Claim example: orthoscopic surgery to fix cranial cruciate ligament rupture in Rottweiler

Lula with her bum lifter One of the conditions that is more prone to occur when your dog is overweight is the tear, or rupture, of your dog's cranial cruciate ligament, which is in your dog's knee.

I am not sure if weight was a factor in Bugsy's case, but I thought it a great example of how something that is very curable but very expensive could perhaps be prevented.

Details:

Bugsy is a 4 year old male neutered Rottweiler who lives in Darien IL. The surgery was done orthoscopically, meaning through a very small opening in the knee, very similar to what is performed on humans for the same condition. This procedure allows a shorter healing time and fewer infections and complications - always a good thing.

DATE ITEM BILLED AMOUNT COVERED IN POLICY? COVERED CHARGES
7/9/2010 Analgesic Inj  $             52.00 Y  $           52.00
7/9/2010 Epidural  $          103.50 Y  $         103.50
7/9/2010 Surg Tech  $             64.00 Y  $           64.00
7/9/2010 Inj-Anitbiotic  $             49.50 Y  $           49.50
7/9/2010 Referral Consult  $             91.50 Y  $           91.50
7/9/2010 Propofol Induct  $             36.25 Y  $           36.25
7/9/2010 Gas Anes  $          324.00 Y  $         324.00
7/9/2010 IV Cath & Fluids  $             88.00 Y  $           88.00
7/9/2010 X-ray  $          131.25 Y  $         131.25
7/9/2010 Arthoscopy  $          742.50 Y  $         742.50
7/9/2010 Tightrope Implant  $          275.00 Y  $         275.00
7/9/2010 Cranial Cruciate Repair  $          606.50 Y  $         606.50
7/9/2010 Cephalexin 84  $             51.71 N  $            0.00
7/9/2010 Tramadol 30  $             22.25 N  $            0.00
7/9/2010 Rimadyl 30  $             65.15 N  $            0.00
Total    $       2,703.11    $      2,564.00

Bugsy's policy has a $200 annual deductible, a 10% copayment, and a $10,000 annual maximum. The drugs and dental extension was not chosen for Bugsy's policy, which is why the take-home drug coverage was not included. Bugsy's monthly premium is $42.72.

The payout for this claim is $2,307.60, which is calculated below (taken from the Explanation of Benefits). The $200 annual deductible has already been taken care of in a prior claim.

STEP 1: Calculate Potential Refund               
  Billed Amount:                  $          2,703.11
  Covered Charges:  (see attached detail)               $          2,564.00
  Annual deductible remaining              $                0.00
  subtotal              $          2,564.00
  Copay 10%  (your copayment)               $             256.40
Potential Refund                   $          2,307.60
                 
                 
STEP 2: Compare potential refund against your annual maximums
     Annual Maximum                $        10,000.00
     Prior refunds for this policy year              $             106.16
     Coverage remaining              $          9,893.84
                   
Your total refund is:                $         2,307.60

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Claim example: orthoscopic surgery to fix cranial cruciate ligament rupture in Rottweiler
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