My Vets Advice and Bill

sheramber

I'm intrigued as to why they won't cover it.

it doesn't look like the OP is going to enlighten us.

adcenv

Basically the insurance uses ambiguous terminology to get out of paying.  But thats not my bug bear.  The crux of it as i see it is in protected in Consumer rights, Duty of Care and Law of Tort.  If a professional organisation provides advice (prior to signing any contract) the a Reasonable person can be expected to rely on that.  My argument is that the professional advice of the 'practice' (to my extremely upset wife) who said 'Im going home to call my insurers' was 'Dont worry we can take care of that for you'...and nothing more like 'but you should go home and check your insurance as well because we arent actually going to do that part of it'.  My wife at the time was extremely upset.  Best practice as advised by their Association - RCVS - says ' Insured clients should therefore be advised to contact their insurers to verify their cover at the earliest opportunity.'  Someone also incorrectly said that vets send over 'plan of works' to the insurers as part of 'taking over the insurance'...but they don't.  The insurance company confirmed that this was sent to them after all the care had taken place.  You may wonder what was up with my dog to accrue £2800.  He had sickness and diaroreah.  An analogy is like someone being taken to a private hospital with a broken hip, very distressed and not thinking clearly,  and saying 'can you help me' and the team say yes of course we can.  The person then says great Id better just check with my insurers that they will pay and the hospital then says 'no dont worry we can do all that for you' then get them to sign a consent form...and a week later give them a bill for £10k.  As if that happens at Bupa!    

ripplyuk

OP, is the reason the insurer refused to pay because the claim was not pre-approved? 

I think the majority of people, especially in a distressed state, would take the vet’s comment at face value that they will ‘take care of everything’. Literally everything. If that was me, I’d assume they will contact the insurers for pre-approval and let me know if there was any issues or if it turned out that I wasn’t covered for whatever reason. I would not be happy if they didn’t do that and just presented me with a bill instead. 

It’s a difficult one though, because they did treat the dog and I’m sure, like any caring owner, you’d have paid for the treatment regardless of insurance. I think the vets have made a mistake in being too careless with their wording about ‘taking care of everything’ and because of that, I would try to negotiate a reduction of the total cost. 

adcenv

Yep RipplyUK you are right.  Once the vet did the 'Bloods' £300 and said it was nothing like cancer etc and was just gastroentiritus, then advised the dog be reyhdrated over 24 hr care my wife decided this would have to be done (and we will pay this part).  But then the vets kept our dog for another 3 days and just administered antibiotics and paracetomal to the tune of about £600 a day...and we just thought they were doing this because he was insured to the value of £3k.

powerful_Rogue

adcenv said:

Basically the insurance uses ambiguous terminology to get out of paying.  But thats not my bug bear.  The crux of it as i see it is in protected in Consumer rights, Duty of Care and Law of Tort.  If a professional organisation provides advice (prior to signing any contract) the a Reasonable person can be expected to rely on that.  My argument is that the professional advice of the 'practice' (to my extremely upset wife) who said 'Im going home to call my insurers' was 'Dont worry we can take care of that for you'...and nothing more like 'but you should go home and check your insurance as well because we arent actually going to do that part of it'.

They shouldn't have to. You should know what kind of cover you have, and if you don't, you go and check. What would you have done had you found out there and then that this was not covered?

My wife at the time was extremely upset.  Best practice as advised by their Association - RCVS - says ' Insured clients should therefore be advised to contact their insurers to verify their cover at the earliest opportunity.'

Exactly, best practise. Not they 'must'.

Someone also incorrectly said that vets send over 'plan of works' to the insurers as part of 'taking over the insurance'...but they don't.  The insurance company confirmed that this was sent to them after all the care had taken place.

Yes they can, and do. I have attached screenshots from my insurance portal below. However if the animal is requiring immediate assistance, do you think it's appropiate to delay things whilst this is being checked?

You may wonder what was up with my dog to accrue £2800.  He had sickness and diaroreah.  An analogy is like someone being taken to a private hospital with a broken hip, very distressed and not thinking clearly,  and saying 'can you help me' and the team say yes of course we can.  The person then says great Id better just check with my insurers that they will pay and the hospital then says 'no dont worry we can do all that for you' then get them to sign a consent form...and a week later give them a bill for £10k.  As if that happens at Bupa!   

That's strictly not what has happened, unless you missed that part out or the story has changed. Did your wife say that she needed to check with the insurance that they would pay out, as that's not what you said. Again, what would you have done had the insurance said on the phone they would not cover this?

My parts in bold.

Undervalued

ripplyuk said:

OP, is the reason the insurer refused to pay because the claim was not pre-approved? 

I think the majority of people, especially in a distressed state, would take the vet’s comment at face value that they will ‘take care of everything’. Literally everything. If that was me, I’d assume they will contact the insurers for pre-approval and let me know if there was any issues or if it turned out that I wasn’t covered for whatever reason. I would not be happy if they didn’t do that and just presented me with a bill instead. 

It’s a difficult one though, because they did treat the dog and I’m sure, like any caring owner, you’d have paid for the treatment regardless of insurance. I think the vets have made a mistake in being too careless with their wording about ‘taking care of everything’ and because of that, I would try to negotiate a reduction of the total cost. 

In an earlier post I highlighted that the OP appears to think that the second and third days of inpatient treatment (from memory) were not really necessary and that he could have provided adequate care at home. However the attitude was (and I am paraphrasing) "the insurance are paying so never mind". 

I suspect that the vet's recollection of the events will be somewhat different to the OP's and backed up by their staff, usual practice and arguably more reliable as they were, presumably, not in a distressed state.

Whilst I sympathise to a point, I stick with my view that the OP might have some claim against the insurers if they have rejected part of the claim unfairly. However I don't see that the vet has done much wrong.

It is frankly naïve to take out insurance without taking the trouble to fully understand what it does and doesn't cover and the procedure for making any claims. The time to do that is when choosing the policy and not at a difficult time when needing to claim. 

visidigi

Our insurance is pretty clear (PetPlan) on what is and what is not covered. But at the same time, if my pet was ill, it wouldn't matter. If they cover it great, if they don't I will - its my pet.

You say they proceeded after the bloods outcome, but surely at that point you had already had the insurance discussion to start with, so now you're revealing there was ongoing dialog between yourselves and the vet during the investigations.

You're now accusing the vet of acting unprofessionally in your post by saying they knew they could treat for extra days because you had '£3k coverage'.

They are the professionals - if you think they have acted unprofessionally then this has nothing to do with your insurance and you should take that up with the appropriate governance party.

I do get the feeling, from the way you're writing and not actually answering the questions being posted - instead using ambiguous answers that match the story you want to tell to indicate you have far too much emotion in this and not enough evidence/fact for any claim to be successful against the vet.

adcenv

There is one single point here.  That is, can you rely on professional advice that was given (not asked of) only in part and was not clear, at a time of great stress and resulted in confusion and a large bill?  The rest is emotive.

comeandgo

adcenv said:

There is one single point here.  That is, can you rely on professional advice that was given (not asked of) only in part and was not clear, at a time of great stress and resulted in confusion and a large bill?  The rest is emotive.

My opinion is professional advice from a vet would be confined to animal treatment, not something to do with your insurance which they would have no idea what you were covered for.

powerful_Rogue

adcenv said:

There is one single point here.  That is, can you rely on professional advice that was given (not asked of) only in part and was not clear, at a time of great stress and resulted in confusion and a large bill?  The rest is emotive.

If it wasn't clear, why didn't you or your wife clarify with the vet? Plus i'd hardly call it advice. You also seem to be ignoring quite a lot of questions asked.