July 6, 2015

Finances....The Evil Step Child of Pet Ownership: Part 1

When it comes to financial decisions and pets it can get pretty heated and ugly and is most oftentimes ignored completely. In the interest of providing as much information as possible, I want to be clear on the cost of my treatment with Gem.

This is part 1 simply because I don't know all the information yet and won't until the end of the week. I decided to break it up and write about what I do know to avoid a massive blog entry later.

For those of you who may not know, Dusty is a small animal vet. We both know and understand the world of vet med very well. We also know about billing practices and alternate forms of payment. I am in the human medical field and while I could bore you all with my point of view of where it has all gone wrong, it does help me to keep things in perspective when it comes to charges. The human equivalent of the same vet procedure (think spay = total hysterectomy) is usually at least 10 times more expensive.

The point is that neither of us were shocked by the estimates we received.

Gemmie has so far received care from two different facilities: the local on call vet who came to the barn and the specialty hospital where she is still at. 

The emergency on call vet came to our farm on a Saturday afternoon after business hours. This created two separate charges: a farm call and an emergency charge. He also sedated her, cleaned the wound locally (he wiped it down with a saline soaked gauze pad, no irrigation or flushing) and applied a compressive soft dressing to stop the bleeding. He did not give her any bute or antibiotics.

Total charge = $372

When I arrived at the specialty hospital the vet was nice, calm and forward about everything. She asked if Gem was insured. I said no. Looking at the wound, she was able to assess quickly and provide an estimate as well as inform me about the deposit required.

What I knew at the time of the estimate:

- Gem would need full surgery meaning general anesthesia, intubation and close monitoring
- The wound would be explored and irrigated
- If the tendon was involved, that would need additional irrigation and exploration as well as repair
- The wound would need sutured closed
- A fiberglass cast would be applied
- She would get local limb perfusions for 2-3 days, IV antibiotics for 2-3 days, daily bute and daily gastroguard
- Hospital stay of 2 weeks, hopefully in ICU

The estimate? $3,000-6000

The deposit? $3,000

I called Dusty to verify this was even possible. The alternative was euthanasia. I'm not being fatalistic. She was bleeding profusely from a massive wound to her front leg. She either needed it repaired properly or put to sleep. Given that, we went ahead with the repair.

When in this situation what are the options available to cover the cost?

1) Insurance - most insurances in the animal world work by having the owner/client pay the bill in full and then submitting a receipt for reimbursement. Even if I had insurance (I will explain why I don't) I would still have had to be able to get my hands on the expected funds up front.

2) Cash/Check - good on you if you have this much readily available in a form that is accessible in the middle of the night/weekends/holidays. Having a special Rainy Day fund for these sort of things is a good idea, but make sure it isn't in a savings or bond type account where you need to move the money around to be able to use it.

3) Major credit cards - having a major credit card that is universally accepted in most situations (think Visa and Master Card. American Express is not accepted in very many medical type settings and Discover is iffy as well, but go with Discover if you can't get Visa or Master Card) with a balance that will cover you in an emergency is a really good idea. Yes, a high available balance does ding your credit score (banks look at the amount you could be in debt not necessarily what you are in debt) but having $6,000 extra available won't kill your credit. This makes the funds immediately available and you can still eat that night.

4) Care Credit - this is a special medical card that can be applied for personally and used for human and animal medical expenses. Typically they offer a 0% interest rate for a short period of time and then jack it up to 25% or something crazy like that. A lot of vet and dental offices accept it and will have brochures and can help you through the process. Vets are starting to get away from it though and I can explain the reasoning if anyone is interested. Relying on this may not be the best bet unless you know for sure that all your area referral and emergency clinics will take it.

Well, I didn't have #1 or #2 and the hospital didn't accept #4, so that left me putting the deposit on a credit card. Fortunately, we do have high limits and while they were not intentionally for this reason I am glad we had them and we will keep them.

As an aside: why wasn't Gem covered by insurance?

Well....because I made a stupid decision under misguided information.

Every horse owner should know what they want in the face of colic. If this were to happen to Gem, she will receive the best medical treatment out there, but I will not put her through surgery. Knowing this, I decided not to insure because for some reason my brain was set on believing that the only reason to insure would be to cover the cost of colic surgery. No surgery = no need for coverage. Except, as we all know, that was stupid. Once she is home and things are settled, I will investigate insurance options for her. Her right front will most likely be excluded from coverage, so lets hope she never injures it again.

One last point before I sign off of this post. Is the estimate of $3,00-6,000 reasonable? Many people scoff at the cost of veterinary medicine. Lets look at it like this:

You or someone you know gets a nasty, deep, dirty wound on the lower leg and cut an artery in the process. I will ignore the cost of an ambulance as it doesn't reflect Gem's case, but typically your  bill begins with a $2000 ride in the ambulance. Instead you have someone drive you to the ER. They assess and clean the wound. The on call specialist is contacted and comes to assess. You are then taken to the OR for emergent care and undergo general anesthesia, irrigation, debridement and closure of the wound (not likely to happen BTW - if it is dirty it usually is left open with a second trip to the OR planned later for closure, but we will skip this to mirror Gem better oh and my OR charges $85 per minute the patient is in the room - not including any supplies, anesthesia charges etc...just the time the room is being used). You are taken to the ICU overnight for monitoring. In the morning you get transferred to a private room for 2 weeks. The specialist comes to visit daily (her care is now free thank you very much insurance rules) as does a primary doctor, infectious disease specialist, probably physical therapy and occupational therapy and a social worker. All charge you every single time they walk into the room.

Anyone want to guess how much that bill would cost?

I don't have time to figure it out exactly, but if it is under $30,000 you would be extremely lucky. I'm not down playing Gem's bill and it does hurt us financially to have to come up with the funds to cover it, but when people start to complain about how much vet medicine costs I get irritated. The above scenario happens all the time in human medicine and nobody bats an eye because the consumer and the payer are separated.

Anyway....I won't get started on that tirade.

I will update the financial information as we progress and I know more. She will be coming home Friday baring anything unforeseen once the cast comes off and that is when we will get the itemized bill and know the final amount due. We will also know if we are looking at continued care in the form of wound care and special shoes etc...


  1. Based on you and Saiph's experiences the past two weeks, I too am looking at insurance.

    1. That is on my to do list once we get things sorted out again

  2. Sounds like you and I have similar logic and finances when it comes to the horses. I would not put a horse through colic surgery and don't have insurance on my guys. I do have a cc with a very high limit that is sitting mostly empty just in case of emergency. When Herbie got hurt and we got a $1000+ deposit, I was lucky enough to pay it in cash, but with the horses, I would use my credit card.

    As for human medical costs... Mike had a kidney stone shortly after I broke my leg. He was in the ER waiting room for a few hours, but the second his butt hit the chair in the actual OR, the pain passed. He got an x-ray/ultrasound to confirm the stone, and a referral to another Dr. That's it. The bill came to $20,000 (covered by insurance, but still!!!)

    As for my broken leg... that was over $100,000....

    1. Wow...I was figuring my 30K was way low, but with your bill I'm sure this would be around the 100k mark as well. Human medicine jumped off the deep end a long time ago and until people start seeing the bills and understanding the charges it won't change or ever be affordable.

  3. Thank you for including the comparison to the human medical side costs. So many people don't bother to look at the cost before insurance. My CT scan + ER visit + sutures on my head with the concussion was $2,000. I was in the hospital 1.5 hrs. Insurance only covered $200 of that. I was honestly expecting the total cost to be more though.

    I wouldn't do colic surgery, which is why my insurance was not higher. It can be up to $10,000 for major medical/surgical with my insurance company. That will be changing after this...but even then, colic surgery is not an option. I agree with you and Dom: I don't think it's fair to the horse. A horse that has colic surgery will have a 50% chance of needing colic surgery again. Not worth it to me. I got it for this type of insanity that you and I are going through. It had already more than paid for itself with Lily's annular ligament injury 2 years ago. 4 ultrasounds, full rads of the fetlock and hoof, multiple vet visits, a stint with cellulitis in that leg, injectable antibiotics, sedatives...it ended up totalling around $3000 when all was said and done. I paid for $600 of that out of pocket. My yearly premium is $350. I kept her insured after that. Her annular ligament on her left hind (same leg as now!) is excluded, and thankfully this injury was higher up...but that's her only exclusion. If you have Gem insured, the exclusion will only be the part of her hoof that was lacerated. So most of her leg would still be covered. ;)

    I had this general impression that high limit cards were hard to get, but I've never tried to get our limits greatly increased, so we will be doing that after this.

    1. Most credit card companies are more than happy to up your limit. Start by calling the cards you already carry and have a good history with. When we adopted Wyatt we had to get money fast and so we called our cards and they upped the limit for us.

  4. I actually had human colic surgery, and was in the hospital for 2 days. My price tag for that was $18k outside of Boston at a teaching hospital.

    I have long decided against insurance for Tristan, and have never really regretted not going for it, honestly. I've been ok to cover his problems (including surgery) in cash, and he has a chronic colic issue that meant many really useful things would've been excluded.

    Thanks for your honesty and your forthright explanations, though. It's always useful to have transparency.

    1. Human medicine is very expensive. Insurance is a tricky thing. If you never have a big bill, then you spent more having the insurance in the long run. This is my first major horse incident, so it was a double hit on both my emotions and my pocket book.