Vet Pricing Structure, client view

[SaddleFitterVA]

This is not a rant, because I do expect vets to earn a living.

I received a bill that was grossly over what I expected. As in, 100% more than I expected.:o:eek::eek:

I started to go down the line items, and realized that there is hundreds in billing ERRORS. Looked like the items got entered twice, by two different people.

But, as a client, the line items that bother me are the ones that have separate pricing structures, on the same bill. An example is tranquilization, sometimes, it is charged at something like 24, others the drugs are separate line items around $4 and then a separate $15 tranq fee. We won't go into the fact that the tranq is often pulled out without even trying a procedure w/out the drugs at all...and even something as non-invasive as xrays on a quiet horse.

When I know every single item is being priced higher than other clinics, that is where I expect the profit, not in an additional bunch of administrative fees over and above the higher costs per line item.

This is not the first time I've had billing errors, but have to say, this round has me seriously considering dropping this practice as the first-to-call. I am fortunate to live in an area with dozens of excellent vets. And, since I usually choose to haul out to most of them, and there is only a 5-10 mile difference in the distance to 5 or 6 clinics, and most of those have surgeries.

It seems that there are a lot of practices that are going to the shot-gun approach of medicine/charges. Do every test, inject every joint, premium fees for every service, etc. I've gotten used to this on the small-animal side of things, and know I need to shop carefully for the premium vs. normal care styles there, but now I'm realizing that I need to have a better interview process to ensure that my thoughts on equine healthcare line up with the practice's.

I also wonder at the cost-effectiveness (non-existent from my POV) for so many to have HUGE and expensive diagnostics centers. It is obvious that those are expensive to build and buy and maintain and so it makes sense that those costs are passed down to ALL clients via higher charges, but it seems that there comes a point where admitting privileges at fewer facilities would be more cost effective on a whole. It seems that there is a bit of "keep up with the joneses" going on in the equine clinic world around here.

It won't be a "scene" or any dramatic declaration, because that isn't how most customers are lost. It will simply be one less 6-7 horse barn worth of calls coming in for routine vet care.

[dr j]

I should just back away from this thread....... but

Did you call and ask about the invoice? I am assuming you did - if there are errors I am sure they want it corrected also. I would also ask for a detailed explanation of the invoice. I know in our software system many of the codes I choose come up with multiple lines - and esp with tranqs etc as a lot of the drugs are controlled substances so when it's invoiced it has to be documented for DEA purposes. For instance if I do a dental exam/float sedate and I use dormosedan/butorphanol the butorphanol amt must be recorded ( controlled substance). So I may code it under code 640 but that code automatically splits it into the two drugs used and asks for the amt of butrophanol used for record keeping purposes.

So there might be sedation charge 24.00, then a Dormsedan 8.00 butorphanol 8.00 for a total sedation charge of 40. vs showing up on your bill as sedation: det/torb 40.00. Or it may look this in a 3 line item Sedation 0.00 Dormosedan 20.00 butorphanol 20.00.( numbers are pulled out of the air- not to compare). All the same thing but based on their invoicing/inventory/recording system.

Just a thought.

[SaddleFitterVA]

I have every confidence that the errors will be corrected.

But, that does not change the fact that the HUGE invoice with double entry of multiple items over multiple days highlights huge variances in charges for the same procedures. It is "my bad" for not asking upfront what to expect from this practice for charges for what was done. Silly me, I figured that if most people were paying in a range for something, that I'd be paying the high end of that range...not double the top figure of that range.

There have been a few other issues over time that are factoring into my leaning away from a practice, but this is not about various issues, it is about how billing and pricing is handled can impact customer perceptions of a practice.

[Ambrey]

So they did the same thing two different days and charged a different amount?

Could there be a weekend surcharge or something?

[IndysMom]

at my barn we were all talking yesterday about how the local vets all seem to be thinking up new ways in which we should care for our horses-all of them involving additional vet calls for healthy horses...

Not happening...

[Deb413]

I am lucky to get an invoice-usually have to call to get a copy, but they sure know how to charge my credit card.

[Ride2Dreams]

It almost sounds like they charged you for the wrong dosage amount, then went to go in and correct it and forgot to cancel out the wrong so you are seeing wrong and right.

JMO though

[rabicon]

Wow, I have the best vet in the world :lol: I do notice that the sedation charges maybe seperated but being a vet tech for years I understand that controlled substances have to be handled that way. You have to keep inventory very well in lock box cases of med. that way you know if something is even missing from your clinic esp if it was robbed you know what was taken and how much exactly. If you don't, wooo I feel sorry for you because the dea will crawl all over you.

That said my vet is great. I had him come do our coggins and always put my horses barn name on the coggins. Never had a problem that his show name is different. Well unknownly to me USDF you must have your show name on there so my vet came back out NO Charge about 2 months later (after I got my first coggins back) and redrew the coggins and did it again at NO CHARGE to me.

My vet also does not sedate any of my horses unless its a MUST!! Just had xrays done on pony and we didn't sedate him. The only must have sedation procedure on the farm is teeth floating. I don't blame him for that :lol: But then again I have a really close relationship with my vet, I have even been given his private cell number for the just in case problems when the answering service is being to slow. He is great and we even choose our farm (beside it being perfect) for the fact that he will still come here.

[trubandloki]

I always pay at the time of service and I am handed my invoice right then. They will gladly go over it line by line if I ask them to.

[SaddleFitterVA]

So, back to the topic, this is again, NOT a rant about a specific item, but how pricing structure impacts client relations.

As a client, I'd like to see:

a basic pricing structure published, farm calls, basic fees they charge such as "admission" or "tranquilizing" fees
prices of commonly prescribed drugs
what commonly run tests cost
Price range of professional services such as ultrasound, joint injection, etcI'd also like the vet know a ballpark for the costs of things, I've more than a few times come back in shock at the prices and the vet acts astonished, the vet had no idea of the cost of items. So, basically, the vet wants to operate with no cost constraints, which would be great, if I had no cost constraints, but I live in the real world on a fixed income (not tiny, but salary).

As a client, I don't like having to call the office try to figure out what all the costs are, so that I can then weigh cost/benefits of various diagnostics or treatments.

I'd like a vet to tell me if there are less expensive drug options we could try, and let me choose the high priced one first (if I wanted).

The reality is that I have a vet budget, especially for certain discretionary items. Things like injectible joint supplements (adequan/legend), joint injections, breeding, along with a few others. Not every service I buy from the vet is required or emergency.

These are the services that I want solid expectations on the costs.

[trubandloki]

But even with a pricing structure in place it still probably leaves them with the ability to charge less for things if they would like (for a good client, etc).


I actually find it strange that your vet does not have basic prices to offer up to you if you ask. I can not see them printing out pages of pricing for clients but I have never had a vet refuse to offer an answer if asked 'what will this cost'.
When treatment is needed it usually is offered in a manner that helps me weigh cost vs treatment length vs benefit to long to term healing, etc.

Maybe I just use an extra good vet (I know I use an extra good vet actually).

[magnolia73]

I guess you just need to control the situation. Get an estimate on pre-planned procedures and physically be there. I literally ask about what everything will cost now. Because LOL, generally it is more than you would think.

I LOVE the guy who fixes my car- he calls you before beginning work and splits out labor/parts cost on each item and gives you what you can expect if you don't take action. (LOL, "$63 for a new trunk latch.... or you leave bungie cords...")

I suppose an equine emergency is much different, but on a routine procedure, if you call the office, it seems like they should be able to do something similar. Perhaps that needs to become a standard practice for all of us not made of money caring for pets!

[SaddleFitterVA]

I have asked multiple times "how much is X procedure?" and gotten "I don't know, you'll need to call the office" as an answer.

This is the same at small animal clinics, although they have started to post some of the vaccine charges now.

Anyone else have contributing thoughts? As an owner of animals, what style do you prefer?


Only the best for Poopsie
Insurance covers diagnostics, I have insurance, go to town
Evaluate Treatment options, costs/benefits, decide
Routine care only
I don't use vets, I can do it all myself.Am I the only person who gets the bill (either at time of service w/ small animals or after receiving invoice in mail for large animals) and is shocked at some of the items that showed up?

I don't think so, as there was a lengthy thread on small animal vets in another section.

I was hoping to get a discussion of various options that people would like to see, not a defensive stance from vets/clients, not to make excuses for common billing errors, etc.

[magnolia73]

When I scheduled Niki for hock injections, I asked about the cost when making the appointment. They were spot on, though she took an extra dose of sedative that added maybe $20 plus some Dex for unrelated hives.

The last vet I used knew what things ran, cost wise. I would just ask her, "OK, what will this cost" and she knew. It wasn't complicated stuff though- blood work etc.

I guess the best you can do is get the estimate when you call to schedule.... and call the office to get costs for recommended procedures that come up in the field. I definitely prefer 3. And I agree- they should be able to ballpark pretty close routine procedures- joint injections- and what, you had a general reproductive type service, correct? They should be able to get those on the spot within $100. I don't think they need say "ahhh- SMZ's- that'll be $56.75" but they should be able to say- $50-$60. And DEFINITELY do quotes as a worse case- we may need to tranq your horse for a full series of knee X-rays - $50 for the tranqs, $100 for the pics and $100 for the farm call. I don't necessarily expect to get a thorough cost estimate from a busy vet, but his office should come through on a pre-planned service.

And I absolutely will not do whatever it takes, whatever the price. I may well do "whatever it takes" but before I give your permission to proceed, I'm going to have a ball park price.

[JSwan]

I don't expect my vet to know the charges for each procedure, potion or pill.

But I also don't think it's that difficult to keep a printout in their truck.

My current vet just keeps a list in his truck. ETA: Not for every conceivable service or product but most of the common stuff.

My former vet liked to surprise me. A lot.

So I choose option 3, which I have no doubt makes me a bad owner who doesn't wuv my pookums. I'll get over it.

[Ambrey]

This would be a great poll, saddlefitter. I choose
Evaluate Treatment options, costs/benefits, decideCost IS a factor. Even in my own care! There are things I'd like that my insurance doesn't cover and I just can't afford.

[Saidapal]

Around here the latest thing - well, really its been going on for a few years - is to give shots every quarter.

I don't use those vets.

I am also from the 'will quietly depart and find someone else' school. I won't call, I won't complain, I just won't call you anymore and will take my money elsewhere. I've found if I do say something I get a lot of blah, blah, blah, you have to understand, blah, blah, blah......so I don't waste my time and it saves me the frustration.

[Janet]

I get the bill from my vet (and pay it, either with check or credit card) before he leaves the barn. He has a lap top computer between the front seats, and a printer in the back.

Some of his prices are high, but I have never been double billed. And if I ask him "why?" on a specific charge he always explains it.

[Ambrey]

Around here the latest thing - well, really its been going on for a few years - is to give shots every quarter.


Well, we do that but it's not the SAME shots every quarter. They do a quarterly clinic and give shots depending on what the current recommended time is.

I can't imagine giving my horses all the shots in one big dose once a year- they get sick enough after the quarterly ones!

[trubandloki]

Evaluate Treatment options, costs/benefits, decide

I use number 3 (which renumbered it self #1 because SF must have used fancy auto numbering stuff).


Not too many people can do otherwise I think.


I have never had a vet even stutter when I ask "but how much will that cost" about a treatment, small or large animal. I would think they would expect people to ask that and be prepared. If it is a procedure they usually give a range.

[Janet]

I've more than a few times come back in shock at the prices and the vet acts astonished, the vet had no idea of the cost of items..
I am confused. Doesn't the vet SET the prices? Why would he/she be surprised by his/her own prices?

[artienallie]

I am confused. Doesn't the vet SET the prices? Why would he/she be surprised by his/her own prices?

In a large, multi-vet clinic, the vets don't set the prices and aren't involved in the business aspects at all.

There are pros and cons to such an arrangement.

[SidesaddleRider]

SaddleFitterVA, what you ran into is what I have run into before, and is VERY frustrating! And hence, also the reason I haul over to Ian Harrison in Berryville for most things other than emergency-type situations or when I need drugs (I can just call a certain vet then and pick it up at the office).

Is is VERY experienced, and he does not immediately do the most high-cost thing, but is very pragmatic, looks at the horse, says it's X, and we can do Y or Z. Y will be $, and Z will be $$, but the liklihood of Z working better is slim, but it's up to you. The costs are set and in the computer, so they can give you a pretty accurate estimate of what things will cost.

An example: I had a mare with a sequestrum that needed to be removed, so I called the clinic and asked for an estimate. They told me that it would most likely be $1,500-1,800 depending on how difficult the chip was to get to, how much anesthesia needed to be used, etc. That was about what I figured it would be. My actual bill at checkout? $998. :)

[LuvMyTB]

No, you are not the only one who has been shocked by vet bills. I started a thread last month in Horse Care because the bill for ER colic treatment and euthanasia was $850--twice what I expected, and she billed me for some things (tubing, rectal) that she was not able to complete due to the horse's violent behavior.

This vet has also, over the past 3 years: not sent invoices, not recorded payments, not dropped off medicine when she said she would, mailed my Coggins to the wrong address, and not mailed my Coggins EVER.

I continued using her because I believed her to be the best in the area. Unfortunately, with this last invoice, she has priced herself right out of my business. I am using a different vet for my new horse.

[Janet]

In a large, multi-vet clinic, the vets don't set the prices and aren't involved in the business aspects at all.

There are pros and cons to such an arrangement.
All cons- from my perspective. I don't think I have used a multi-vet practice (except for specialist stuff like MRI) for 20 + years.

[rabicon]

My vet doesn't know an exact figure. Like, say my horse had to have shots and coggins done and needed his teeth floated. He can't say to me well thats going to be 100.00, he'll say about 100.00, maybe a little more or less but round about that area. To me it sounds like you need to try some new vet practices and see if you can find one that suits your needs better. Some vets don't think they should have to deal with the pricing of things, they are the vet not the office manager etc... and some vets are hands on with every aspect of their business, like mine. Try out some new ones. Maybe even call them ahead of time when you know you need something and see if they can tell you an est. or exact figure.

[BuddyRoo]

It was our policy to give a high/low estimate and have the client sign a consent form.

Typically, even in an emergency situation, we would get an animal stabilized and then start talking money.

I can't imagine NOT having a discussion about $$ before authorizing treatment.

At our clinic, we did have a fee schedule. When the charges were entered, the fee could be changed--let's say we had propofol by the bottle in the system...and we only used 1/2 a bottle, we could reduce the price--but generally, it was pretty easy to put together an estimate of charges and have the client sign off ahead of time.

[RedMare01]

At the vet clinic I previously ;) used, I have no idea how the prices were set up. The last bill I got from them was for spring shots and bloodwork for my mare. I got the invoice, sent the check (~$200, kind of high, but I was pretty much okay with it). The vet left a message on my voicemail a few days later saying the bloodwork was back and to please call him back to discuss the results. When we talked (actually we played phone tag a couple of times and I did not speak with him until two weeks after the appointment- glad nothing was really wrong with my mare), we had all of a five minute convo in which I did most all of the talking. I got another bill for $32 for his five minute "consultation." I threw a fit about that one and did get it taken off my bill after talking with the manager multiple times.

One thing I really don't understand is the farm call fee. With some vets, the one farm call fee ($50 or whatever) gets split between the number of horses the vet sees, whether it is two horses or ten horses. With this vet, I always got charged for half of the farm call fee even when there were many more than two horses being seen (there are probably 30 horses on the farm I board on). So for spring shots, I paid for half of a farm call (half = $28) and if all of the ten or eleven other owners did also, the vet is making $300-400 on top of the services he is performing. Is this the norm? :confused:

Caitlin

[wingedmare]

WOW, our vet charges A farm call and splits it between everyone. HOWEVER our Vet's charge for a farm call is quite high and you have to schedule it months in advance. So, that ALSO means if you have an emergency getting the vet to the farm is nearly impossible. I don't fault him for it however, seeing as how he is the only Equine Vet within 2 hours. So, we just haul the 30 min to the clinic for all procedures and emergencys (if it is safe to move the horse of course).

Now, this does affect charges in that they are more expensive than I was used to when there were several vets competing in the same area. However, my Vet is very good about giving discounts where he can (IE. MIlitary, Senior Citizen etc.) and there has only been one time with a billing error and that was due to a new employee/new computer system combo and was fixed quickly.

Guess I'm really lucky too.

[SaddleFitterVA]

All cons- from my perspective. I don't think I have used a multi-vet practice (except for specialist stuff like MRI) for 20 + years.

I might start to agree with this perspective soon.

[SLW]

I have asked multiple times "how much is X procedure?" and gotten "I don't know, you'll need to call the office" as an answer.

This is the same at small animal clinics, although they have started to post some of the vaccine charges now.

Anyone else have contributing thoughts? As an owner of animals, what style do you prefer?


Only the best for Poopsie
Insurance covers diagnostics, I have insurance, go to town
Evaluate Treatment options, costs/benefits, decide
Routine care only
I don't use vets, I can do it all myself.Am I the only person who gets the bill (either at time of service w/ small animals or after receiving invoice in mail for large animals) and is shocked at some of the items that showed up?

I don't think so, as there was a lengthy thread on small animal vets in another section.

I was hoping to get a discussion of various options that people would like to see, not a defensive stance from vets/clients, not to make excuses for common billing errors, etc.

At the equine practice where I work the failures happen when communication is dropped on either side. That is also how we pick up new clients- they become unhappy with another practice.

If your a new client walking through our front door I will scope out your expectations and needs as a client. Are you a person who will use the university for treatments/diagnostics? Is Dobbin disposable in your eyes, just another mouth to feed? Do you even have a clue about your horse's basic needs? I'll listen for statements like "I treated the barb wire wound myself for 12 days then took Dobbin to Doc Stewart for help and Dobbin still ended up dying from lockjaw. That Doc Stewart is a bonehead." :(

We have no problem giving estimates for services to be given, it is all part of communication. And no one is going to judge you for not taking Dobbin to K-State for colic surgery when Doc turns to you and says "it is a surgical colic."

One practice I onced used had a ding-bat of a front office gal. A kitty of mine had been in for two surgeries within 3 weeks to remove cancer on one ear and remove the entire other ear. A complication came up overnight and I rang them first thing and said "this is going on, please have Doc So-N-So call me". No call by 2:00 that day so I called back. The Ding Bat then told me "Doc So-N-So is out of town until Monday." Grrrrr. :mad: They lost me after that.

Communication, if they are not giving it to you I would walk.

[Marshfield]

This doesn't excuse whoever mailed the invoice not catching the billing errors, but I can tell you that the type of invoice you describe does sound very similar to a glitch we used to experience with our old program.

As for pricing structures, I'm on the small animal side these days; but I do fairly frequently see invoices from other practices (I'd really prefer that the other practice fax the darn proper medical record, but that's another story). I have seen some who charge far more than I do for vaccines, but negligibly for the exam. Or huge markups on meds. So, it can be somewhat hard to compare practice to practice. And then there's huge regional variations.

There's also very much a variation in standard of care depending on region of the country. Which, of course also impacts costs.

As for knowing what things cost, some stuff I can tell you the price off the top of my head. Routine canine c-section is $900 to $1200. The rest I can look up readily. And in my office, for anything beyond a routine annual visit you'll get an estimate, itemized, in writing.

[FalseImpression]

We just switched vet practices at our barn. Our previous vet was pretty reasonable though. I never felt overcharged. On the contrary, he would take 12 xrays, but only charged for 4 or 5 if that's what he really needed for a diagnosis. Once, he phoned me after reviewing the bill already sent, that he had caught a mistake and the amount was already credited back to my cc. Last Fall, he told my BM that my mare did not need her teeth floated and it could wait until Spring. When I saw a charge for floating and sedation on the bill, I called the office. They checked with him and he confirmed that he had not done it and credited the cc once again. We used to pay about $6.00 as our share of the call.

There was no call fee (shared or otherwise) on the new practice first bill. All the vaccines were about $5 more than on the bill from the previous vet a year earlier. The total was within cents though of previous bill.

I receive a bill after the end of the month. I call in my cc # then and they process the payment and send me a receipt. So far, so good and pretty reasonable.