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


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