Claim Example: portosystemic shunt surgery

Xander-KariNiebell-1 I am not a veterinarian so I had never heard of a Portosystemic Shunt before working in pet insurance. Have you ever heard of it before now?

Despite my ignorance, a Portosystemic Shunt is a serious hereditary condition that affects both small dogs (particularly Yorkshire Terriers and Miniature Schnauzers) and large dogs (Irish Wolfhound) as well as people too.

What is a Portosystemic Shunt?

For those of us not versed in veterinary speak, it's a blood vessel that bipasses the liver so that some of the dog's blood is not scrubbed of toxins and the liver doesn't get the blood flow it needs to do some of the other good stuff it does like help the immune system and produce important blood chemicals. Over time, the poisons accumulate and the dog eventually dies if left untreated.

Treatment

Surgery is the most effective treatment where the offending blood vessel is clamped off, forcing the blood to go where it's supposed to. I've seen surgery costs range anywhere from $2,000 to $5,000 so it's definitely something you want pet insurance to cover given the costs involved (make sure your pet insurance policy covers hereditary conditions though).

Here's a claim example from 2010 from a simple surgery on Ozzie, a 1 year old Yorkshire Terrier in Havre De Grace, Maryland.

DATE ITEM BILLED AMOUNT
1/14/2010 Referral Examination $121.00
1/14/2010 Protein C $45.00
1/14/2010 Bile Acids Test $50.50
1/14/2010 Nuclear Med Portal Scintigraphy $120.00
1/14/2010 Butorphanol -Omnicell $6.00
1/15/2010 Lactulose Syrup $6.00
1/15/2010 Biopsy $53.00
1/15/2010 Cefazolin -Omnicell $7.00
1/15/2010 Buprenorphine  $18.00
1/15/2010 Dextrose 50% $4.00
1/15/2010 Professional Fee $42.00
1/15/2010 ICU Care Level 2 $100.00
1/15/2010 Portosystemic Shunt, Extraheptic $184.00
1/15/2010 Professional Services $300.00
1/15/2010 Material Charges $75.00
1/15/2010 Inhalant $277.00
1/15/2010 Doppler $21.00
1/15/2010 Bair Hugger $16.00
1/15/2010 Misc Drugs $40.00
1/15/2010 Continous Rate Infusion $16.00
1/15/2010 Ventilator Surcharge $16.00
1/15/2010 Dopamine $0.75
1/15/2010 Initial Fluid Set up $100.00
1/15/2010 PCV/TP $8.50
1/15/2010 Glucometer Reading $34.00
1/16/2010 Meloxicam Suspension $6.00
1/16/2010 Neomycin $6.00
1/16/2010 Buprenorphine  $18.00
1/16/2010 Meloxicam Inj $6.00
1/16/2010 Professional Fee $42.00
1/16/2010 Professional Fee $42.00
1/16/2010 ICU 1/2 day $47.50
Total   $1,828.25

This surgery was performed at a specialty clinic at the University of Tennessee's College of Veterinary Medicine. More complex surgeries can run over $4,000, depending on the number and location of blood vessels involved and where they were performed.

Ozzie's pet insurance payout was calculated as follows:

STEP 1: Calculate Potential Refund            
  Billed Amount:              $1,828.25
  Covered Chgs:            $1,828.25
  Annual deductible remaining          $0.00
  subtotal          $1,828.25
  Copay 10%  (your copayment)           $182.83
Potential Refund               $1,645.42
               
               
STEP 2: Compare potential refund against your annual maximums
     Annual Max            $10,000.00
     Prior refunds for this policy year          $46.48
     Coverage remaining          $9,953.52
                
Your total refund is:             $1,645.42

Ozzie had a $500 annual deductible, which had already been used up by his preliminary visits to the veterinarian to investigate his illness, and a 10% copay and $10,000 annual maximum. His policy premiums are $278.14 a year.

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