Vet wrongly informed me insurers had authorised treatment, went ahead and now won't refund me(32 Posts)
To cut a long story short, my dog needed a dental scale and polish. My vet put in a form to obtain pre-authorisation from the insurers (which does unusually cover scale and polish if for medical reasons). Shortly afterwards the vet told me the pre-authorisation had been granted and I therefore went ahead with the treatment - costing £500 (yes I know!).
When I did not receive reimbursement from the insurers I contacted the vet and they admitted the treatment wasn't authorised because they hadn't sent in the form and then, when they did send it in (after the op), the insurers queried the claim and have refused to cover the treatment.
Vet is now saying sorry, even though it was their mistake, because the treatment was necessary 'and you'd have gone ahead with it anyway' (big assumption there) they're not going to refund me.
Before I go in all guns blazing, do you think the vet is right? I'd have thought they would at least offer a partial refund - after all, part of the £500 is just profit to them. They're obviously not interested in retaining my custom that's for sure, as I'm off once I've got this sorted!
Grateful for any views.
I've never heard of a vet ringing/ dealing with an insurer prior to treatment and would always assume that was my job as the owner ,hence I think its your mistake so therefore your problem .
No I disagree with the last poster. I worked in a vets for a while and we would sometimes contact insurers to ask if they would authorise paying for treatments. This is your vets fault. If they won't fully refund you ask for a breakdown of all the costs as you can guarantee that they will have charged more knowing you had insurance. £500 for a scale and polish is ridiculous.
My dog recently had a scale and polish as his teeth had got a bit full of plaque and he hates us cleaning them. It was £170 for the op and £50 for the seniors blood tests.
You need to have a rant at the vet as there's no way I'd have paid that much to have my dogs teeth cleaned and therefore I would expect them to at least meet you half way. Is there no one else you can report them to? Saying you would have had it done anyway doesn't really justify their fraudulent attempt at fleecing money out of you.
Yes pre authorisation does exist. Usually there is a form with sections for both owner and vet to complete. It does sound like you have been misinformed by your vet.
I think you have a leg to stand on as you only gave consent for the procedure to go ahead on the understanding that the insurance would cover it, and you have been mislead. Vets can't make the assumption that you would have had it done anyway. Did it say anything on the consent form you would have signed when your dog was admitted re payment etc? Could you ask for a copy of the clinical notes to see if anything is mentioned re the pre authorisation discussion?
If the vet told you pre-authorisation was granted you don't have to pay. You went ahead on the basis of what the vet told you and it was the vet's mistake that the request was not pre-authorised (or at least an answer given by the insurer). If it goes to small claims court you will have to pay the same as if the insurance did cover the work (ie any excess), don't agree to pay more than that. The vet cannot prove that you would have gone ahead anyway or that you didn't rely on the vet's representation that the work was approved.
Thanks all for your replies.
flora I know what you mean and I'm kicking myself that I didn't seek the pre-authorisation myself. However, my vet did not offer this as an option - they said they would submit the forms for pre-authorisation as this is what they always do. The insurer is PetPlan.
It does annoy me that the vet has said 'you'd have had the treatment done anyway so we're not refunding'. This is so not the case. They did pre-anaesthetic blood tests and x-rays (which of course found nothing) which bumped up the cost. Had I been paying myself I'd have not had these extras but gone for a straightforward scale and polish. From this point of view it's particularly annoying since you'd think the vet would at least meet me half way.
I will definitely be asking for copies of the medical notes - thanks for the suggestion aked. If I get nowhere I'll be looking at what ethical code vets have to sign up to and will report them if necessary as you suggest ilovemydog.
If they told you they had had this treatment preauthorised I would offer the excess. To do a preauth you have to fill in a form which someone has obviously forgotten to do. It was probably an honest mistake but its THEIR mistake therefore they should be out of pocket. I have never known an insurer pay for a scale and polish!
If you are having real trouble I would suggest writing to the practice manager first. The next step would be to contact the RCVS.
Firstly some practices are licenced agents of pet plan find out if your practice is one of these. If they are complain to the practice and pet plan.
If they are not check if they are registered with the FSA. If they are not registered with the FSA and not an agent of pet plan they are not allowed to send claim forms or pro formas direct to the insurance company the forms must pass through you the insured and any reply must come to you. So they may have breached FSA regulations. This will all carry weight to your argument to obtaining a refund.
Thanks for the replies - most helpful. I've had a response from the vet saying even though it was their mistake (they've admitted they forgot to send off the form) because I would have had the treatment anyway (absolutely not the case as I had a variety of options open to me including getting a second opinion) they're not going to refund me. It is particularly galling since I've had 2 animals registered with them for 6 years, paid them thousands in fees and this is how they choose to deal with it. If they even offered me a partial refund it would be something but their attitude is really disappointing.
There is something quite dishonest about this they never sent the form off, but phoned you to say they had had authorisation.as a member of the same profession it stinks.
I would encourage you to complain to the Royal College of Veterinary Surgeons on the basis of dishonesty and unprofessional behaviour. Section 2 of the code of professional conduct states Veterinary Surgeons must be open and honest with clients and respect their needs and requirements. Neither of these things have been observed in your case.
The vet is in the wrong. They can't know what you would have decided to do "anyway". They screwed up the authorisation, so they need to bear the cost.
Don't let this drop - I'd be looking at all the avenues lonecat has suggested. They are hoping you will quietly give up and go away. Don't make this easy on them!
Thanks all for your replies. Will definitely be looking at RCVS and code of professional conduct - thank you lonecat . Yes ajandjjmum I paid them - they're not the sort of vets to wait for the insurers to pay them (even though they took responsibility for sending in the claim). So yes it makes it more difficult since they will have to put their hand in their pocket. I'm happy to pay the excess as then I'll be in the same position as if the insurers had paid - I'm just struggling to understand why the vet doesn't think this is a reasonable compromise.
I'm going round to the practice later to collect copies of the full medical records as well as a copy of the pre-authorisation form. I will update!
A mistake at best or fraud at worst?
Either way, you consented to treatment based on what the vet said to you at the time. The vet saying what you would or wouldn't have done anyway isn't relevant.
Ask the vet to take responsibility for the mistake like a proper professional with the threat of issuing proceedings under small claims if he refuses.
Another vet here. This seems utterly wrong to me. I hate to say this about another member of the profession, but I would be putting in an official complaint to the practice owner, and if that doesn't work, I would be speaking to the royal college & looking at putting in a formal complaint.
In which case I would be furious - they behave in a disorganised and unprofessional manner, and expect you to pay the cost. The fact that PetPlan have refused to pay because of the high charge confirms that you are being ripped off.
I would start with some very loud conversations in their Reception about how you've been landed with a £500 bill, when they said they'd cleared it with your insurer. And take it from there. Isn't your DB a medical negligence lawyer - I'm sure he be happy to give you some pointers?!!!
Message withdrawn at poster's request.
I asked for my last post to be deleted as with hindsight I was probably getting a bit carried away. My usual paranoia probably!
Another vet here. We would never have done this either - we would probably have refunded the whole cost if we'd made the mistake, or at least given a big credit on the account.
Thanks alice I agree they could offer me a a credit and at least that way keep me as a client. As things stand I'm highly unlikely to hang around.
Is it a certainty that the very didn't send of the form? I read your post that you had deleted and it sounded as though that might not be the case? Sorry, not trying to be difficult, but if people on here are advising you it is important that they have all the facts, some of the post sounded as though it was quite pertinent.
Another vet just adding my house to the others. I'm really sorry this has happened to you.
Refuse to pay more than your insurance excess would have been, and if they press the matter then just say you are taking it further. My bet is that they won't follow up. Make sure you write everything down down and keep notes of who you speak to in case this flares up in the future. But in your shoes I just wouldn't pay more than the excess.
I'm ashamed of my profession when I hear stories like this. We're not all like this
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