Insurance Not Paying Out. Vet Going To Take Me To Court.

cptrayes said:
I'm guessing you are Bristol from your area, so I'll confirm that this is not about Bristol hospital, but I have a similar problem with centres with big machines needing to use them to pay for them.

A friend of mine sent a horse for a single foreleg lameness investigation to a big name hospital two months ago. The FIRST thing they did was a gamma ray scintigraph. Only after that did they nerve block to the foot, where the issue was. I find it extremely difficult to understand any possible justification for a scintigraph before a nerve block in a horse which is reliably lame in one leg only.
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Because they love to play with their new toys!Natural enough ,but expensive if it gets racked up.
 
fredthoroughbred said:
Thanks everyone. There were no exclusions on the policy and with regards to a pre-existing condition, kind of. Basically he broke the leg a year previously but it wasn't a clean break, it was very messy and he had to have it flushed at the vets every 48 hours until it grew some flesh coverage. It went well and amazingly he made a 100% recovery. A few months later he had a funny turn on a walk, very lethargic, no appetite etc. I took him to the vets, he was put on a drip and given antihistamines and made a full recovery within a couple of hours. The same thing happened a few months later, the vet gave him a course of antibiotics and he came back fine again. Maybe five or six months later, he had his final episode, was referred and they found 800ml of fluid in the cavity around his heart, they drained it but it came straight back. They then operated but his kidneys failed as his blood pressure went very low and he was pts : ( Pretty traumatic and pretty sketchy in terms of knowing what happened. The insurance are saying that it was linked to getting an infection a year before when he had his open wound. Everyone has said, it's unlikely but it can't be ruled out.
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What a rotten time you've had/are having!

Its a shame that they couldn't decide whether it was linked before they let the bill run up!
 
Honey08 said:
What a rotten time you've had/are having!

Its a shame that they couldn't decide whether it was linked before they let the bill run up!
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I don't think vet schools are veterinarians are obliged to consider whether or not an insurer may or may not pay out before treating. They generally consult with the owner, ask if they are insured and tend to ask HOW the owner would like to proceed. I am prepared to be corrected, but isn't the vet's obligation to treat as far as the owner sees fit, and the owner's obligation to check about the insurance?
 
I would pay the bill as a lot of people on here have already said (either in a lump sum or contacting The Bush to see about paying up in installments), I would also get an expert opinion from them about the likelyhood of the connection between last years incident and this happening. I would then contact the insurance company about this and start complaint proceedings if they are still unwilling to cough up/compromise, start the complaint proceedings as soon as possible as you can't just refer to the Ombudsman, they step in when the complaint is not dealt with to your satisfaction by the company, you can't complain straight to the ombudsman, so the quicker the complaint proceedings start the quicker you can refer to the ombudsman.
insurance companies will always try and wriggle out of paying things, with the amount outstanding either the ombudsman or the small claims court (again where the expert opinion will come in).
My vet always asks if I'm insured and how do I want to proceed, but my vet is brilliant and allows me to pay up my vets bill, I'm not insured after an arguement with an insurance company 18 years ago, I have put the premium equivalent into an account each month and paid vets bills from that (given the number of blood tests and medication she is now on, we have kind of run out and are paying up the remainder, but this is the first vets bill in 18 years so not bad).
 
Naryafluffy said:
I'm not insured after an arguement with an insurance company 18 years ago, I have put the premium equivalent into an account each month and paid vets bills from that (given the number of blood tests and medication she is now on, we have kind of run out and are paying up the remainder, but this is the first vets bill in 18 years so not bad).
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My vet actually advised this instead of using an insurance company, owing to the problems a lot of people have as well as the number of dogs were in the house (was living with mum, it's her account).

I'd see if the vets can come up with a repayment scheme and then I'd take it further with the insurance company
 
I cant belive Im reading this. Your poor greyhound gets a lot of treatment to try and save him and then when YOU have to pay for it you think you shouldnt have to just because its a uni? That is crazy!
Pay your bills - it should be treated as no different from any other company you deal with - they do the work, you pay in full on time. Its partly because of people who do not pay their bills that veterinary work is so expensive. All too often people say "Do anything to save him/her" and often WONT put a value down when asked then "can't afford" to pay. Its very very frustrating.

Lexiedhb - I cant believe you just suggested that - idiocy!! Would you try that on with any other professional?

As for the vet's letter saying she cannot be certain it is connected though it is unlikely - ANYTHING she signs her name to, she must stand over. NO way would I falsely certify anything for a client - it is far beyond the call of duty and not orth my career. As for gettin a second opinion vet to write a letter for that - forget it, if your vet has written letters then they will have been passed by the insurance company's veterinary adviser. These guys have 20yrs+ experience so can make up their own well informed minds about whether diseases/injuries are related or not.


ETA - I read the first 2 pages then posted befoe reading the rest. I am extremely sorry about your dog - I see the difficulty with linking it. Raising a complaint is probably worth doing, your vet has done as much as she can, but worth pushing the insurance again anyway. However, with regards to you outstanding bill, if the inurance still wont pay, then the above still stands.

And yes, it is the owner's responsibility to check insurance and to make sure they have the money to pay BEFORE going ahead with treatment - not the vets.
 
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glenruby said:
As for the vet's letter saying she cannot be certain it is connected though it is unlikely - ANYTHING she signs her name to, she must stand over. NO way would I falsely certify anything for a client - it is far beyond the call of duty and not orth my career. As for gettin a second opinion vet to write a letter for that - forget it, if your vet has written letters then they will have been passed by the insurance company's veterinary adviser. These guys have 20yrs+ experience so can make up their own well informed minds about whether diseases/injuries are related or not.
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So why does anyone get a 2nd opinion then if all vets/doctors etc must come to the same conclusion from 1 letter?
My friend had the vet to see a horse, wasn't happy with the diagnosis so got a 2nd opinion, which then turned out to be the correct diagnosis.
The original vet has stated that it's unlikely in her opinion, may the 2nd vet would say the same or maybe in their opinion it's not connected at all, that's why we are advising her to ask.
I don't think anyone is suggesting that she doesn't pay, and from the original post the OP thought the insurance company would pay and she was going to argue with the insurance company over payment but the vets want payment now. Everyone on here is advising to pay the vet and then take it up with the insurance company.
Bear in mind that the insurance companies advisers are likely to go with the opinion that it may (however highly unlikely) be connected, that's how insurance companies work.
 
SusieT said:
'I would tell the vet that is their fault the insurance are not paying due to what they wrote and see if they will split the bill.... '

No. The vets have a responsibility to tell the truth. If that truth is that they cannot rule out the problem being caused by a previous health issue, that is what they have to say. Why should they pay for telling the truth?
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but the truth is so very wishy washy.... either say YES it was related or NO it wasnt, not if it happened once a million moons ago on a blackcurrent tuesday then they are related. Have some conviction and no room for doubt.
 
Lexie - there are many cases in which a vet can be certain (read as beyond reasonable doubt) that 2 conditions are not related - however NOT in this case. No cause was found for the first 2 infections both of which responded to ABs. We dont know from the post if ANY infection has taken hold at the time of the break - but i assume it was a high risk if it was being constantly flushed. Infections can lay dormant for a period of time and respond to treatment but not be fully "cured". The above outslines the element of doubt - not small enough IMO ( without the full facts of course - but then the insurance company will not necessarily have a huge amount more info to go on than we do) to be happy to say definitely not related.

Naryafluffy this has nothing to do with a normal 2ndopinion. And a second opinion vet wont give a 100% answer without examining the animal as well as full records (or usually repeating some diagnostics) which in this case sadly is not possible. There is a possibility a professional witness vet with experience in this area may be worth trying though. Though, basically, the insurance company vet advisers ARE their professional witnesses and experts in their field. The fact of the matter is, if their vet adviser sees that there is a direct link or a possibiltity f one which cannot be/was not ruled out - then that is it. A second opinion wont make them change their mind - UNLESS, it is brought to court/ombudsman. Then it would be best to have the expert treating your animal to back it up.

Yes, I agree - problem has nothing to do with the vet. Sort your bill out first then do what you want with the insurance company.
 
SusieT said:
'I would tell the vet that is their fault the insurance are not paying due to what they wrote and see if they will split the bill.... '

No. The vets have a responsibility to tell the truth. If that truth is that they cannot rule out the problem being caused by a previous health issue, that is what they have to say. Why should they pay for telling the truth?
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Whilst this is pure conjecture, most vets will ask about insurance, if they feel that the problem is likely to run into serious money. Being told "Oh yes, He's insured" is rather giving them a free rein.

The problem arises when the Vet's opinion, negates the insurance, and under those conditions, I would ask that they again review their bill. It seems that they treated the dog, poked an horrendous bill into the owner, and then pulled the rug from under the owners feet. When the Vet received the questions from the insurance company, then they must have been very well aware of the results of their words.

Whilst my thoughts may not stand up in court, the Vets would be very well aware that their actions contributed to the owners problems, and short of appearing to be a little less than straight forward, it may provide a degree of leverage!!

Alec.
 
glenruby said:
Naryafluffy this has nothing to do with a normal 2ndopinion. And a second opinion vet wont give a 100% answer without examining the animal as well as full records (or usually repeating some diagnostics) which in this case sadly is not possible. There is a possibility a professional witness vet with experience in this area may be worth trying though. Though, basically, the insurance company vet advisers ARE their professional witnesses and experts in their field. The fact of the matter is, if their vet adviser sees that there is a direct link or a possibiltity f one which cannot be/was not ruled out - then that is it. A second opinion wont make them change their mind - UNLESS, it is brought to court/ombudsman. Then it would be best to have the expert treating your animal to back it up.
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There were 2 vets look at this animal, the OP's normal vet and the The Dick Vet after it was referred, that is who they are being advised to get a 2nd opinion from as they treated it as well and I'm assuming they would know what was wrong with the dog and if they are likely to be related. Until you ask the vet from The Dick Vet then you won't know if their opinion is the same as the original vet.
 
Personally I had a similar issue with horse insurance and an ambiguous letter from a vet. Vet letter said horse had a ' small bony growth near hoof wall that could be ringbone but no changes noticed. Horse insurer discluded whole leg from insurance. Vet wrote another letter saying she re examined and was happy it wasn't ringbone. Leg went back on cover with insurers.

Vets are not stupid they know what insurance companies are like and the first question asked on needing one is ' is your animal insured'?

I believe treatment plan is adapted according to whether the animal is insured or not. If it is they will do more.

I feel for you OP, we spend our premiums expecting vet costs are met in our hour of need and when they aren't following some letter its maddening. I would contact your vet saying you need a definitive answer to whether an infection from a year ago caused a death a year later. If yes pay the bill and put it down to experience if no challenge it. If the answer is yes however I would wonder about the treatment in that year not being sufficient to heal your dog, was the severity not noticed early, was the treatment finished too soon etc etc.

Anyone who thinks vets are anything other than money making machines, whether thats through us or the insurers are sadly naive.

Having said that any genuine bill should be paid.
 
BBH said:
Anyone who thinks vets are anything other than money making machines, whether thats through us or the insurers are sadly naive.

Having said that any genuine bill should be paid.
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Generally speaking, vets are working for a living. They often do the job because they love it, but it IS still a living they have to earn. Veterinary medicine IS expensive and we do expect the best care from them.

I understand the frustration of trying to get an insurer to pay out. I've had to pay for rather expensive bone scan on my horse 2 years ago simply because I didn't have the vet phone them BEFORE to let them know what they were going to do and why. I naiively thought that the treatment was covered (it was, but only with the magic phone call first). Expensive lesson learned the hard way.

Can't blame the vets though.
 
Wasn't going to contribute to this but had to respond to BBH's sweeping comment that all vets are money making machines. My vets have always discussed all options with me, whether animals are insured or not, and will always do their best to keep costs down. In fact after losing Buffy in the summer, after a lot of treatment (she wasn't insured) the vet didn't charge me for pts (including a home visit) as he said he felt she had cost me enough over the years.
To OP, as I understand it, your own vet stated she couldn't rule out a connection, so it possibly would be worth asking the vets at The Dick if they could help. However you really cannot refuse to pay the vet hospital, you are quite lucky they didn't ask for payment up front, I think a lot of vet hospitals do this because they have been caught out so many times by people not paying. If the hospital feel able to state the 2 conditions aren't linked then I would follow the procedure suggested above to take action against the insurance company.
 
MurphysMinder said:
Wasn't going to contribute to this but had to respond to BBH's sweeping comment that all vets are money making machines. My vets have always discussed all options with me, whether animals are insured or not, and will always do their best to keep costs down. In fact after losing Buffy in the summer, after a lot of treatment (she wasn't insured) the vet didn't charge me for pts (including a home visit) as he said he felt she had cost me enough over the years.
To OP, as I understand it, your own vet stated she couldn't rule out a connection, so it possibly would be worth asking the vets at The Dick if they could help. However you really cannot refuse to pay the vet hospital, you are quite lucky they didn't ask for payment up front, I think a lot of vet hospitals do this because they have been caught out so many times by people not paying. If the hospital feel able to state the 2 conditions aren't linked then I would follow the procedure suggested above to take action against the insurance company.
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Very well articulated, my vets are brilliant and are aware that my horse isn't insured and discuss any way that can bring treatment costs down i.e. just running the blood test for ACTH levels instead of everything, suggesting getting medication at a pharmacy as they can't competitively price her medication etc.
I would speak to the Dick Vet about paying it up, years ago we had a pony go in and the insurance wouldn't pay for his treatment and they were really good about it (but that was years ago, but worth speaking to them about), obviously we don't know what communication you've already had with the Dick Vet and if they know of the issue over insurance not paying out or if they just think you're not paying, but speak to them and explain and then take it from there, if you end up down the Ombudsman route you will need to get their expert opinion anyway I would think.
 
Thank you all for your great advice. I'm not a vet hating, payment refusing horror, I just wondered if anyone had ever had any positive outcomes in a similar situation. Clearly not. The vets were lovely and they tried their best and acted very sensitively towards the situation (although I stand by my statement about them using their big, fancy, expensive machines a little bit too willingly). They did ask if I was insured and I said that I was because I was fully insured with no exclusions. I don't see why you should have to consider not having work done to your pet if you are fully covered, that's what it's there for. I wouldn't say I was naive for thinking this. Anyway, I can probably get half of the money and fingers crossed they let me pay the rest off (very slowly). I'll let you know how I get along. Thanks again : )
 
Onee last point - BBH I have to say youare very wrong and would love to know what motive you think these vets have for racking up costs. Doyou really think the money is what they are thinking about?
How mny of you have a senior partner as your usual vet? How many have a more junior member of staff without a financial interest in the business? How much do you think a a) year, b) 5 year, c) 10year qualified vet earns? How much less or more than the average vets salaries do equine vets earn? Has it ever occurred to ANYONE who claims vets are just trying to get their money by doing asmuch diagnostics etc that YOUR vet is not gaining anything financially from it? Thought not. MOST (almost all) vets are not paid on commission - therefore the cost of treatment has no bearing on their income. FACT


Naryafluffy -that IS what I recommended she do but most replies were telling her to source another 2n opinion. I read the previous replies ages ago, yu can drop the patronising tone thanks.
 
fred_t_b,

I really don't mean to labour the point, but were I in your shoes, I would ask of the insurance company, to see the evidence which they have, to deny your claim. ie. the vet's report. If the Insurance Company have grounds for refusing payment, then you have the right to have those grounds placed before you, I'd say.

If they worded their questions in such a way that the vet had no choice but to be open, then you also have no choice but to pay the bill. If however, the vet volunteered information which wasn't asked for, and that negated your right to compensation, then the vet, in part is responsible for your position, and should offer a reduction in their charges.

Ask to see the vet's report, you are entitled to that.

Alec.
 
My personal opinion is that one way or another the bill needs to be paid as it is not the Dick vets fault that your insurance company is throwing their toys out the pram. I think if they have thus far given you 9 months to find the money and are only now talking about court then they have been very reasonable. I'd say pay off what you can afford now and work out a payment plan for the rest. Also as has already been said it may be worth asking their opinion on whether the 2 conditions are related. It may be that they agree with your own vet in that there is no way of saying absolutely 100% for sure but that it is unlikely or it may be that their greater amount of experience in that area allows them to say that they don't feel there is a connection. Got nothing to lose by asking certainly. Did your insurance company inform you at the time of the original condition that they would be placing exclusions on your policy, if not that could certainly be something to throw into your complaint to them. Unfortunately if they did tell you about the exclusion after the treatment for the original condition and there is a slight chance that the two are linked then they may be able to justify why they are refusing to pay, still stinks morally and they really should have told you at the outset if they thought there was a chance of them not being able to pay as you may have had to set lower limits on what you were prepared to spend but they may still end up getting away with it! Good luck with it anyway!
 
Just a thought - but you probably had to sign something saying that you would pay if the insurance company would not - that is standard policy and I had to do that when my horse was scoped - I had rung the insurance company to check I was covered and taken my vets advice but there was STILL an element of doubt that they would pay (this is NFU) - not a pop at them just that not all the bills etc were in. Good advice on here and I would have gone ahead thinking I was covered too but think the ombudsman are the way to go. Very often if you stand up and make a fuss, these companies will back down because it is cheaper to do so!
 
If your vet can honestly say its say 90% chance its unrelated, 10% chance it is, I would be asking the insurance company to settle on that basis ie pay out 90% of the claim, Worth a go as it would make a big dent.

Also recommend getting the Dick vet to give their opinion and demanding the vet reports from the insurer.

In the meantime I would be getting the credit card/loan or whatever you need to and getting the Dick paid or making an instalment arrangement with them. Its not their monkey to sit on their shoulder, it's between you and the insurers. Yes treatment at vet colleges is v expensive but thats no secret, its just the way it is. Its not their fault people choose insurance based on lowest premium and not on their reputation for honouring claims.
 
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