Anyone having a problem with insurance claims?

RE: Anyone having a problem with insurance claims?

Arlo Guthrie — Wed, 10 Jun 2015 19:26:17 GMT

[quote user="Lisa Whitehouse"]when we raised this issue RSA told us we would have to make the decision on who to use without compromising the patient.[/quote]

Hi Lisa, that's interesting, and slightly reassuring!

But the network of referral practitioners is still causing a right old hoo-haa.

The latest coming from RSA is that insurance policies will be honoured if you go outside their network (or unless the policy already says so), you do so without ringing them first.

But it does seem that this is the direction that RSA wants to go in, and the main problems are:

1. They say that they could provide the same level of care within their network for a very much reduced price. However, when you look at their network, I think they would struggle to field an RCVS Specialist between them, so that simply can't be true.

2. Oftentimes, cases are referred without a diagnosis (or an accurate one), making it very difficult for a referral practitioner to estimate costs with any degree of accuracy.

3. Seems to take no account of other factors which affect a referral. The thing that comes straight to mind is the geographical location. I can imagine in some cases, for example less mobile clients, it would not be fair to send them off to a network referral practitioner that was significantly further away than a non-network local referral practice.

At this stage, what it really comes down to is the degree to which clients are pressured (if at all) into using an RSA preferred centre, and if anyone has any experience of that, it would be very interesting to hear.

Beyond that, various people (RCVS, BCVSp) are trying to engage with RSA to try and get them to rethink their criteria before it passes into policy, so to speak.

RE: Anyone having a problem with insurance claims?

Mason8 — Wed, 10 Jun 2015 19:20:33 GMT

It sounds like they are moving toward the direction of health insurance in the States. My family cannot see any specialist not approved by the insurance company first which may mean having to drive 1 to 2 hours away from home. My Grandmother on a specific medication for at least 10 years had to change to a different medication because insurance had a contract with another drug company so had to use that instead. When having adverse reactions to some of the new medications that they told the doctor to change her to, the doctor had to provide letters and evidence to the insurance company to justify going back to the old medications and still struggled to get approval to do so. They dictate what operations she has and when she can get treatment covered. Health care is dictated by insurance companies not the doctors. I hope this isn't the future of pet insurance over here!!

RE: Anyone having a problem with insurance claims?

Lisa Whitehouse — Wed, 10 Jun 2015 18:32:43 GMT

My practice is in the trial area as of yet not had an insured animal with RSA policy needing referral, luckily we use one of the practices listed but our maint concern is we do our out of hours and the insurance hot line is not 24/7 365 days, when we raised this issue RSA told us we would have to make the decision on who to use without compromising the patient.

RE: Anyone having a problem with insurance claims?

Sal the 1st — Tue, 09 Jun 2015 22:54:57 GMT

It struck that this could create a sort of monopoly - if you get referral practices joining in with insurance companies there will come a time where the cost of referral is going to be effectively 'controlled' by the insurance companies, and that cost may or may not be a true reflection of the amount of work up on a case.

I can see why some practices would go in with insurance companies as it would be like a guaranteed workload and income - just so long as they stayed on good terms but in the long run would it work quite so favourably? If the majority of your work is through the insurance companies (which will be price capped I suspect) then where do you get the time to take non insurance referrals. Will it mean that some participating practices get sent certain cases based on their pricing rather than their specialist capability?

RE: Anyone having a problem with insurance claims?

JaneRVN — Tue, 09 Jun 2015 18:12:54 GMT

So far it seems to have been across the North of England.

The RCVS hve created a response that was posted on here I'm sure. They weren't overly impressed but obvs have no jurisdiction until a complaint comes to them.

i agree with Sal that at some point there will be clash between vet advise and insurance company advice. The RCVS stance was that advice by a qualified professional should not be ignored.

im advising everyone to read their policy renewals. I've just moved pet insurance for both my pets as my previous company no longer covers any issues caused by ecto or endo parasites! WTF! I live in a lungworm hotspot, treat for it, but know that there's still a risk... They are not getting any more money from me!

RE: Anyone having a problem with insurance claims?

Arlo Guthrie — Tue, 09 Jun 2015 17:42:20 GMT

Bump - anyone else? Anyone in the area of the trial?

RE: Anyone having a problem with insurance claims?

Sal the 1st — Fri, 05 Jun 2015 23:09:29 GMT

haven't had any problems yet - but then we aren't in the area of the trial - was talking about this only this evening with the boss. Do I think it is fair ? - probably not and is just another one of the pitfalls clients will need to be aware of in future when insuring their pets, it also discriminates against the referral practices who refuse to kowtow to the insurers. From what I recall I think More Th>n insurance is recommending that clients go online for long term medication as it is cheaper and now we have another bunch dictating which referral practice and clients moaning because their insurance has gone through the roof. I think it is going to put some people off insurance and I also suspect it might put some practices off doing direct claims if there is a chance they wont get paid by the insurers

I am waiting to see what happens when an insurance company recommends a preferred practice over one that the referring vet would like to use and the insurer preferred referral has less experience or expertise in a procedure than the vet preferred referral and something goes wrong -lets face it with the best will in the world things don't always go to plan - even the text book cases. I can see one almighty blame game taking place along with compensation claims. I think this could cause a lot of problems to referring vets, owners and referral vets alike.