Reasonable Expectations VIII: Written Cost Estimates

This is the eighth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through seven can be found at www.speakingforspot.com/blog.

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.  Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?  Will you be charged $300, $800,  $1,300? Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?  Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.
• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
• Written cost estimates are discussed during 14% of appointments.
• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill. 

Why is a written estimate preferable to a verbal estimate? Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.   So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!  With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

Best wishes,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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14 Responses to “Reasonable Expectations VIII: Written Cost Estimates”

  1. Amy Says:

    My Dr. Badvet actually refused to do an estimate when my Karly was gaining weight (diabetic) in preparation for surgery b/c it was “way too premature to do an estimate.” I didn’t inquire further because I was afraid he didn’t think she would live long enough to get to that point. In hindsight that should have been a red flag moment, but I had never asked for one before. I knew her surgery would be expensive and I wanted to start saving toward it and possibly tapping a few relatives for a loan.

    My new vet just did an estimate for the part of my new dog’s surgery she feels comfortable about doing… and referred me for the rest. It’s similar but less complicated than my Karly’s case, and my Karly had two complications that cost her two more anesthesias and cost me over $500 (almost cost a trip to the ER for emergency surgery but she made it thru the night and got patched up in the morning). In hindsight I realize Karly should have gone to a referral hospital.

  2. Kate Says:

    Dr. Kay,
    I work part time for a veterinary practice and I was disappointed to learn that, although a heartworm test is included in a senior lab profile, our practice still charges for a separate heartworm test, even if the client gets a senior profile. I now know that for my own dogs to say that I don’t want a heartworm test, but I so wish I could help clients save the redundant cost. I feel as though I am an accomplice, but I need my job. Some clients are personal friends, and without “narc-ing” on my employer, I try to guide them to lower-cost options. Though I do this outside the work setting, I then feel disloyal to my employer.

    I am in a position to provide written estimates for some services, but I don’t know how to deal with this particular issue. I used to recommend that clients get the full profile, telling them that the heartworm test is included, and that for $50 or $60 more they could get the HW test plus important information about early onset of disease. It sounded like a win-win to me, and if I could continue to present it this way, more clients might opt for the higher cost/higher value bloodwork.

    Needless to say, I am disappointed in this pricing protocol as well as some others that have come to my attention.

    Could you comment on this?

  3. Terry Albert Says:

    I had a recent experience where the vet would not provide a written breakdown of the costs, just a grand total of $800 for stitches due to a dog bite. There was a list of items, but not what each item cost. I had to insist that she give me a breakdown of the costs- which she said her computer couldn’t print. Is this common? I would think they have to have the breakdown to come up with the estimate.

  4. Louisa Says:

    Fortunately, I have never had a problem getting an estimate from my vets. I honestly can’t remember each time who’s brought it up, but it hasn’t been an issue. True, I’ve had estimates with a huge range (100%), like my last one for a surgery for 1 of my 2 dogs, but at least I had that to go on. Frankly, even though I agree that a vet should offer one up front, when it comes right down to it, since the buck stops with the client, I think the ultimate responsibility for getting an estimate should rest with the client if the vet hasn’t come up with one. Not asking for–& getting an estimate strikes me as the equivalent of writing a blank check & who the heck does that? How many people can afford to do that?
    So not finding out what may be coming at you is lunacy.
    Or idiocy; take your pick.

    Louisa

  5. Debbie jacobs Says:

    I resent having to ask what a procedure is going to cost. I’m surprised that more vets are not aware that clients might feel this way. A local emergency clinic provides a high/low detailed estimate. They require payment on the low cost at the time of leaving your pet. After my last visit I received a refund because the low price included a procedure they ended up not needing to perform. Had I needed to pay more it would not have come as a surprise as I had already been prepped for that possibility.

    I wish my regular vet did this.

  6. Pam Says:

    Great article and it might prove very useful in our rescue. We have been getting killed with some extremely high vet bills and this would be a great way for our fosters to submit documentation with their request for vet authorization.

  7. Margaret Says:

    I work for a dermatologist and thankfully most of our clients realize we are expensive (or rather, we are almost guaranteed to do a procedure since their dog has been diagnosed with something or potentially with something) and they ask the receptionists about all the costs when they make their first exam appt. Our Dr does not like to give estimates unless clients ask because many people get offended, but mostly he feels that it makes clients think the services are optional when they aren’t. We never run tests that aren’t absolutely necessary to diagnose and treat their pet, which is why they are seeing us. ALTHOUGH, we do not usually do tons of very expensive procedures, so costs are usually pretty easy to nail down for people, and again, they usually ask before they even come in (and we send a welcome letter with cost estimates of our most common procedures). Unless it is one of our occasional laser surgery patients, our bills are rarely more than $800-1000 at the max.

    And I totally agree on the written estimate aspect–we always give those out when possible (i.e. when they are not on the phone asking). We’ve had clients quote estimates back to us that make no sense, and that none of our employees would have told them for X procedure and thus we end up losing money & in a very awkward situation…

  8. Miriam Yarden, B.Sc.,MS,APDT Says:

    Case 1) My client wanted to take advantageof the $39.99 spay/special her vet was advertising with flyers. At the pre-op meeting she asked for a written estimate and the total came to – wait for it – $430.00! WHY? Because the 39.99 covered only the surgery itself. not the pre-op meds, suture materials, antiseptic wash, anasthesia, intravenous fluids, needles, nursing, cage space, boarding. antibiotics, pain patch, collar and the kitchen sink. I saw the detailed list and was appalled. She left and went to a low-cost clinic which made her vet extremely irate.
    Case 2) Goldnen Retriever presented with a limp which turned out to be a torn ligament, Written estimate was given, but a day or so before taking him home, she received a call that something else was found and he will have to stay another two days. Two days later: he has to stay another three days. Three days later: another two days. In the meantime the bill was getting larger and larger. Finally, at almost $4000.00 she had enough. Six months later the same vat was sued in court by a multitude of clients who had the same experience with him. He lost in a big way in fines, loss of business and harsh words from the AVMA. He is still practicing but his estimates are closely scrutinized.

    Such conduct is not frequent but happen often enough to make clients wary. As for me, although I am not a veterinarian, I work with countless vets closely and even I know that such practices are unethical, marginally legal and certainly unnecessary.

  9. Dr. Tony Johnson Says:

    This is a great series, and this piece one of my favorites! I am with, Dr.Kay – discussing costs is not the fun part of our job, and it doesn’t happen in so many cases because of out natural aversion to it. It is an absolutely necessary evil, though – some of the most furious clients I have ever dealt with have been the ones who were not provided an accurate estimate.

    In emergency medicine, though, clients have to keep one thing in mind – these are estimates, not guarantees. We often have circumstances arise that we did not predict of foresee, and that can change the final bill to a huge degree. The best way around this is to constantly update owners on the bill, and provide estimates with a broad range.

    Our estimates are signed by the owner, and usually have a low range and a high range. In general there is quite a spread between the two – estimates where the high end is 2 or 3 times the low end are not uncommon.

    Many, many sincere thanks for such a great series of articles!

  10. Dr. Nancy Kay Says:

    In response to Terry’s comments, every veterinarian and/or their staff should be willing and able to provide an itemized cost estimate. If indeed their computer or staff are unable to do so I have to believe they are behind the times!

  11. Dr. Nancy Kay Says:

    In response to Kate’s comment- I really feel for you. You are caught between a rock and a hard spot, having to promote some practice dynamics that sound less than ethical in order to maintain your job status. Might there be a way to have a heart to heart talk with the doctors and/or hospital administrator to address your concerns? If we give them the benefit of the doubt, is it possible that they have not realized the issue the way you have? Best of luck sorting this out!

  12. Natalie Says:

    For more expensive procedures, my vet’s staff does typically offer a written estimate actually. They prefer to have the client see an itemized cost up front.

    I think it is very important to recognize clients’ discomfort with asking. Many of us want to do it all but it’s just not realistic in a lot of cases.

    In the comment by the person from the dermatologist, for example, all of the expensive tests might be necessary to diagnose the dog’s or cat’s condition but that still doesn’t mean the client can afford them. Paying for a consult is one thing. Paying for a very expensive procedure is something entirely different.

    Having just asked for a ball park estimate on an MRI and back surgery, I would say there is some value in ball park estimates… they tell me whether my funds are anywhere in the ball park to even think about it!

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  14. EmilyS Says:

    heh.. try to get written estimates from your own doctor! Or understand the bill you get from him. By comparison, my vet is a model of openness.

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