Large vet's bill - advice please

Rummer

So sorry to hear about your boy.

There must be a professional body that you can contact to get advice? Try contacting the British Veterinary Society or go to the CAB. Solicitors often offer a free initial consultation and then at least you will know legally where you stand so that when you finally get to speak to someone you have all the facts.

1jim

Sooz00 wrote: »

The surgery was scheduled to be an abdominal exploratory surgery. We had agreed that if it was operable (i.e. not attached to blood vessels etc.) then they would remove it. If not, they would try and debulk it to try and make it more chemo sensitive as he has handled his chemo well apart from this one resistant mass. When they opened him up, they saw it was vascularised and attached to 'the pylorus/proximal duodenum, the epiplon and the body of the pancreas' (took that from the discharge note). It also says 'Some major physiologic blood vessels were adherent to the mass and had to be ligated'. They didn't contact me at that point. They decided that despite the risks (which were high), they would attempt a complete resection which obviously caused complications, loss of lots of blood, etc.

I have already spoken to one of the clinicians involved and they have said the bill is correct and stands. They made me feel more guilty for even questioning it by saying that they should have told me but their priority at the time was to save my boy. I feel quite hurt and let down by that on top of everything else. They say they can't foresee complications like this but the bill is accurate. They corrected it by about £50 in my favour because they charged me for blood used in a transfusion that my other related pet actually donated. This was only after they rang me to tell me they thought they were going to lose him on the table due to complications and blood less. At that point I suggested the transfusion.

He is insured but this bill leaves us no cover left for any follow up. We already know follow up is required and will be ongoing as prior to removal of the mass, the biopsy confirmed large cell lymphoma. If I had known the operation would be this expensive, I don't think I would have put him through it, if I couldn't afford the aftercare. It wouldn't make sense or be fair to my boy. I'm not eligible for PDSA but I don't think they would pay toward this anyway.

I think I need to have a conversation with the MD. The office staff were not very helpful yesterday because the clinicians do the bills themselves. I wondered if there are any rules about things like this, estimates being way under and no-one advising. Previously, they had always advised if something was going to go over estimate so you can make informed choices so although I suspected my bill may be more due to the complications, I had no reason to suspect it would be significantly more, certainly not double!

Sorry, I was going to cut and paste some of your message but think I get the gist of what has happened,
you and vet agreed plan, explore, remove if possible, partially treat if removal wasnt possible
vet decided to do more work (not agreed before hand) after starting procedure but did not agree this with you before proceeding- this work caused complications and you have been billed for them.The vet did this with best intentions but it was not what you would have wanted

Did you sign a consent form/agreement? If you have read it carefully- is there a clause about "any other procedure that is deemed necessary" or similar- if so you may have to pay

In human healthcare the medics would normally open up the patient- see what they are dealing with and if more difficult than they were expecting and hadnt discussed this before the procedure would ask relatives how they wanted to procede.

Given that the £4k is covered by insurance the vet wont be to worried about this, what I would make sure they know is that because of this huge bill that you now can not cover follow up care costs and see if there is any way they can assist with these expenses in anyway or if they can suggest an alternative course of action.

To be honest though I am a realist and if you dont want to read the rest please stop reading now (same goes for anyone else who will get angry/upset/emotional as it is really not my intention to upset or cause distress)
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Ok, my take on this, assuming the rest hasnt worked is that the £4k bill that you currently have is covered by insurance, let insurance deal with it
you cant afford follow up care, insurance wont pay for more than the £4k above,
you probably have already thought anout letting him go and have alluded to this already in some of your posts. Given the above points and the need to reduce suffering it is probably time to let him go peacefully without further pain or suffering. I know that this is not what you wanted, hoped for or expected but from a purely pragmatic view it is probably the most humane. I hope if you have read this far that this has not upset you, that was not my intention. Best wishes

rising_from_the_ashes

Jim, if I was in the OPs shoes this is what would have made me really angry.

By proceeding with an op that appears to have been a hugely more complicated procedure than initially discussed, they have taken away the right for her to make the decision on whether she would want to put her pet through such a big op and, IMHO, that's disgraceful (and a separate issue from the money side of it).

OP, how is he today?

kiwi07

How is your cat today?

Sooz00

Elle7 wrote: »

Was chemo still an option after he had been opened up?

I haven't yet studied this fully, but I understand that after surgery there is a recovery period in which chemotherapy would be 'inadvisable' (I'm looking at my study books now!) so maybe it was the case that there was no alternatives.

If there was, I think I'd be discussing the options with the vet. They don't seem very contactable...I don't think emailing or calling back later is a suitable response to an animal who has just had such a big surgery and is not eating or drinking independently. Before he was released they should have witnessed him doing this, and that he was urinating/defecating properly - he should not have still been on a drip, in most circumstances.

It may be that they feel he will thrive better at home, if he gets stressed in vets/around strangers/around other animals, but they should have warned you that this was why they were releasing him, and to take him straight back in if he struggles at all.

In my opinion, treatment isn't complete, and you should take him back and explain that for a bill that is double what was quoted you are not at all happy, and speak to someone who is in a position of authority.

As an afterthought, you should have discussed treatment options before he went into surgery - if you did, and you told them that if any blood vessels etc were involved you did not want them operated on, then why did they do it?

While you are there, I would also make sure you know exactly what is happening with regards to the prognosis. This should also have been explained before - do they believe this will give him a substantial period of time (years?) or is it a more temporary treatment? I'm sorry if that is an upsetting question - its just that as the owner you should be given the choice of what area to go for...while vets have the animals best interests at heart, they also need to consider what you want.

When my dog got MVD, there were a range of medications available at first, but when we took him in to say goodbye, they could see I was very, very upset. I hyperventilated, and had to delay it for 15 minutes to calm down. I really struggled with it - at this point they offered other treatments, in this case manually 'draining' his chest to make him more comfortable, which would possibly give him days or weeks. This was entirely my choice - the same principles should have been applied to you. It is your decision if you want any treatment, and how much.

I hope this has been of some help and isn't just a huge ramble!

E x

Hi Elle,

Re chemo. The plan would have been to close up, wait a week and then start on a new chemo protocol. We were also looking at radiation being a possible option at a different clinic.

With regard to the op. it was an exploratory surgery to see if the mass was operable. The ultrasound a few days earlier had made it seem like it was not mesenteric and that there were not major blood vessels involved so might be operable. The surgery was to investigate this and if found to be the case, remove it if safe to do so. When they went in, they found it was attached to major organs and major physiologic blood vessels. IMO, they should have called at that point and let me know so I could make an informed decision, but that didn't happen, they just decided to go ahead.

They didn't tell me how long this would give him.... at the moment I still don't know the prognosis and we don't know what the effects of the complications they encountered will be either. Ligating blood vessels and removing part of the intestine and pancreas may cause complications themselves.... he needs monitoring and someone needs to go through everything with me in detail....

The situation with the bill has been escalated to the financial director for the moment as the managing director is not back in for another week or so. I need to discuss things with both really, one about the financial side, one about the clinical side. Particularly in light that I have had to take him back in and they are now charging emergency fees and insisted on repeating procedures my GP vet carried out so I am paying twice for things...

Sooz00

rising_from_the_ashes wrote: »

Oh Sooz, I'm so sorry to hear you're boy's been through the mill and hope he's a bit better this evening?

I agree with you totally - if you'd agreed that the lump should be removed if "easily done" then this is what they should've done. If, on opening him up, it was obvious that this wasn't the case and the surgery would be much more extensive, then they should've called you at that point, discussed it with you and allowed you to make the decision on whether to go ahead or not. (I've known loads of vets who have done this - and they obviously do as it appears they rang you later on in the op, so why couldn't they have done it earlier!).

I'd ask for a meeting with the Senior Partner of the practice to discuss further. It's not as if it's a small amount - £2k over the estimate is just ridiculous.

I'm also sure that if you'd not been insured (which they will obviously know), they'd have phoned before going ahead to make sure you would be able to pay!

Good luck and keeping my fingers crossed your boy recovers soon (((hugs))).

Thank you. I feel they would have done the same had he not been insured. I am not at all happy at the position we are in now, at £2k, the operation was viable if the mass was operable (and not attached to organs, vessels etc) At £4k, it wasn't as it does not allow me to do the follow up required.

I also feel he was released too early as he did not seem to be doing well at home so I have had to take him back in which has now incurred emergency fees and fees for repeated procedures at multiple vets. The bill for emergency admission, repeating the ultrasound my own vet did an hour and a half earlier, giving fluid and pain meds is another £500-800 on top!

The £4k bill has been escalated the the financial director but I also need to discuss the clinical side with the managing director.

Sooz00

john1 wrote: »

Sooz00

Around 13 years ago my” Buddy” had to have animal hospital treatment to remove a wheat seed lodged in his lung. The vet estimated that the total charges would be £500 max to which I agreed.

Picking him up I was presented with a bill for £790. I rejected this £290 increase. Having previously read that for any professional estimate, the final bill should not vary by more than 10-15%. The vet who carried out the operation was called who agreed to charge the original amount when the article was mentioned.

I can’t put my hands on the original article (pre 1998) but basically I recall it read that any final bill should be within 10% of estimate, I believe this is true for builders, car repairers as well as solicitors vets etal.

The only information I can readily find is about solicitors over charging; Google “Wong v Vizards (1997)”, also” Reynolds v Stone Rowe Brewer (2008)” for more info .You may be able to delve deeper into case history than I.

Can't but hope that all goes well for you all

Thank you for this John. It is useful information. I will have to see if I need to resort to this or not. They haven't followed RCVS guidelines with regard to fees and estimates etc. I find that in itself quite embarrassing for this particular practice.

Sooz00

1jim wrote: »

Sorry, I was going to cut and paste some of your message but think I get the gist of what has happened,
you and vet agreed plan, explore, remove if possible, partially treat if removal wasnt possible
vet decided to do more work (not agreed before hand) after starting procedure but did not agree this with you before proceeding- this work caused complications and you have been billed for them.The vet did this with best intentions but it was not what you would have wanted

Did you sign a consent form/agreement? If you have read it carefully- is there a clause about "any other procedure that is deemed necessary" or similar- if so you may have to pay

In human healthcare the medics would normally open up the patient- see what they are dealing with and if more difficult than they were expecting and hadnt discussed this before the procedure would ask relatives how they wanted to procede.

Given that the £4k is covered by insurance the vet wont be to worried about this, what I would make sure they know is that because of this huge bill that you now can not cover follow up care costs and see if there is any way they can assist with these expenses in anyway or if they can suggest an alternative course of action.

To be honest though I am a realist and if you dont want to read the rest please stop reading now (same goes for anyone else who will get angry/upset/emotional as it is really not my intention to upset or cause distress)
.
Ok, my take on this, assuming the rest hasnt worked is that the £4k bill that you currently have is covered by insurance, let insurance deal with it
you cant afford follow up care, insurance wont pay for more than the £4k above,
you probably have already thought anout letting him go and have alluded to this already in some of your posts. Given the above points and the need to reduce suffering it is probably time to let him go peacefully without further pain or suffering. I know that this is not what you wanted, hoped for or expected but from a purely pragmatic view it is probably the most humane. I hope if you have read this far that this has not upset you, that was not my intention. Best wishes

Thank you for your reply. You are spot on with the situation, yes. If they had advised the extent and invasiveness of the mass, we would not have gone ahead and I would have tried a new chemo protocol or possibly radiation. I wouldn't have PTS because at that point, I would have had insurance cover left and essentially, despite the cancer, he was a well cat. I know that sounds odd, but he was eating, drinking, cuddling, playing, interacting with me, other cats, dogs etc. A happy cat despite the mass. The thing is, the option was taken away and they made the decision for me, which is not okay and has led to where we are now.

Following more investigation and as I mentioned to John above, they also didn't follow the RCVS rules regarding fees and gaining consent to increase estimates.

1jim

am glad that my post did not cause offence, it is a horrible situation to be in...... you could (if you could face it) try the local paper and see if they could run with it,,,,or someone like the consumer money reporters in observor/guardian etc may take this up

Sooz00

Thanks to everyone who asked how my boy is. At the moment he is back with the specialists and stable on fluids and pain meds. I had to take him back Friday.

My own vet did bloods and glucose plus an ultrasound which showed fluid and swelling/inflammation on Friday afternoon. He was also lethargic and not wanting to eat. I basically think he was discharged too soon and pain relief with withdrawn too early and he was not observed off fluids before release to see how he would cope. My vet liaised with the specialists the whole time so they knew what was going on and could advise what scans to do and treatment to give.

After they found fluid and swelling and were debating whether to tap, I had to take him back to the specialists who insisted on doing another ultrasound of their own. I will be charged £500-800 for the emergency admission, ultrasound, hospitalisation and fluids/painkiller treatment. At the moment, there is not enough fluid there to tap so we don't know what it is - could just be fluid as part of the healing process but could be blood, infection, a leak from his bowel or pancreas etc. I am sure they will be monitoring the situation but I am anxious. They say he is stable on the fluid and pain meds and want to keep him in until tomorrow so that the clinician in charge can review and take it from there.