs are expensive and I likely couldnt afford such things without insurance especially when faced with an emergency. Such is the case with pet insurance. <--I know people hate car references, but it was the best I could do on short notice!

No one but the pet's owner will know what insurance is going to cover what they will need (regular wellness exams vs emergencies) or what their budget for such ventures would be....which is why I like Dr. Khuly's idea of mentioning it, but not going into detailed specifics unless prompted to do so. Give people the tools to find/use pet insurance, but not force it down their throats.

As far as pet insurance particulars go (and maybe some things to be mentioned while speaking with clients about pet insurance) many people dont realize that the best time to purchase pet insurance is while the pet is young, and has no "pre-existing conditions". A few companies will accept older pets, but everyone Ive researched is a bit snotty about "pre-existing conditions". Many companies also dont cover congenital issues (hip dysplasia is the bane of my existence with one dog), but some companies will (like the company we are currently with). Finally, every company has a slightly different way they pay out...many use a "pay scale" in which regardless of the cost of your visit they allow a certain payment for say a TPLO with hospitalization vs a urinary tract obstruction. Few companies actually pay based off of the bill you submit (our current company does, which is part of why we use them). It is up to the pet owner to know in what instances they will require this insurance and other nuances of their pets life to make an appropriate decision.

Over at Healthy Assurance (and now on the Daily Vet) they have a lovely piece on the nuances of pet insurance. One that was mentioned there, which I had meant to say, is that almost every (if not every) pet insurance company is based around the pet owner paying the the bill with their vet and then being reimbursed by the pet insurance. To me, that means that pet insurance is designed to work with any existing payment system an owner already has such as a savings account or specific credit card, but not in lieu of such things.

On a side note, CareCredit is lovely and wonderful, but not everywhere accepts it....just something to be sure of before choosing an emergency or specialty hospital.

I have lots of animals and as an experienced owner I do what I can to keep them safe and healthy. They get their shots and a good diet and are not allowed to roam.
Insurance policies involve a wager- I wager I will need the coverage and the company wagers that I won't. Being that I am a pretty good money manager and make a middle-class income, I pay out of pocket for needed care. Some of my animals do experience 'death by estimate', but more often euthanasia has been chosen based on quality of remaining life. There are many things worse than death, and I recognize that for myself as well as my animals.
BTW, most of my animals qualify as livestock and I actually lost a horse that likely could have been saved if there had been a large animal vet available. There was not...but that's another story that maybe Fully Vetted would like to address.

I was told on VIN that it's actually against the law for veterinary professionals to offer any advice on insurance. Not even just for a specific insurance company - but for any, even handing out several brochures.

I'm not sure if this is true, though - anyone know?

Personally I don't think it should be our responsibility at ALL to advise people on it. It's just a murky area I don't want to get involved in.

I haven't heard that. Could it have been in regard to a particular state?

Perhaps one of the readers with a legal background can shed some light on this because I'd really like to know, too.

Thanks for this info. I'm headed over to VIN to check that out. Never heard that.

In fact, I can't imagine that it's true as I can see no legitimate reason for standing in a veterinarian's way of recommending any product or service, financial or otherwise.

As long as there's no "kickback" there *should* be legal or ethical reason not to recommend pet health insurance.

I'll check it out.

Insurance law in most states forbids a non-licensed agent from discussing, binding, quoting, or selling an insurance plan. However there is no specific law that I am aware of against discussing broad conditions such as "Clients have been happy with Plan A because it covers X but not so happy with Plan B".

I think the breeder, shelter, or rescue group should inform the adopter of the general availability of pet health insurance.
Ultimately, the owner/guardian will have to determine the best insurance for their pet based on age, breed, and other factors.
The veterinarian could mention it as well, but I'm guessing this would be after a fairly expensive visit, which is not the best time to consider insurance. A young animal with no pre-existing conditions will get the best rate.
I've noticed that there are many more insurers now, than there were just a few years ago. There is fair variation in cost and coverage too. I'd rather my veterinarian and the clinic staff keep up to date with the changes in health care and not try to be experts in insurance too.

I've crunched the #s on insurance, and figured out that it is not worth my while. Yes, there was one expensive occassion when it would have saved me lots, but for most of the stuff I get done, it wouldn't help at all.

I think vet hospitals would do a better job helping their clients by establishing discount programs for loyal clientele. Offering payment plans. etcetera.

When pet insurance leaves you still paying mostly out of pocket for most stuff, I don't see the point of it.

I would argue that human health insurance, by insulating us from the true cost of what we consume, has caused us to not question the need or efficacy of many procedures and treatments. People might demand an expensive MRI for a sprain despite a doctor's reluctance. But who cares right? The insurance is paying.

Until the 1950s even there really wasn't a formal health insurance system and HMO/PPOs were not even a twinkle in the AMA's eye. What you got through your employer was hospital insurance and, by and large, you paid for your own visits to the GP directly.

In short, I don't think paying out of pocket is necessarily a bad thing though for sure it can be a burden until the insurance reimburses. Veterinary costs are rising much, much faster than consumer inflation and pet insurance currently has little impact on this trend given its low penetration overall.

Alex, when pet insurance policies start covering chronic care for diseases associated with aging, I will look again. Kidney failure, cancer, asthma, diabetes, hyperthyroidism -- other conditions common to cats over 10 years old.

If that is already true, I'm betting the premiums will be more than I pay out of pocket for my own health insurance, and with employer subsidy. I spend WAAAAY more $$ out of pocket on my pets care than on my own in a typical year. Just in the last two years ONE cat has had bloodwork 4 times, two dentals, an echocardiogram, a urinalysis (or two?) two rounds of meds, an ultrasound and a biopsy. And I'm pretty sure paying monthly premiums for insurance might only have gotten 1 blood panel and urinalysis per year paid for out of all that (oh, maybe the office visits that went with it). If that is correct, I would end up spending marginally MORE to have insurance, not less overall, and almost nothing I've had done on this 11 y/o cat with vague but persistent symptoms and no diagnosis (other than herpes infection since birth, which might make her uninsurable anyway), would have been covered.

Re: what drives service-seeking in human medicine. As for patients "demanding" MRIs for sprains, I think it is more usually doctors ordering them, because our current human health care system is pay for service.

We are getting there with vet med too. There have been articles published re; the hit vet med is taking in the economy, stating that the solution is to sell more services to, and raise prices on, the clients who are still willing to come in and pay.

Most of us, however, have our limits. So far the number crunching I've done hasn't shown me that insurance will help me with that. Just take more money out of my pocket so that when serious and expensive chronic diseases strike with aging, I have less $$ available to get treatment for them for the pets.

I think it's fair to say that your out-of-pocket costs for your own health premiums are lower than pet insurance but that's because your employer picks up the bigger slice. For example, I have 2 kids and a wife, my monthly premium is $1,200 and I pay 10% of it. Even my 10% is way more than most pet insurance plans cost.

Regarding your point about chronic conditions in older pets, I think you have to not look at insurance as a budgeting tool, as many of us have been conditioned to. Look at auto insurance: you pay $1,000/yr (say) for years and years yet no one runs around complaining that they haven't had an accident and a chance to "use" their auto insurance. Why does insurance have to be conditioned upon usage? I don't have life insurance hoping I die, it's just in case. It's peace of mind and you pay for that. However if you have the discipline to save $50 or $60/mo consistently year after year to afford a high level of veterinary care for your pet then you should and perhaps pet insurance is not right for you. But when a high-deductible plan costs only $10-20/mo even for large-breed dogs then the smart money is on a small savings account with a protective pet insurance policy sitting above it, every time.

And as far as veterinarians and their fees, I read an article in AAHA Trends magazine recently that said the reason vet fees keep going up is because most practice owners don't want to do the hard work of figuring out how to value their services. Instead they just raise fees, which as you point out forces good customers to spend more (happily) and others to perhaps go without or go elsewhere. Not a happy outcome I'm sure but I have a lot of empathy for veterinarians who want to do the right thing for pets but who are buffeted by many forces beyond their direct control.

Pet insurance - as it's being pushed in my area - is certainly NOT preventing "death by estimate" unless the pet parent is fairly well off.

The "pay upfront/wait for reimbursement" is the reality. Veterinarians are touting it as "preventing catastrophic decisions" (aka death by estimate). I have seen and heard senior citizens literally bawling because even while they have their pet insurance, they simply do not have the funds to pay up front.

Just how many beloved cats/dogs are being euthanized because of the misleading information?