Claim example: Boss the Rottweiler swallowed a rope toy

When you bring a new dog or cat into your house, you are going to spend a lot of time puppy- or kitten- proofing your residence. Even then, even the most unassuming toys can cause trouble you never expected.

Who knew that an innocuous chew toy such as dog rope toy could chew up a Rottweiler's intestines and his dog mom's bank account - to the tune of $8,000+. Ouch all round!

Boss had 2 visits to the vet: the first to check out poor Boss who suddenly wasn't doing so well; and second, for emergency surgery and hospital care to remove the rope toy he had swallowed.

Here are the details of the two claims, even the first check up was hefty.

Claim 1 - what's wrong with Boss?

DATE ITEM BILLED
AMOUNT
COVERED CHARGES
2/4/2012 IV Set up $40.00 $40.00
2/4/2012 Cefazolin Injection $25.00 $25.00
2/4/2012 Gen Health Profile $95.00 $95.00
2/4/2012 Electrolyte Analysis $25.00 $25.00
2/4/2012 PCV $12.00 $12.00
2/4/2012 Normosol x 1 Liter $15.00 $15.00
2/4/2012 Exam $50.00 $50.00
2/4/2012 Rads Study/Interp $140.00 $140.00
Total   $402.00

$402.00

Boss's policy had a $300 annual deductible, $10,000 annual maximum, and 80% reimbursement rate, with take-hope prescription drugs included as well. His monthly premium is $45.88.

STEP 1: Calculate Potential Refund
  Billed Amount:           $402.00
  Covered Charges: $402.00
  Annual deductible remaining       $300.00
  subtotal       $102.00
  Your Share of the claim (20%)       $20.40
Potential Refund            $81.60
             
             
STEP 2: Compare
  potential refund against your annual max
     Annual Maximum         10,000.00
     Prior refunds for this policy year       0.00
     Coverage remaining       10,000.00
             
Total refund is:         81.60

 

Claim 2 - surgery and after care

Poor Boss wasn't able to pass the rope toy himself and it was chewing up his intestines so he needed surgery to remove it.

DATE ITEM BILLED AMOUNT COVERED CHARGES
2/4/2012 EM Standard Sx Supplies $105.23 $105.23
2/4/2012 Fluid Admin Set $23.56 $23.56
2/4/2012 Fluid Plasmalyte $5.83 $5.83
2/4/2012 Fluid Pump $28.00 $28.00
2/4/2012 Hydromorphone Injection $11.19 $11.19
2/4/2012 Diazepam Injection $16.71 $16.71
2/4/2012 Propofol Injection $20.20 $20.20
2/4/2012 Bupivicaine Injection $8.45 $8.45
2/4/2012 Lidocaine Injection $5.25 $5.25
2/4/2012 Anes Induction and Intubation $15.00 $15.00
2/4/2012 Anes Iso $150.00 $150.00
2/4/2012 Arterial Cath/Placement $35.00 $35.00
2/4/2012 OR Equip Fee $42.00 $42.00
2/4/2012 Suction Collection Canister $16.54 $16.54
2/4/2012 Emer Tech Fee $157.00 $157.00
2/4/2012 Anes Monitoring $125.00 $125.00
2/4/2012 DuraPrep Lrg 20cc $21.00 $21.00
2/4/2012 Lap Sponges $17.62 $17.62
2/4/2012 Suture Pack Fee $124.56 $124.56
2/4/2012 Ioban Sheet $25.14 $25.14
2/4/2012 Dressing Primapore $14.98 $14.98
2/4/2012 Fluid NaCl 0.9% Irrigation $7.55 $7.55
2/4/2012 Laparotomy Exploratory $625.00 $625.00
2/4/2012 Gastrotomy $332.00 $332.00
2/4/2012 Intestinal -Anast $412.00 $412.00
2/4/2012 Add J-Tube Placement $252.00 $252.00
2/4/2012 Jejunostomy Tube $10.20 $10.20
2/4/2012 Jackson Pratt Drain Placement $132.00 $132.00
2/4/2012 Ligasure Use $165.00 $165.00
2/4/2012 Drain Jackson Drain Flat 7mm $30.80 $30.80
2/4/2012 Drain Jackson Drain Bulb Reservoir $27.84 $27.84
2/5/2012 Exam Transfer $80.00 $80.00
2/4/2012 Hosp $454.25 $454.25
2/4/2012 Infusion Punp $103.35 $103.35
2/4/2012 Monitoring ICU $87.00 $87.00
2/4/2012 Catheter $50.00 $50.00
2/4/2012 Fluids Add Pot Chloride $20.25 $20.25
2/4/2012 Fluids Add Injection $36.25 $36.25
2/4/2012 Sod Chloride $17.10 $17.10
2/4/2012 Fluid Add Fentanyl Citrate $23.70 $23.70
2/4/2012 Sod Chloride $15.00 $15.00
2/4/2012 IV Secondary Set $10.95 $10.95
2/4/2012 Plasmalyte-A $27.15 $27.15
2/4/2012 AMS 6 CBC/Ptt $103.00 $103.00
2/4/2012 Istat * (Lytes + Acid/Base) $242.00 $242.00
2/4/2012 PCV/TS $78.55 $78.55
2/4/2012 BP $108.00 $108.00
2/4/2012 Mefoxin 1gram $301.70 $301.70
2/4/2012 Injection Admin Addl $100.00 $100.00
2/4/2012 Famotidine Injection $59.75 $59.75
2/4/2012 Injection Admin Addl $25.00 $25.00
2/4/2012 Cerenia Injection $178.90 $178.90
2/4/2012 Inj Admin Addl $25.00 $25.00
2/4/2012 Fentanyl Patch $73.65 $73.65
2/4/2012 Anesthesia Recovery $68.00 $68.00
2/6/2012 Transfer $125.00 $125.00
2/6/2012 Hosp $65.00 $65.00
2/6/2012 Continuous IV Fluid Admin $39.00 $39.00
2/6/2012 Thoracic or Gastric Tube $69.00 $69.00
2/6/2012 Blood Pressure $88.00 $88.00
2/6/2012 Plasmyte-A $54.28 $54.28
2/6/2012 Metoclopramide Injection $66.60 $66.60
2/6/2012 Pot Chlor 40mEq $7.60 $7.60
2/6/2012 Hespan 500ml $109.08 $109.08
2/6/2012 IV Drip Set $31.02 $31.02
2/6/2012 IV Ext Set $6.78 $6.78
2/6/2012 Locking Blunt Cannula $2.04 $2.04
2/6/2012 Clinicare Liquid $33.03 $33.03
2/6/2012 Special Feedings $28.00 $28.00
2/6/2012 Famotidine Injection $18.60 $18.60
2/6/2012 Cerenia Injection $70.85 $70.85
2/6/2012 Cefoxitin Injection $162.25 $162.25
2/6/2012 In Patient Injection $66.00 $66.00
2/6/2012 Istat Chem $96.00 $96.00
2/6/2012 PCV/TP $40.00 $40.00
2/6/2012 Cytology $47.00 $47.00
2/6/2012 Bandage Placement $30.00 $30.00
2/6/2012 Tramadol x 1 $10.06 $10.06
2/7/2012 Hospitalization $65.00 $65.00
2/7/2012 Continuous IV Fluid Admin $39.00 $39.00
2/7/2012 Hosp Daily Exam $49.00 $49.00
2/7/2012 Blood Pressure $44.00 $44.00
2/7/2012 Plasmalyte-A $40.71 $40.71
2/7/2012 Metoclopramide Injection $21.00 $21.00
2/7/2012 Clinicare Liquid $55.05 $55.05
2/7/2012 Special Feedings $28.00 $28.00
2/7/2012 Hespan 500ml $109.08 $109.08
2/7/2012 Famotidine Injection $18.60 $18.60
2/7/2012 Cerenia Injection $70.85 $70.85
2/7/2012 Cefoxitin Injection $66.70 $66.70
2/7/2012 Tramadol x 2 $10.12 $10.12
2/7/2012 Prilosec x 3 $13.60 $13.60
2/7/2012 In Patient Injection $55.00 $55.00
2/7/2012 Med Admin $33.00 $33.00
2/7/2012 PCV/TP $40.00 $40.00
2/7/2012 Istat Chem $96.00 $96.00
2/7/2012 Individual Chem $41.25 $41.25
2/7/2012 Pot Chlor 40mEq $4.38 $4.38
2/7/2012 Bandage Placement $30.00 $30.00
2/7/2012 Cytology $47.00 $47.00
2/7/2012 Kro Ameprzol $10.49 $10.49
2/8/2012 Canine Low Res Can Food x 12 $31.56 $0.00
2/8/2012 Cerenia x 4 $58.92 $58.92
2/8/2012 Tramadol x 20 $11.20 $11.20
2/8/2012 Metoclopramide x 30 $15.10 $15.10
2/8/2012 Cephalexin x 42 $21.76 $21.76
2/8/2012 Hospitalization $16.25 $16.25
2/8/2012 Continuous IV Fluid Admin $9.75 $9.75
2/8/2012 Hospital Daily Exam $49.00 $49.00
2/8/2012 Bandage Placement $30.00 $30.00
2/8/2012 Istat Chem $48.00 $48.00
2/8/2012 PCV/TP $20.00 $20.00
2/8/2012 Med Admin $11.00 $11.00
2/8/2012 HRTBN Tab $3.99 $0.00
2/4/2012 Discount -$10.00 -$10.00
2/4/2012 Tax $14.45 $14.45
Total   $7,835.20 $7,799.65  
The payout was calculated as follows:
STEP 1: Calculate Potential Refund
  Billed Amount:         $7,835.20
  Covered Charges: $7,799.65
  Annual deductible remaining     $0.00
  subtotal     $7,799.65
  Your Share of the claim (20%)     $1,559.93
Potential Refund          $6,239.72
           
           
STEP 2: Compare
  potential refund against your annual max
     Annual Maximum       10,000.00
     Prior refunds for this policy year     81.60
     Coverage remaining     9,918.40
           
Total refund
  is:
    6,239.72

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Claim example: Boss the Rottweiler swallowed a rope toy