Claim Example: leg laceration on a Boxer

0107010922 There are a couple of reasons to share this claim. The first being - OMG, it was expensive! The second being that it nicely illustrates how we handle claims that combine covered and non-covered conditions.

Dallas, a five year old female boxer living in Watchung, NJ, was playing outside for a minute and next thing her mom knows, she's limping. So she carries her in just to find blood all over her hand.

Dallas' injury 011 Turns out Dallas had torn a chunk of skin out of her leg, which needed anesthesia to check there was nothing embedded in the wound. While she was under, the vet did a teeth clean and ended up having to pull 13 teeth. Unfortunately, Dallas's policy did not have dental coverage so the teeth cleaning and the extractions were not covered by her policy.

So how did we split the costs of the shared items on the invoice? We estimated that 33% of the surgical time was spent on fixing Dallas's laceration so we split the common items that way.

Here's the invoice without the specific teeth items in it (it would be really really long otherwise - the total bill was $2,696.61) so you can see how the 33% was applied.

DATE ITEM BILLED AMOUNT Shared? COVERED CHARGES
1/6/2011 Hospitalization $69.03  Y  $22.78
1/6/2011 Blood Pressure $61.95  N  $61.95
1/6/2011 Catheter $60.44  Y  $19.95
1/6/2011 IV Fluids $61.88  Y  $20.42
1/6/2011 Torbugesic Injection $42.85  Y  $14.14
1/6/2011 Anesthesia Inhalant $164.77  Y  $54.37
1/6/2011 Anesthesia Addl $238.70  Y  $78.77
1/6/2011 Buprenorphine Inj $42.85  Y  $14.14
1/6/2011 Penicillin Inj $33.80  Y  $11.15
1/6/2011 Atropine Inj $33.80  Y  $11.15
1/6/2011 Laceration Repair $258.76  N  $258.76
1/6/2011 Drain Insertion $68.36  N  $68.36
1/6/2011 Bandage Application $56.92  N  $56.92
1/6/2011 Buprenorphine HCL Inj $42.85  Y  $14.14
1/6/2011 Waste $5.70  N  $5.70
1/6/2011 Nurse Care $36.17  Y  $11.94
1/7/2011 Boarding - medical $52.14  N  $52.14
1/7/2011 E-Collar $34.91  N  $34.91
1/7/2011 Bandage   $56.92  N  $56.92
1/6/2011 Discount ($56.92)  N  ($56.92)
1/6/2011 Tax $5.57  N  $2.44
Total   $1,371.45   $814.14

The calculation of the refund is as follows (from the Explanation of Benefits):

STEP 1: Calculate Potential Refund               
  Billed Amount:                 2,696.61
  Covered Charges:  (see attached detail)              814.14
  Annual deductible remaining             200.00
  subtotal             614.14
  Copay 20%  (your copayment)              122.83
Potential Refund                  491.31
                 
                 
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:               491.31

Eek! That was a big bill. And what's worse is that if Dallas hadn't hurt her leg, her mom would continue to be unaware of her dental issues and Dallas might have ended up much more sick than she already was, particularly as she has a heart murmur.

What do you think?



Paws for Japan Day today

Cat escapes tsunami in Japan If we'd seen a movie of what is now going on in Japan, we'd say it was too far-fetched, to incredible to be believed. An earthquake, a tsunami, and a nuclear event at 4 reactor in the quake zone. What next - Godzilla and a meteor?

But we're seeing and believing it now as the awful events unfold with perfect clarity and horror. One minute, life is normal; the next, nothing will ever be the same again.

There are so many worthy charities to support at this time of need for Japan but there are three in particular I wanted to bring to your attention if you wished to support those that are pet focused:

World Vets - World Vets responders are on the ground in Japan working with Japanese animal welfare groups

Search Dog Foundation - six SDF Canine Disaster Search Teams are on the ground in the Tsunami zone looking for survivors and bodies

Japan Earthquake Animal Rescue and Support - a coalition of HEART-Tokushima, Animal Garden Niigata and Japan Cat Network, three groups that have been rescuing and rehoming animals in Japan for many years.

Thank you for chipping in what ever you can. Every little bit helps.



We're Adopting the Internet Today! Courtesy of Petfinder

Adopt-internet-day_logo Today is Petfinder's 15th anniversary and to celebrate, I have pledged to spread the word online about adoptable pets today, March 15, 2011.

DSC_1558 My three cats, Lily, Rocket and Rosie were all adopted, either from a shelter or from "under the gooseberry bush" and I encourage all of you to consider adopting your next cat or dog. All you need to do is go online to search the type of dog you are looking for.

Petfinder has so many beautiful cats and dogs on their website but I thought I'd pick one for you in the Cleveland area - just in case you happen to live nearby.

Here is Gracie, a Husky / German Shepherd Dog mix (Cleveland, OH) and here's her story:

Gracie is a very sweet 5 year bundle of joy. Gracie is very well behaved, likes other dogs, cats, and children. She is a very smart girl who will make a family a wonderful pet. She has lots of love to give and she needs to find a new forever home. Her former owner suffered some medical problems and had to be put in a nursing home. Please help Gracie find a new owner she can love.

Gracie 1
Gracie 1 

Don't you just want to wrap her up in your arms and take her home with you?



Cardiomyopathy in Cats

Disco-MargaretLendo Cardiomyopathy is any disease of the heart muscle but diseases of this type tend to fall into one of three major categories:

Dilated cardiomyopathy -  inability of the cardiac muscles to contract properly. In cats, it's almost always caused by the deficiency of Taurine in the diet so is preventable and treatable

Hypertrophic cardiomyopathy - most common in cats, an abnomally sized left ventricle that is assumed to be hereditary

Restrictive cardiomyopathy - where the heart muscle fills in the chambers. Occurs in cats but rare

Cats go their whole lives without any symptoms; however, others may: 

  • collapse or have difficulty breathing (often the result of major changes to heart rhythm or congestive heart failure, respectively)
  • have sudden life-threatening blood clots (usually leading to hind limb weakness or paralysis known as Saddle Thrombus) or
  • suddenly die (for those who suffer sudden, devastating electrical disturbances to their heart rhythms)

Diagnosis generally involves looking at the heart with:

  • X-rays (demonstrating marked enlargement of the heart),
  • EKGs (electrocardiograms, which may or may not show electrical disturbances in the heart) and
  • cardiac ultrasonography (echocardiograms) to elucidate the physical changes in the heart muscle (most effective)

Maine Coon cats and American Shorthairs are most prone to cardiomyopathy, though all cats are potentially at risk.

For more details, the Embrace Pet Health Center has a very informative view of Cardiomyopathy written by Dr. Patty Khuly.

Related Posts:
March is Genetic Condition Month at Embrace Pet Insurance
Guest Post: the importance of consider hereditary conditions when choosing a dog
Claim Example: portosystemic shunt surgery

Cardiomyopathy in Cats 



Claim Example: calcium oxalate kidney stones in dogs

image from blog.embracepetcommunity.com Poor little Lokey, just a year old and already suffering from bladder stones; more specifically calcium oxalate stones.  This poor French Bulldog had to undergo surgery to remove the stones and has had several claims as a result. 

Total costs for the condition over just a few weeks accumulated to $1,010.99.  Because Lokey had already had a previous claim to meet his annual deductible, his mom got an automatic 90% of the surgery and aftercare covered, making her reimbursement $847.15.

Date Diagnosis Claimed Covered Paid
1/4/2011 Bladder Stones Surgery $888.12 $818.40 $736.56
2/8/2011 Resolving Hematuria $83.93 $83.93 $75.54
3/1/2011 Recheck Urinalysis $38.94 $38.94 $35.05
  Total $1,10.99 $941.27 $847.15

Note that the difference between the claimed and covered amount on the surgery was a correction for a pre-existing Umbilical Hernia Repair that was not covered.

Angela writes:

image from blog.embracepetcommunity.com I'm very grateful for the coverage provided for the bladder stones.  It helped us out so much!...You guys have been great to deal with and I will be happy to do a review….I've attached some of my favorite pictures of Lokey and he also says thank you so much!!  I really appreciate everything you've done and hopefully we won't have any more claims for a while!





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