Referral Vets crazy crazy Bill! Nothing like the quote!!!

snopuma

snopuma

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Ok so rushed very injured horse to referral vets, told 70% chance of getting through, never ride her again, but hope as a broodmare told would cost £5000 +VAT agreed to go ahead despite no insurance!

Told it would be surgery then 4 weeks there in a cast. Horse PTS on day 18 and bill pleasantly put in bag with cremation box and bits of mane, how thoughtful!

Invoice is nearly 9,500 holy S**T!!!!!!

Queried with them and told to pay up or court

Checked with trading standards and they say only have to pay reasonble costs towards estimate.

Now vets saying that they never told me 70% chance and that I insisted on going ahead despite really poor prognosis!!!!! WTF this never happened

Complained to vets that this was a lie now have letter today saying not to contact them as I have made a serious allegation against a member of staff? What when I said that was a lie? It was a lie! they have changed the notes and are running to the hills

WHAT CAN I DO?
 
My god! I really can't add anything of importance but I had similar with a Vet practise. They misdiagnosed my dog then reffered to late, the dog died a horrendous death 20 mins after arriving to the hospital.

We tried to take further with vets as we had very good evidence, we then found they had changed all the notes. We knew they had done this as we had seen the note on the computer when are dog was with them. I couldnt believe it tbh, upsetting wasn't the word. It's very hard to take any form of action against vets.

Did you get the estimate in writing?
 
If notes are computerised it is impossible to remove or change hem completely without there being evidence of changes. This is the way that veterinary software is set up. Changing it can go against them in court - as the info deleted cannot be verified. Send them an official letter staitng how unhappy you are etc etc. Very few practices will want to take you to court and may offer a settlement. However you may come up against the VDs who are very very good at defending cases so you need a watertight case to win tbh. Im not sure a false estimate and a large bill are justification for not paying up though. What op did your horse have? 70% success is atually quite a low success rate. Its not uncommon for owners to refuse to pay up when the outcome is not what they hoped for - bills have to be paid whatever the outcome.

Just to add, £5k plus Vat and euthanase/cremation(which wouldnt have been quoted for) would be approx £6.5-7k. I suspect some of the extra was related to the complications resulting in her being PTS - these are never quoted for with the initial estimate. Were you kept up to date with treatment along the way - drugs etc. Any extra treatment tried before pTS?
 
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I assume the vets did not produce a written estimate at the time (which is bad practice in itself), but was there anyone else present when they discussed possible costs with you?

This looks like it may escallate into a legal dispute so I would advise you to get legal help now. It would be best not to call or e-mail them, but put everything in writing. Depending on what your lawyer says (do you have BHS memebership? might your house insurance cover legal advice?) you should write to them, outlining what they had initially said and asking for a full break down of costs, including exact procedures carried out, number of hours worked on the horse (including which vet did the work), cost of livery, cost of drugs, cost of euthanasia, cost of cremation, etc.

Sorry you are having such a horrid time of it, especially following the death of your horse.
 
glenruby said:
If notes are computerised it is impossible to remove or change hem completely without there being evidence of changes. This is the way that veterinary software is set up. Changing it can go against them in court - as the info deleted cannot be verified. Send them an official letter staitng how unhappy you are etc etc. Very few practices will want to take you to court and may offer a settlement. However you may come up against the VDs who are very very good at defending cases so you need a watertight case to win tbh. Im not sure a false estimate and a large bill are justification for not paying up though. What op did your horse have? 70% success is atually quite a low success rate. Its not uncommon for owners to refuse to pay up when the outcome is not what they hoped for - bills have to be paid whatever the outcome.

Just to add, £5k plus Vat and euthanase/cremation(which wouldnt have been quoted for) would be approx £6.5-7k. I suspect some of the extra was related to the complications resulting in her being PTS - these are never quoted for with the initial estimate. Were you kept up to date with treatment along the way - drugs etc. Any extra treatment tried before pTS?
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No complications, apart from they were doing a second cast change, said 'its a mess I'm sorry' and we had her PTS, And I would be querying this just the same if she had been there the full four weeks, and was home now in her stable on box rest I am sure it would have been about £14,000 by then and that's just not on, they had the cheek to say their estimates are accurate in one of their letters! Cremation and drug to put her down only come to about £650 inc VAT so its still way way over!
 
Estimate-5K. Vat-6-7K.
+ PTS costs-6450=7650. So still a 2K difference. did anybody flag this up before then? Did you sign anything regarding it only being an estimated cost? How do you know they've changed the notes?
 
So sorry that you have lost your horse and instead have a very large (by anybody's standards) account to settle.

One difficulty is that you probably have no history with the referral practice, they do not know you and you are not bonded to them, therefore they are less inclined to help.

Presumably you signed a consent form when your horse was admitted, there was probably a section on payment there. You may not have registered the terms as you were surely very upset.

Your own referring vet will be up to speed on the case, have you discussed it with him, could he act as a mediator?

As a previous post, think very carefully before taking them to court, the Veterinary Defence Society is a force to be reckoned with.

I hope you find a way to get this resolved.
 
I would say if you had a written estimate of the costs i.e. around £5K + VAT that if the bills started to come anywhere near this mark they should have informed you asap. Then you could have decided whether to carry on with treatment or PTS. Even if they are saying the extra was due to the unfortunate actions of having her PTS there is a difference between £6K and £9.5K!!

When i had my last horse treated at leahurst, he wasnt insured i had to sign to say that i authorised treatment upto £ x amount.... and if the treatment was coming near that figure they would let me know so i could reassess.

I agree the way they have given you the bill is disgusting. Sorry for your loss
 
SusieT said:
Estimate-5K. Vat-6-7K.
+ PTS costs-6450=7650. So still a 2K difference. did anybody flag this up before then? Did you sign anything regarding it only being an estimated cost? How do you know they've changed the notes?
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I know they have changed the notes, because the vet who i dealt with through all of this went through them very soon after she was PTS and now the other vet who is writing all the letters who I do not know has informed my that the notes now say 'she has a poor prognosis, and that I 'Insisted' on going ahead anyway' which never happened, if a vet can change the notes then how can I keep telling the truth and they keep making things up?
 
1stly I am really sorry about your mare.......recently my dog had to be operated on and although initially it was a quote they kept me updated on all the costs all the way through and offered the costs for alternatives, even day and night care costs.

Each time I had to give consent.

On another note I took a friends horse to a referal vets very recently and they too gave costs before continuing e.g exrays, nerve blocks, cost of medication

I can not believe this veternary practice did not diclose full costs, infact I would ask them for the initial evidence to the potential costs. Personally I would pay them ' reasonable' costs then let them take you to court, they would then have to prove why the incresae is payable - reasonable costs could be an average of some quotations from other vets or the costs you expected, definitly pay some because the courts will just see it that you are looking for a way to not pay.

Good Luck..........
 
Have you asked your vet about the notes changing? You ahven't answered my other questions which are quite important.
 
SusieT said:
Estimate-5K. Vat-6-7K.
+ PTS costs-6450=7650. So still a 2K difference. did anybody flag this up before then? Did you sign anything regarding it only being an estimated cost? How do you know they've changed the notes?
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Sorry!

I had an update at 1st cast change 10 days in that it was 3,800, and I thought at the time thats alot but then, after that it was just box rest and bute, still leaving 2.5 weeks and 1200 sounded alot to cover that, I mean thats some full livery! she had a catheter in and every time they administered bute the charged me for the bute and £10 each insertion into the catheter (nice work if you can get it!) The charged me £125 + VAT just for turning up (referral fee) I signed a consent before I even knew what we were up against, it was sign here and what feed does she have, did you bring any rugs? I don't have a copy of what I signed we got bustled into the waiting room. Also I have 6 witnesses at my yard who heard the conversation between my vet and the referral vet and my vet telling me that they are quoting £5000 + VAT and me saying ok. Not to mention OH as a witness to the estimate in the vets office at the referral and a third party who also was relayed the estimate and percentage and prognosis.
 
Catheter care can be expensive, not unreasonable for chaarging for it. Ok, so you signed a form, can you get a copy of that? My guess is it will say this is an estimate, it could be a lot more and that will be where your legal case will fall down, particulary as you did get an update when it was 1200 from 5K, at a referral centre that will ratchet up.
5K was just an estimate, not an actual this is where it stops. Howeevr almost double is a lot. So after the ten days what else was scheduled? At the second cast change was she anaesthetised again? What else racked up the money? These are the things you need t look at,i.e were the costs reasonable.
I think you should be able to argue some of this down I have to say, but impossibel to say without seeing the bill
 
SusieT said:
Catheter care can be expensive, not unreasonable for chaarging for it. Ok, so you signed a form, can you get a copy of that? My guess is it will say this is an estimate, it could be a lot more and that will be where your legal case will fall down, particulary as you did get an update when it was 1200 from 5K, at a referral centre that will ratchet up.
5K was just an estimate, not an actual this is where it stops. Howeevr almost double is a lot. So after the ten days what else was scheduled? At the second cast change was she anaesthetised again? What else racked up the money? These are the things you need t look at,i.e were the costs reasonable.
I think you should be able to argue some of this down I have to say, but impossibel to say without seeing the bill
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The price for 18 days of antibiotics is £2,500 + VAT alone I got a quote from a pharmacist and this is 10 times what it costs for me to buy it and they still make money when I purchase it at that price, the bute is 5 times what it costs, the ACP is 4 times what it costs, 'catheter care' interesting term, we were told that the catheter would change sides etc so that the vein wouldn't collapse, I saw her every 3 days the catheter was always the same side and with respect a trained monkey could put an injection in a catheter!
 
I would phone your own vet monday morning and discuss it with them as to wether they think the charges are reasonable, and where they feel you should go from hear, sadly I fear that you will be paying most of this bill, with nothing to show for it.
R.I.P. Horsie
 
I'm sorry to hear about your horse. What was the exact injury she was in a cast for and what exact drugs was she on?
The reason I ask is I have 4 yrs experience of equie nursing in an equine hospital and knowing your horses injury will help me make some sense. Last time I was equine nursing hospitalisaton wasnt cheap and putting a cast on a horse is expensive as the materials are, due to the expensive drugs, some medications used to treat horses are extremily expensive and unfortunately vets dont have a choice but to order through their supplier for things if the animal is an inpatient. Baytril for example is extortionatley expensive and the average horse has about 60mls at a time.

How long was your horse hospitalised for? Did she have any clip signs on the other side of her neck?
 
In all honesty my first reaction is that 5k + VAT does not sound like a lot to cover surgery, cast changes, hospitalization for a number of weeks and any medications required. Any medications administered to horses cost a lot simply because of the high doses and hospitalization costs an arm and a leg as it is not your bog standard "full livery" (and god knows some places charge in excess of £100 a week for that!) and includes all the monitoring and nursing care given to the horse as well as food and mucking out. I'd say you need to request an itemized bill if that is not what you have been given already (I do agree that the manner in which this was handed over was far from professional and this should either have been done in person with someone on hand to discuss it with you or it should have been posted to you) and go through it with a fine-toothed comb and if there's anything you aren't sure about then query it. Also don't worry about not been given a copy of the consent form you signed, it's not really common practice for owners to get a copy of these but legally the practice should have retained the form and filed it (let's put it this way, it would reflect very badly on them if not ). If they really genuinely did lead you to believe that the 5k was an absolute estimate and they failed to inform you when it became apparent costs were going to exceed this and you have strong reason to believe your records have been tampered with then by all means lodge a complaint. (you may also want to look into lodging a complaint through the RCVS if you really do strongly believe professional misconduct has taken place here)
 
flaxen said:
I'm sorry to hear about your horse. What was the exact injury she was in a cast for and what exact drugs was she on?
The reason I ask is I have 4 yrs experience of equie nursing in an equine hospital and knowing your horses injury will help me make some sense. Last time I was equine nursing hospitalisaton wasnt cheap and putting a cast on a horse is expensive as the materials are, due to the expensive drugs, some medications used to treat horses are extremily expensive and unfortunately vets dont have a choice but to order through their supplier for things if the animal is an inpatient. Baytril for example is extortionatley expensive and the average horse has about 60mls at a time.

How long was your horse hospitalised for? Did she have any clip signs on the other side of her neck?
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lacerated heel bulb all to the way to the front of the hoof then a split 2/3 rds of the way down the hoof from the top, x-rays revealed more than 25 fractures to the pedal bone.

she was on crystapen and gentamicin, bute and acp (for 10 days)

and no clipped area on the other side.

Any help would be greatly appreciated, I can't sleep properly and the worrying is making me ill.
 
I am so sorry this all happened, I understand just how you must feel, don't rush in to anything, already you have advised them verbally that you are unhappy.
I suggest that you pay only up to what you consider reasonable( don't be specific here just in case they make an offer less than you were willing to pay), but pay week by week, (say £50 to £100 per week), always pay on same day so the record looks good in court, from now on, you must now act in a formal and positive way.
You need legal advice, but not much at this stage, I would let them get in touch with you regarding payment, and respond within seven days to each letter, if they phone you or you communicate in any way, make sure that any mutual agreement is put in writing, it is up to them if they want to put anything in writing if you cannot come to an agreement.
I think your own vet should be kept informed, it seems to me that they are in the best position to act for you informally (maybe behind the scenes), the fact that you were uninsured is relevant, did you say to them "fix it at any cost?"" did you discuss the possible outcomes with them, what were their impressions of your attitude at the time, these things are relevant, and they may have given the other lot the wrong impression, or the right impression, you really need to know. One thing you could do is to set up a meeting with your own vets, to include the senior partner and any vets you dealt with at the time, this may help your case, and it can't make it worse imho.
This is going to drag on, try to dictate the pace yourself rather than having notification of legal action taken against you one morning out of the blue.
 
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Pay the £5000 plus vat.Send it by post ,as a cheque.Include in your accompanying note,"in full and final settlement". Dont go into details keep this note Very brief.They will almost certainly bank the cheque,and then the matter is closed because they have accepted payment in full settlement.If they dont bank the cheque ,at least you have made a reasonable offer of payment and it is then up to them to try to pursue you in court. This will at least gain you credability in court. Dont discuss anything with the vets now that they have threatend a court action.
 
MrsD123 said:
I am so sorry this all happened, I understand just how you must feel, don't rush in to anything, already you have advised them verbally that you are unhappy.
I suggest that you pay only up to what you consider reasonable( don't be specific here just in case they make an offer less than you were willing to pay), but pay week by week, (say £50 to £100 per week), always pay on same day so the record looks good in court, from now on, you must now act in a formal and positive way.
You need legal advice, but not much at this stage, I would let them get in touch with you regarding payment, and respond within seven days to each letter, if they phone you or you communicate in any way, make sure that any mutual agreement is put in writing, it is up to them if they want to put anything in writing if you cannot come to an agreement.
I think your own vet should be kept informed, it seems to me that they are in the best position to act for you informally (maybe behind the scenes), the fact that you were uninsured is relevant, did you say to them "fix it at any cost?"" did you discuss the possible outcomes with them, what were their impressions of your attitude at the time, these things are relevant, and they may have given the other lot the wrong impression, or the right impression, you really need to know. One thing you could do is to set up a meeting with your own vets, to include the senior partner and any vets you dealt with at the time, this may help your case, and it can't make it worse imho.
This is going to drag on, try to dictate the pace yourself rather than having notification of legal action taken against you one morning out of the blue.
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I now agree with the idea of paying the £5K with full and final payment, if you are happy with that, make sure you advise them that there were five witnesses (time and date), this is absolute essential to any outcome, and by the way, after this is all over and the dust has settled there is no reason that I can see that you don't make a complaint to their governing body, they take a dim view of unprofessional behaviour.
 
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I am really sorry you have to deal with this as well as the sad loss of your horse in very stressful circumstances. I think you need professional advice
 
So very sorry you lost your horse in such a sad way. I think Mikes idea is a good place to start. Then get some legal advice about what to do if they chase you further.

The one thing I would say is that vet care or medical care for humans is labour intensive and expensive. I know you can buy antibiotics for less and you would be able to inject a catheter but you pay for the additional care and knowledge that goes into the whole package. I am not saying they did or did not overcharge but they are a business and are profit making so arguing about how much they choose to charge for their services will probably get you nowhere. Your best bet is to stick to facts and argue that the bill was double the estimate. I suspect if you have lots of witnesses you will win. Good luck.
 
I am surprised at them even trying with that number of fractures to a pedal bone.Hope they accept your £5000;if you need help use the SHG people to find you a soliciter.Good Luck.
 
EAST KENT said:
I am surprised at them even trying with that number of fractures to a pedal bone.Hope they accept your £5000;if you need help use the SHG people to find you a soliciter.Good Luck.
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^^^
Agree, seems crazy to even attempt something with that amount of fractures. I think that vets are unused to owners questioning their charges due to the emotion attached to animals. I think Mikes suggestion is a good one!
 
TBH would you want an untrained person injecting? Someone who didn't appreciate that it needs to be kept sterile?
I am amazed they attempted it with a wound like that, I really can't see them saying 70% prognosis,
You may be able to get the antibiotics cheaper but as mentioned above, they have suppliers. Everything is marketed to cover the overall cost for the hospital-i.e running costs, staff costs, machine costs. I suspect the second GA was what racked you bill up if she had a second GA for cast change? You never said.
I would be v. interesed to see the bill as I think it will explain and as long as costs were reaonable, and you signed the form saying this was only an estimate, you will not have much luck.
 
so sorry to hear of your loss and the situation you are in. Just a few examples of my situatuion and how i think it was handled in the correct manner.
my horse was reffered to a large equine practice. from the very first minuite we sat down with the vets and they went through an estamated cost form word for word with me. they discussed my budget, any possible complications and there assosiated costs. went through the livery costs in full and what that did/didnt cover and what any extras would cost. even though this was an emergency they still took the time to explain everything in full, gave me a signed copy of everything and rang every day to tell me what they'd done and how much my bill was. in the end it came in about £25 under there estimate in the end.
 
Toadd, catheter sites are not routinely changed as once it is present so long as there are no problems, it is good to stay there.
 
Isn't an estimate just that - an approximation of costs?

I'm assuming that the bill breakdown looks correct and that you have no complaints about your horses treatment - however if this is not the case a letter outlining your concerns is how to start discussions with the practice. And if you can't reach agreement you then proceed to take legal action.
 
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