Tips on Facing the Veterinary Estimate You Cannot Afford

Too often pet parents want to avoid the vets office because they fear they cannot afford to go. This was not always the case. Veterinarians were, (and some of still desire to be), trusted, humble, affordable and focused on patient care over financial ability. Everything was offered. Everything was affordable. Every person around the pet care was honest and the veterinarians reputation mattered. Our names were our badges of respect in the community. In those days everyone knew everyone else and you didn't need credit cards or credit ratings. While life was simpler so were the options we had for diseases.

No one should ever have to leave the vets office feeling broken, especially, heart broken, and certainly not bank account broken. The goal of this blog is to also be able to leave with a sense of being heard and offered options to meet a wider spectrum of financial ability. I am also here to be transparent and honest. I have been a practicing veterinarian and hospital owner for 20 years.

If your pet is an integral part of your life, and you have financial stability to permit advanced specialty care, there are numerous highly skilled veterinarians working in impressively modern facilities that rival human care, without limits, and pushing the barriers of miraculous. There are almost no limits to what we can do, or what is available to save your pets life. In modern veterinary medicine there are no horizons we will not let you pay for. We will never abandon hope nor options as long as you can pay.

When you cannot we offer euthanasia and an alleyway with best wishes to finding someone else who cares enough to do it at their own expense. You are not guaranteed anything in life and you sure as heck aren't our problem if you lack the cash (or credit) to get your pet out of whatever pickle you find yourself in. If society wants us to be better than this, more compassionate, and self sacrificing it has yet to take a good long look in the mirror and ask itself what it has ever given back for someone less fortunate. While I meet some amazingly kind people in my day to day life I more often meet angry, demanding, accusatory jerks. If you want someone to be kind to you you might want to be kind to others first. 

The public wants to believe that veterinarians are in this for the love of animals, but lets be real honest, we are here for pets, not people. People, well they will break you, sometimes intentionally. 

For every person who comes to me seeking affordable care they are always nice at the beginning. They are always nice when they have little to bargain with, a dying pet in their lap and a promise to pay us back. The reality is that their past behaviors for how important that pet in their life is is a very good prognostic indicator for how likely they are to actually pay you back. Many of the emergency surgery requests I get on a daily basis have not vaccinated their pets in years, or ever, have never used preventatives, and never spayed/neutered their pets. The owner will tell you how much they love their pet, swear that they are good for the money to pay you back for services, and yet they have tattoos, nails, and a new car in the parking lot. There isn't one vet out there who isn't nodding their head right now. If your pet was everything to you their health, safety and current precarious position would be in good hands at the over-priced, yet-capable ER right now. Spare us the excuses. 

When it comes to an immediate medical or surgical plea for emergency care be open, honest, courteous and ready to compromise/negotiate. If you want to be a belligerent, angry, accusatory, demanding bully I (and I expect everyone else who actually went to vet school and sacrificed what we had to (like 8 years of our life) is very unlikely to help you. I am only here to help your pet who is in this predicament only as an innocent victim. Remember this. For most of the people I see they have little to negotiate, less to compromise, and still would rather see their pets as theirs, even if that means deceased, instead of treated.

Always Be Kind. Then ask what you can do to keep your pet alive.

Here are my tips to finding affordable care for your pet;

First, always be the example you want your vet to be. Be kind, compassionate, and be focused on your pet as the center of everything you do. In simple terms, if you want the vet to put your pet above all else, do the same.

Remind the vet who your pet is to you. Maybe this doesn't seem sensible to you, after all you already know what your pet means to you, but, us vets, well we see so many pets that we have to emotionally distant ourselves from them so we can maintain some degree of analytical, scientifically based care. We have to be able to do and not be encumbered by fear/stress/grief/longing/loving/emotions. It is a sad truth that we need to have a layer of armor even when we came here to be healing and compassionate. Life strips the soft vulnerable layer from you as a protective mechanism to survival, but life is about love so remind your vet to see the world, your pets life, as an extension of this.

Remind yourself that you can find help. Affordable help, and don't give up. I see a lot of people who find me after they have asked for help in dozens of other places. The key to these people; they all adored their pets, and they all refused to give up until they found the care they needed. I have dozens of examples of this. Dozens. Here are some real-life examples:

Blocked Cat. Meet the many cases I saw in the previous blogs. Go to Pawbly.com. Read through the storylines. We post the cases and the invoices. All are real cases that I saw, treated and helped. This is the power of finding a veterinarian who is passionate about petcare, the immense power of keeping the patient in the focus of all we do, and, very importantly, working with a team that is independently, privately owned. You, every client facing a veterinarian who is not being given affordable options for their pets care, have options, rights and ways to find help. Ask hard questions, and document everything.

Here is my step-by-step approach to finding affordable, meaningful care.

1. Provide an accurate, honest, brief description of what is going on with your pet. When it started, and list any and all medications, foods, and supplements that you are giving. I strongly recommend that you put this in writing and email it to yourself and the vet clinic you are at. Document everything. Every word, every name of every employee you interact with. These documents are your best way to keep everyone honest and accountable. Document and then disperse to the veterinary provider. Insist that they acknowledge receipt of your email. Document this too.

2. Your vet will then perform an examination. When they come back to you after the exam ask them to provide it to you in writing. If the vet does not return ask to speak to them, and ask for the exam findings in writing. Get a copy of the physical exam before you leave. Write down who you spoke to at every interaction. 

3. Ask for their top differential diagnosis. Ask them to try to narrow down them to three. In some cases this might be impossible based on the lack of diagnostics. The differential diagnosis MUST be recorded. You should ask the veterinarian to review what you record for errors and accuracy. Many medical terms sound alike. Spelling and specificity matters. I use an app on my phone to email myself these notes. You can use a pad of paper.. Whatever works for you,, BUT, record and provide a copy to the clinic/hospital. This insures everyone is being provided correct information. Before consenting to anything ask what the veterinarians differential diagnosis(es) are. Write this down and ask the vet to confirm that you have it correct. 

4. The estimate that you are going to be given should be explained line by line. You should be able to write down why each item is recommended. This will take time but it must be explained to you so you understand what the veterinary team is asking to do and why. Get a copy for yourself and take notes on this copy.

5. From the list of differential diagnoses ask the veterinarian which are treatable and which are not. They may not know, but they should have an idea as to which would need immediate interventional care AND be curative, and which will not. From those that are treatable ask for the estimate to treat. If this is cost prohibitive ask if there is a more conservative/affordable way to treat so that you can be transferred to another veterinary clinic (like your vets office) where the cost of care might be a small fraction of what it is here.

6. Omit any disease and treatment plan for a non treatable disease. Say for instance a brain tumor. While there are possible treatment options for this (and actually high success rates for brain tumors, most pet parents do not consent to brain surgery, or organ transplants, etc). If it is not treatable, or affordable for you to treat, ask them to only do the diagnostics for the treatable.

7. Ask the veterinarian to provide you one, yes, just one, diagnostic, to help identify the presumptive differential diagnosis. Write this down. Ask them to confirm this. If they argue, or refuse, remind them that every veterinarian was trained by this. Using the skills we were taught to be able to identify 1, just 1 test to do next. It is absolutely your right, and our responsibility to provide honest, transparent work-ups for your pets care. This is how I practice medicine. Why my vet clinic is so popular. Why we get so many requests for transferring care. We have conversations. Meaningful, honest conversations. We are here to help. We help in anyway we can. We are able to give away care. We are that focused on pets being given a compassionate chance.

If I have a very sick patient I will almost always ask for a comprehensive blood work panel (full chemistry (25 to 27 items on this), a CBC, a urine, tick borne disease (common in my area), fecal (intestinal parasites or parvovirus) and a thyroid panel. Cost for this is about $250. I will also ask for xrays (3 view chest and abdomen) for about $300. In the ER setting where these panels might be $600 each you can ask for a minimum database. The veterinarian should be able, and willing to scale down these to one or two items. You need to ask and get the answer to these presumptive differential diagnoses in writing. (Please see the disease specific blogs for what the minimum database is for each).

If you end up at my clinic and ask us for help this is what we will ask of you.

Leave No Patient Behind

George is a 9 year old indoor domestic short haired cat who visited us about a month ago for straining to urinate in the litter box, and producing only small amounts of urine. 

He presented again to us yesterday; unable to urinate. George is now a "blocked cat" or, UO cat (for urinary obstructed) cat. 

He found us, like they all do, with a little bit of luck, and a parent with limited resources. 

When he arrived on Saturday morning at the vet clinic we suspected that he was blocked. We also hoped that his parents had a rainy day account of immediately accessible funds so we could send him where he needed to be; the ER. The ER these days require a $4,000 deposit for this. It is beyond my comprehension what they do with that $4k, but it seems ubiquitous enough amongst the lot of them so it must be accountable in some list of line items. 

Within 20 minutes of Georges arrival at my clinic my phone rang.

"Sorry to bother you, (I was away for the Thanksgiving holiday), but, we have a blocked cat here." 

"Is anyone there willing to unblock him?" I asked.

"Yes."

"Ok, then we will figure out how to pay for it later. Have the owner go through our emergency sheet. Have someone else in the room with them to serve as a witness. And, make sure she is ok with us sharing the story and photos. Call me if you need anything."

"Ok. What would happen if we didn't help these cats?"

"They would die at home a miserable death, or be euthanized. Just like all of the rest of the cats. You know that." I replied.

My office manager agreed to go over everything with George's mom. She was working from home, on her day off because that's what George needed from us. George is a perfect example of who we are. He is deserves to be cared for. He is why I went into veterinary school. He is my WHY as much as any of the regularly paying customers are. Maybe more so.

George, the morning he arrived at JVC.

Here is the Facebook post we put up that morning; Georges first FB post here

"This is George.  He has found himself in a hopeless situation today.  He is blocked, and his mom only has $400 available to help him.  At our practice unblocking runs $800 - $1,000.  Despite the lack of funds we’ve agreed to help him, because we know without help George will die.  George and his mom could use some help financially with the cost of his care and treatment over the next couple of days.  Donations can be called in or made in person directly to George’s account.   Donations can also be sent via PayPal to jarrettsvillevet@gmail.com, please note that your donation is for George.

A big thank you to our kind hearted Dr. Ahrens who agreed to stay late to help George today.  ❤️"

A few hours later we posted an update;

Waking up from surgery.

"George is out of surgery and resting!  Thank you to all who have donated.  Please know any funds raised in excess of what is needed for George will be used to help another pet in a predicament like George. 

We truly couldn’t do this without the kindness and generosity of those who support us in our mission to help pets like George."

Two hours after the first post was put up we had raised $1900 for George. 

I posted a video on his story. Find it here; Inspire an army to save lives video here.

George update

One day post op. Looking good George

He is feeling SO much better with the help of our rockstar Saturday staff. He is getting his sq fluids currently (he is awesome at it) & taking his meds like a good boy.

So, George is a miracle, right? I mean its an incredible thing to be able to be given the treatment you need at a price your client can afford? Why doesn't every veterinarian do what we do? 

Well, because they think they can't. I hope to set an example of how this can be done. And remind everyone how good it feels to help save these lives.

We take a can-do approach to these cases. We take a leap of faith that we can save these pets first of all. We only offer payment plans, pro bono, take a risk on non-payment for cases that we think will survive and have a good return to a quality of life. We do not offer this to patients used for breeding purposes, people who are abusive, unkind to the staff, and who we do not believe will continue to provide routine preventative future care. For all of the cases we do not offer pro bono, or potentially not pay us back, we do offer to have the pet parents the option of signing over their pets to us. We will find a home for them, or keep them as our own for the rest of their lives. While this might sound cruel or unkind there are situations where pet parents realize they cannot provide the care their pets need, and they put this above all else. These are the people we want to over extend ourselves for. Sadly, almost everyone would rather their pet suffer, remain without treatment, and ultimately die than give them up. There was a case of a 4 year old dog who swallowed a corn cob who died recently after the owners declined the offer to give lifesaving surgical intervention. They watched her die over 4 days while they tried to raise the $3500 the ER required as a deposit versus signing her over to the rescue who offered to take her and get her the surgery she needed. 

Here is the document we use for these cases. We ask the pet parent to initial each line and then give them a copy for their records. If people would come to me and say "I love my pet so much that I would rather have her treated and alive with someone else than dead with me." I would do everything to save them. I don't think I am alone with this. 

For more information on this please see our website; Jarrettsvillevet.com see the tabs for Financial Assistance and Immediate Help.

All clients who cannot afford the estimate for needed care at Jarrettsville Vet must agree to and sign the following;

___ I understand this is an emergency.

___ I understand my pet would be best served at an ER, ICU, referral center.

___ The only reason that I am NOT at the ER/referral center/ICU is that I cannot afford it.

____ I understand that my pets current condition is (we fill in our differential diagnosis here).

____ I understand that I may not fully understand the extent and severity of this condition without a referral or additional financial resources

____ I have been given an estimate for care;

I can   ______        or    _____       cannot afford this estimate.

____ I understand that the estimate may change as my pets status changes. We will offer a payment plan if we go over your estimate.

If I cannot pay the estimated deposit for care I will;

1.       Sign a letter of collateral. If the invoice is not paid in 90 days the collateral will be transferred to JVC at my cost and the item will be sold for payment. Collateral item is; ______________

2.       Allow my case to be shared on any social media platform of JVC’s choosing to try to raise funds for my pet and awareness for their condition. This will help pay knowledge forward and maybe spare another pet from this condition.

3.       Follow all suggestions to include full story write up, starting a Go-Fund Me, sharing the fundraising efforts of JVC, and assisting with future fund raising projects at JVC

4.       Volunteer at other non-profits to pay it forward.

____ I allow JVC to share photos, videos and pertinent patient info for an indefinite period of time at their choosing.

____ I allow JVC, Dr Magnifico have full access and rights to my pets story. Past, present, future,

___ I will provide updates as asked and allow JVC, Dr Magnifico, the GSF, TPGSF, to share my pets story.

___ I understand that JVC has offered to help me care for my pet as an extension of compassion, kindness and shared goals to help end suffering and provide care regardless of financial constraints. It is with this in mind that I will be kind, compassionate, and generous with the actions and comments about my pets care.

___ We reserve the right to refer care back to an ER/ICU/specialist at any time.

 

Our Immediate Need Policy and Expectations for Non Clients are as follows: 

· We strive to offer affordable options for pet owners.

We usually require a full deposit at the time of intake for any emergency services. Our team will go over an estimate for your pet’s care once your pet is assessed. 

Please visit our website for additional resources to help with paying the balance. 

CareCredit may be utilized. You can apply for CareCredit via their website - https://www.carecredit.com/applyo Payment plans will be offered only to existing clients who have applied for or exhausted CareCredit. Payment plans are provided via Vet Billing

· Any financial concerns must be discussed at the time of receiving an estimate. 

· If you cannot afford the exam fee, the estimate for diagnostics and the treatment plan we will ask what is feasible for you financially, emotionally and physically to care for your pet long term. You are asking us to put your pet above the cost of running a veterinary facility, paying our staff and the emotional burden we take on with these cases.  

You will receive a copy of our Client Rights and Responsibilities and be expected to abide by it. We will not tolerate abrasive behavior directed to our staff. We are here to help you and your pet and expect to be treated with kindness. 

We will work together as part of a team for what is in the best interest of your pet. 

In working within the confines of financial concerns we may discuss with you waiving some diagnostics to keep the estimate within your budget. 

If it is determined that it not feasible for you to care for your pet long term, or if you pet is in need of immediate emergency care and we can not come up with a reasonable financial plan we may discuss surrendering your pet to one of the rescues we work with so that may receive the lifesaving care they need. 

· Jarrettsville Vet is a small animal general practice, we do not have staff in the building overnight. In most cases you will be expected to pick your pet up before we close. 

· We are working your pet in as an emergency. This means that the veterinarian may defer update calls to the support staff. Please rest assured that if your pet’s condition worsens you will receive a call. 

· It is our policy that if your pet is in need of emergency surgery and is intact, they will be spayed or neutered at the time of surgery. This is non-negotiable, if you are not agreeable to this clause please seek services elsewhere. All patients will also be vaccinated for rabies and given a microchip with Jarrettsville Vet listed as the contact for the life of this pet.

· You will allow us to share your pet’s story on Pawbly.com and social media at the discretion of the veterinarian. 

· If you receive funds from our Good Samaritan Fund you will participate in JVC or Good Samaritan Fund fundraising or volunteering and agree to the terms and conditions of our Good Samaritan Fund Recipient Policy. By signing below, you are indicating that you have read and understand our Emergency Services Policy.