Claim Example: Inguinal Hernia Repair in a Dachshund

DSC_0051 As the final post of our focus on obesity this month, I thought it a good example to use where this hernia could have possibly been prevented through weight management (although such a young dog is likely to have needed surgery no matter what).

An inguinal hernia is a defect in the opening from the abdomen down to the testicular sac and obesity sometimes can change something miniscule and not noticeable into a serious condition that needs surgery to fix the defect.

Details of the claim for Roxy, a 1 year old Dachshund living in Pomona CA:

DATE ITEM Tax BILLED AMOUNT COVERAGE TYPE COVERED IN POLICY? COVERED CHARGES
11/7/2009 Examination    $             42.00 IL Y  $           42.00
11/7/2009 Radiograph Abdomen    $          159.44 IL Y  $         159.44
11/7/2009 Chem 5 (5-6 Tests)    $             60.70 IL Y  $           60.70
11/7/2009 Total Body Function    $          143.00 IL Y  $         143.00
11/7/2009 Ova/Par-G 1 yr    $             53.00 IL Y  $           53.00
11/7/2009 Fluid Therapy Set Up    $             92.40 IL Y  $           92.40
11/7/2009 Fluid 1st Bag    $               0.00 IL Y  $              0.00
11/7/2009 IV Catheter     $               0.00 IL Y  $              0.00
11/7/2009 IV Administration Set    $               0.00 IL Y  $              0.00
11/7/2009 Fluid Pump    $             18.95 IL Y  $           18.95
11/7/2009 Hospitalization    $             77.00 IL Y  $           77.00
11/7/2009 Occupancy    $               0.00 IL Y  $              0.00
11/7/2009 Nursing Care    $               0.00 IL Y  $              0.00
11/7/2009 Prof Care     $               0.00 IL Y  $              0.00
11/7/2009 Intensive Care Level 1    $             15.45 IL Y  $           15.45
11/7/2009 Exam Pre-Anesthesia    $               0.00 IL Y  $              0.00
11/7/2009 Preanesthes/Induction    $             57.85 IL Y  $           57.85
11/7/2009 Gen Anes 1st 1/2 hr    $          118.60 IL Y  $         118.60
11/7/2009 Gen Anes Add. 15 min    $             53.30 IL Y  $           53.30
11/7/2009 Anes Monitoring Lv 2    $             63.20 IL Y  $           63.20
11/7/2009 Hernia -Inguinal    $          494.35 IL Y  $         494.35
11/7/2009 Nursing/Injections    $             59.00 IL Y  $           59.00
11/7/2009 Ampicillin     $             19.48 IL Y  $           19.48
11/7/2009 Injectable Buprenorphin    $             27.07 IL Y  $           27.07
11/7/2009 Amoxicillin     $             20.80 IL Y  $           20.80
11/7/2009 Metronidazole     $             50.70 IL Y  $           50.70
11/7/2009 Tramadol HCL  Compounded    $             34.30 IL Y  $           34.30
11/7/2009 Intest HE K9 14oz Can Qty 10 Y  $             25.80 MI N  $              0.00
11/8/2009 Day Hospitalization    $             46.20 IL Y  $           46.20
11/8/2009 Intensive Care Level 1    $             15.45 IL Y  $           15.45
11/8/2009 Fluid Therapy Nursing    $             15.45 IL Y  $           15.45
11/8/2009 Oral/Topical Nursing    $               9.60 IL Y  $              9.60
11/8/2009 ChlorhexiDerm Flush    $             19.20 IL Y  $           19.20
11/8/2009 Gentamicin/Clo    $             26.18 IL Y  $           26.18
11/8/2009 Medical Waste Fee    $               4.99 IL Y  $              4.99
11/10/2009 Metacam     $             32.48 DD N  $              0.00
11/7/2009 Tax    $               2.26      $                  -  
Total      $       1,858.20    

 $      1,797.66

Roxy's policy had a $200 annual deductible, a 20% copay % and a $10,000 annual maximum but no drugs and dental coverage selected for a monthly premium of $32.50. The payout on the claim was calculated as follows (taken directly from the claim Explanation of Benefit)

STEP 1: Calculate Potential Refund               
  Billed Amount:                  $          1,858.20
  Covered Charges:                $          1,797.66
  Annual deductible remaining              $             200.00
  subtotal              $          1,597.66
  Copay 20%  (your copayment)               $             319.53
Potential Refund                   $          1,278.13
                 
                 
STEP 2: Compare potential refund against your annual maximums    
     Annual Maximum                $        10,000.00
     Prior refunds for this policy year              $                0.00
     Coverage remaining              $        10,000.00
                   
Your total refund is:                $          1,278.13

Is this something you've come across in your dog?

Related Posts:
August is Obesity Month at Embrace Pet Insurance
Claim example: orthoscopic surgery to fix cranial cruciate ligament rupture in Rottweiler
Guest post: number one pet health problem is obesity
Measuring my cats' body mass index - the FBMI

Claim Example: Inguinal Hernia Repair in a Dachshund



Measuring my cats' body mass index - the FBMI

IMG_0067 A couple of weeks ago, I came across an article by Dr J (though twitter) on the Feline Body Mass Index. It's the same concept as the human BMI measurement where you look at a person's weight and height and work out the percentage of body mass made up of fat.

Being the math geek in me, the article had a formula for calculating a cat's body mass index so I thought I'd give it a whirl for my two 1 year old indoor cats, Rocket and Rosie (who will forever be known as The Kittens in our household).

Here's your cat’s FBMI calculation:

While your cat is in a standing position, with the legs perpendicular to the ground and the head upright (good luck with that!):

  1. Measure the circumference of your cat’s rib cage. (The level of the 9th rib is ideal.)
  2. Now measure the length of the lower back leg from the knee to the ankle and write down both numbers, because with what is coming, you probably won’t remember them.

Calculating the FBMI

  1. Divide the rib cage measurement by 0.7062 and subtract the length of the leg.
  2. Divide that answer by 0.9156.
  3. Subtract the leg length from that number, and that is your cat’s BMI.

And here it is in action for Rocket and Rosie (it was not easy to get them to stand still for the measurements - tape measures look like fun dangly things to feisty young cats):

BMI calculation Rosie Rocket Plump
(1) Rib cage  15.0 15.5 32.6
(2) Leg 4.0 4.0 4.0
(3) = (1) / 0.7062 -(2) 17.2 17.9 42.1
(4) = BMI = (3) / 0.9156 - (2) 14.8 15.6 42.0

Since a cat is considered overweight, or plump, at a FBMI score of 42 or more, I also worked out what waist my cats would have to have to be considered overweight - the "plump" column in the table above.

Instead of 15-16 inches it is now, they'd have to double their girth to be considered overweight. Quite frankly, I'd be worrying well before that and putting them on a diet much sooner. I might consider the double girth as obese, not just overweight, but that's just me.

So instead of relying on a formula to know if your cat is overweight, follow the following rule of thumb:

If you can't feel your cat's ribs when you run your hand down her chest, she likely needs to lose a pound or two.

Some other tips from Dr J on managing your cat's weight:

  1. feed high quality food (we feed the kittens Wellness canned twice a day and some Core dried kibble to go with it)
  2. limit free feedings (we do free feed some Core during the day but only enough for both cats to be done during the day before night time feeding)
  3. exercise freely (both are indoor cats but we have play time in the evening and they love racing up and down their cat tree and chasing puff balls around the house)

It's hard keeping an indoor cat trim but definitely worth the effort I think. How do you manage with your cats?

Related Posts:
August is Obesity Month at Embrace Pet Insurance
Claim example: orthoscopic surgery to fix cranial cruciate ligament rupture in Rottweiler
Guest post: number one pet health problem is obesity
Measuring my cats' body mass index - the FBMI

Claim Example: Inguinal Hernia Repair in a Dachshund



Other interesting changes in the Embrace Pet Insurance policies

Jake You'd think that after the last 6 posts on the pawsome changes to our policies in our move to RLI (see Embrace has a new insurance partner - A+ rated RLI Corp), I'd have exhausted the list by now but there's still more:

  • you can now get a policy for a 6 week old pet and up (used to be 8 weeks)
  • we have new deductibles, including a $1,000 a year deductible. The premiums on these sweet policies are really really low
  • and did I mention we cover prescription diet cat and dog food in our Wellness Rewards Plus plan, as well as gastropexy, OFA and PennHIP x-rays, and umbilical cord repair? I probably did but I really like those new additions! :D

OK,  back to work now. Just thought you'd like these nice extras to wrap up the week.

Related Posts - move to RLI
Embrace has a new insurance partner - A+ rated RLI Corp
What the new Embrace / RLI partnership means for you - new terms and conditions
PennHIP Pet Insurance Discount now available at Embrace Pet Insurance
The new and improved Embrace Wellness Rewards program
Anyone interested in some Embrace Dental Rewards? Pick me, pick me!
Embrace Continuing Care Sublimits are gone!
Other interesting changes in the Embrace Pet Insurance policies 

 

 



Embrace Continuing Care Sublimits have gone!

Note that this post has been updated for Dec 31st 2010 conversion date.

No more sublimit on the Embrace continuing care benefit 
(see Embrace has a new insurance partner - A+ rated RLI Corp).

Yesterday, I talked about cleaning up some niggling things about the Embrace Pet Insurance product, specifically the Embrace dental illness coverage.

Today, we talk about the old Embrace continuing care sublimit of 25% of the annual limit in the second year of the condition.

I've never liked the sublimit but it was something that Lloyd's felt strongly about so that is what we offered. Now that we have some claims experience under our belts, RLI agreed with us that we could remove the sublimit if we added a lifetime limit of $50,000, so we agreed - woohoo! I'm thinking that a $50,000 lifetime payout limit is more than enough for any one dog or cat, don't you think?

Another thing to note is the lifetime limit only applies to RLI claims so if you had claims with Lloyd's before you moved to RLI, they don't count towards the limit. Another woohoo!

So, what does mean for those of you with Lloyd's policies? To set the stage, there was a period of about 4 months where we converted various states from Lloyd's of London terms and conditions to RLI terms (see Lloyd's, RLI admitted and RLI Mt. Hawley states here).

Now we are the end of the year, most of the states are with RLI (all states except MA, NY, FL, and WA), with those 4 exception states being issued on Mt. Hawley paper (a subsidiary of RLI) using the Lloyd's terms and conditions. The one change to the Lloyd's terms for Mt Hawley is that the continuing care sublimit has gone and the lifetime limit is in.   

In summary in regards to the Continuing Care sublimit:

  • If you bought a Lloyd's policy recently, you will renew into an RLI policy. The good news for you is that the continuing care sublimit will have no impact on you since it only comes into effect in the second year (and you'll be cozy with RLI by then)
  • If your renewal is coming up, you will have no continuing care sublimit and you move to the lifetime limit that only counts claims with RLI

The interesting thing about the continuing care sublimit is that is had very little claims impact in the grand scheme of things but people felt it very restrictive (can't blame them - I agree!) so I'm glad we got rid of it.

Any questions?

Related Posts - move to RLI
Embrace pet insurance policies finally move over to RLI!
Embrace moves 12 more states to RLI
Embrace has a new insurance partner - A+ rated RLI Corp
What the new Embrace / RLI partnership means for you - new terms and conditions
PennHIP Pet Insurance Discount now available at Embrace Pet Insurance
The new and improved Embrace Wellness Rewards program

Anyone interested in some Embrace Dental Rewards? Pick me, pick me!
Embrace Continuing Care Sublimits are gone!
Other interesting changes in the Embrace Pet Insurance policies



Anyone interested in some Embrace Dental Rewards? Pick me, pick me!

Introducing the new Embrace Dental Rewards Plan, which covers the prevention and treatment of cat and dog dental disease!

Since Embrace launched in 2006, a few small things have been niggling me about our Embrace Pet Insurance policies, one being the way we covered dental illnesses:

  • Dental accidents are covered in the base Embrace health insurance product, just like in the human world, but our dental illness treatment coverage was lumped in with our prescription drug coverage - many people wanted to buy them separately
  • our dental illness treatment did not cover teeth cleaning, which disappointed pet parents :(
  • and dental illness is generally preventable so it felt odd to have coverage for the illness without the prevention (the teeth cleaning)

So, when we worked on moving our policies over to our new insurance partner, RLI (see Embrace has a new insurance partner - A+ rated RLI Corp), we decided to do the whole thing over and the Embrace Dental Rewards Plan came about.

Here's what it covers:

Dental Rewards Flyer Aug 2010
Dental Rewards is just like the Wellness Rewards Program in that it is not insurance but something more akin to a health spending account for the prevention and treatment of pet dental illnesses.

  • There are no sublimits on each procedure - you get to chose how you spend your money.
  • There are no deductibles, no copays, and no waiting periods so you can use it right away.
  • If you pay upfront for the year, you pay $101 less than the $400 benefit you can use so if you know you are going to have your dog or cat's teeth cleaned, you would make money on it. For monthly policies, the gain is about $53. (that's why it's called a Reward :) )

Note that:

  • Dental accidents are still covered in your regular Embrace Pet Insurance accident and illness policy
  • if you had the Drugs & Dental extension on your Lloyd's policy, you'll still have the Prescription Drugs plan on your RLI plan

We like preventing dental illness in our dogs and cats - don't you?

Related Posts - move to RLI
Embrace pet insurance policies finally move over to RLI!
Embrace moves 12 more states to RLI
Embrace has a new insurance partner - A+ rated RLI Corp
What the new Embrace / RLI partnership means for you - new terms and conditions
PennHIP Pet Insurance Discount now available at Embrace Pet Insurance
The new and improved Embrace Wellness Rewards program

Anyone interested in some Embrace Dental Rewards? Pick me, pick me!
Embrace Continuing Care Sublimits are gone!
Other interesting changes in the Embrace Pet Insurance policies





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