RSA Insurance Group, which underwrites pet insurance on behalf of MORE TH>N, Tesco Bank, M&S, John Lewis, Argos and Homebase, has clarified recently announced changes to its policy conditions concerning cases which need to be referred for specialist treatment.
In a letter dated 22nd May, which was sent to practices in the Midlands and the NW, the company said:
"With effect from the 25th May 2015, if you need to refer a pet under any of the above Brands to a specialist or referral vet, and the visit is not in response to an emergency, then our customer / your Client can contact us on the relevant number below before any appointment is made. We will then agree which of our preferred specialist or referral practices our customer should go to, dependant (sic) on the individual circumstance relating to the claim. If our customer does not get in touch with us or we have not agreed to the visit, then this could result in our customer suffering a financial impact. This amount will be in addition to the policy excess."
Speaking to VetSurgeon.org, Keith Maxwell, Head of Pet Claims at RSA said: "What we're saying to the primary practices is that we want to speak to our customers before they go to a referral vet. We want to engage with our customers to let them know that we have referral vets who we are starting to work with across those specific regions. We are not saying to customers that you have to use those referral vets and if you don't, we won't provide cover."
This appeared to contradict a statement that a member of VetSurgeon.org had received from John Lewis earlier which said: “If you decided to go to a specialist that wasn’t approved by us, we wouldn’t cover the costs." Keith said: "That is not correct."
Clarifying the financial impact referred to in the company's letter to veterinary practices, Keith said: "In terms of any sort of financial impact on the customer, if we think about the level of benefit that a customer will have under their insurance policy, they will have a maximum cash benefit. If a customer goes to one specific referral vet and the cost of treatment is extremely high, and they have a choice of going to a referral vet that we have been interacting with to get a like for like treatment, the cost will be lower, the financial impact on the customer will be that the overall benefit available to them will be eroded at a faster rate."
He added: "The other thing I would say is that certain customers under our policies will have a policy excess which will be on a percentage basis. Now if you think about a higher cost treatment which will incur a percentage excess, it will be a higher amount the customer will have to pay, as opposed to going to a referral vet where they can get the exact same high quality treatment, but the overall cost will be lower; they will pay a lower excess. So we are not saying we are going to penalise a customer. There are other financial consequences i.e. eroding benefit or having to pay a greater amount of excess."
Whilst RSA appears not to be removing the freedom of choice over referrals, there remains the potential for a conflict of interest when a primary practitioner recommends treatment at a centre they believe to be the most suitable for the case, and the client then rings the insurer only to be advised to use an alternative, primarily for reasons of cost. Keith said: "What I would say is that we are at the start of a journey. We've selected a small part of the country. We are very much in a 'test and learn' phase. As we have selected referral vets, we have gone through obviously quite a lengthy process of engaging with referral vets, looking at specialism, looking at their accreditation, looking at their capability, their skill, equipment within their practices, what their areas of specialism are, so we are building up this view. It does come down to we want to learn from this. We want to engage with our customers. We want to offer our customers choice. We want to make sure that our customers will not be receiving an inferior service or inferior treatment or level of specialism in any specific way."
VetSurgeon.org asked how RSA has selected its preferred referral practices, and how others can join its network. Keith said: "When we started this journey, we made contact with a significant number of referral vets across the country. Some referral vets just said point blank 'No, we don't want to talk to you'. Others said 'Yes, we'd like to come and have some discussions'. So we took those forward and then we took the referral vets through a benchmarking process based on a full list of criteria, and within RSA we have veterinary expertise helping us along that journey, so we're not just doing this on our own. We are very much an open door to interacting and liaising with referral vets."
Keith concluded by saying: "We are focused on our customers here. We are focused on making sure that pet insurance is sustainable in the long term, both for our customers and for vets across the country."
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It is intolerable that lay people could interfere with a veterinary surgeon's clinical judgement in this way.
Wynne
HWR- is exactly right, you would be slightly more impressed if they had at least involved some kind of clinical audit instead of the usual shmoosing activities that oil the wheels of the world these "suits" inhabit. So basically they have made some deals to cut costs via regular use and guaranteed income ,aka Car repairs. Personally I have never trust anyone called "Keith", they always seem to end sentances with words like "mate" and sell poor quality used cars.
On the plus side it may help to bring some of the more ridiculous excesses of referral pricing under control!
we have had two ridiculous situations in the last 24hrs. they do not discuss with the client anything. they are asked for a full quote from the referral practice for treatment as expected before they will agree to anything.
this has lead to our practice pretty much grinding to a hault with animals requiring orthopaedic surgery that is not "emergency" enough to just use common sense, never mind clinical judgement to say head there now to the open slot while I write a referral letter, compile imaging and send clinical notes.
instead, we have to essentially complete our side of the referral, get the referral centre to check the notes, make judgement on their action, provide an estimate, contact the insurer, who will then call the owner and referral centre to say yes or no.
If they want to call the shots based on money, provide the clients a list, based on their home address of which referral centre they think is cheapest, let the practices know who to use and monopolise the whole thing. why base treatment on good relationships, expert knowledge and client care. put a pound sign and some commission on it.
If a case is painful, but they don't regard it as an emergency, then would a prosecution under the AWA be appropriate?
It may all be in a bid for them to cut their costs. Maybe if they cant they will close the insurance business - which is unlikely. I am sure they will find another way to make it worth their while. Maybe we need to look inwards here.
People with long memories may recall that a few years ago the insurance companies were in discussion with the specialists to cut primary care practitioners out of the loop so that certain procedures would only be carried out in a specialist centre. So perhaps we shouldn't be over sympathetic now the boot is on the other foot.
Pet insurance has without a doubt largely funded the massive increase in second opinion practice. To my mind it is obvious that the pet insurance companies would wish to use their position as major paymasters to get a good deal. This isn't unethical but merely follows the model of human health insurance where it is normal for the insurance companies to offer work to suitably qualified practitioners at set tariffs.
What is so surprising is that this hasn't happened sooner.
I agree with Martyn Lee on this. Pet insurance has to be affordable or owners will stop insuring their pets, it can only remain affordable to the masses if referral centre charges are sensible. As a first opinion vet, I do sometimes feel referral fees are very high. However, they provide excellent care to the pets we refer and it would be a dreadful shame to lose all of the wonderful facilities that have sprung up over the last 10 years. Hopefully a balance can be established that keeps the cost of pet insurance under control AND allows referral centres to continue to provide the specialist clinical care that is advancing veterinary medicine.
What we do not need is extra paperwork in first opinion practice when arranging an emergency referral.