Embrace Pet Insurance Blog

Tuesday, August 31, 2010

Claim Example: Inguinal Hernia Repair in a Dachshund

As the final post of our focus on obesity this month, I thought it a good example to use where this hernia could have possibly been prevented through weight management (although such a young dog is likely to have needed surgery no matter what).

An inguinal hernia is a defect in the opening from the abdomen down to the testicular sac and obesity sometimes can change something miniscule and not noticeable into a serious condition that needs surgery to fix the defect.

Details of the claim for Roxy, a 1 year old Dachshund living in Pomona CA:

DATE	ITEM	Tax	BILLED AMOUNT	COVERAGE TYPE	COVERED IN POLICY?	COVERED CHARGES
11/7/2009	Examination		$ 42.00	IL	Y	$ 42.00
11/7/2009	Radiograph Abdomen		$ 159.44	IL	Y	$ 159.44
11/7/2009	Chem 5 (5-6 Tests)		$ 60.70	IL	Y	$ 60.70
11/7/2009	Total Body Function		$ 143.00	IL	Y	$ 143.00
11/7/2009	Ova/Par-G 1 yr		$ 53.00	IL	Y	$ 53.00
11/7/2009	Fluid Therapy Set Up		$ 92.40	IL	Y	$ 92.40
11/7/2009	Fluid 1st Bag		$ 0.00	IL	Y	$ 0.00
11/7/2009	IV Catheter		$ 0.00	IL	Y	$ 0.00
11/7/2009	IV Administration Set		$ 0.00	IL	Y	$ 0.00
11/7/2009	Fluid Pump		$ 18.95	IL	Y	$ 18.95
11/7/2009	Hospitalization		$ 77.00	IL	Y	$ 77.00
11/7/2009	Occupancy		$ 0.00	IL	Y	$ 0.00
11/7/2009	Nursing Care		$ 0.00	IL	Y	$ 0.00
11/7/2009	Prof Care		$ 0.00	IL	Y	$ 0.00
11/7/2009	Intensive Care Level 1		$ 15.45	IL	Y	$ 15.45
11/7/2009	Exam Pre-Anesthesia		$ 0.00	IL	Y	$ 0.00
11/7/2009	Preanesthes/Induction		$ 57.85	IL	Y	$ 57.85
11/7/2009	Gen Anes 1st 1/2 hr		$ 118.60	IL	Y	$ 118.60
11/7/2009	Gen Anes Add. 15 min		$ 53.30	IL	Y	$ 53.30
11/7/2009	Anes Monitoring Lv 2		$ 63.20	IL	Y	$ 63.20
11/7/2009	Hernia -Inguinal		$ 494.35	IL	Y	$ 494.35
11/7/2009	Nursing/Injections		$ 59.00	IL	Y	$ 59.00
11/7/2009	Ampicillin		$ 19.48	IL	Y	$ 19.48
11/7/2009	Injectable Buprenorphin		$ 27.07	IL	Y	$ 27.07
11/7/2009	Amoxicillin		$ 20.80	IL	Y	$ 20.80
11/7/2009	Metronidazole		$ 50.70	IL	Y	$ 50.70
11/7/2009	Tramadol HCL Compounded		$ 34.30	IL	Y	$ 34.30
11/7/2009	Intest HE K9 14oz Can Qty 10	Y	$ 25.80	MI	N	$ 0.00
11/8/2009	Day Hospitalization		$ 46.20	IL	Y	$ 46.20
11/8/2009	Intensive Care Level 1		$ 15.45	IL	Y	$ 15.45
11/8/2009	Fluid Therapy Nursing		$ 15.45	IL	Y	$ 15.45
11/8/2009	Oral/Topical Nursing		$ 9.60	IL	Y	$ 9.60
11/8/2009	ChlorhexiDerm Flush		$ 19.20	IL	Y	$ 19.20
11/8/2009	Gentamicin/Clo		$ 26.18	IL	Y	$ 26.18
11/8/2009	Medical Waste Fee		$ 4.99	IL	Y	$ 4.99
11/10/2009	Metacam		$ 32.48	DD	N	$ 0.00
11/7/2009	Tax		$ 2.26			$ -
Total			$ 1,858.20			$ 1,797.66

Roxy's policy had a $200 annual deductible, a 20% copay % and a $10,000 annual maximum but no drugs and dental coverage selected for a monthly premium of $32.50. The payout on the claim was calculated as follows (taken directly from the claim Explanation of Benefit)

STEP 1: Calculate Potential Refund
Billed Amount:		$ 1,858.20
Covered Charges:		$ 1,797.66
Annual deductible remaining		$ 200.00
	subtotal	$ 1,597.66
Copay 20%	(your copayment)	$ 319.53
Potential Refund		$ 1,278.13


STEP 2: Compare potential refund against your annual maximums
Annual Maximum		$ 10,000.00
Prior refunds for this policy year		$ 0.00
Coverage remaining		$ 10,000.00

Your total refund is:		$ 1,278.13

Is this something you've come across in your dog?

Related Posts:
August is Obesity Month at Embrace Pet Insurance
Claim example: orthoscopic surgery to fix cranial cruciate ligament rupture in Rottweiler
Guest post: number one pet health problem is obesity
Measuring my cats' body mass index - the FBMI
Claim Example: Inguinal Hernia Repair in a Dachshund

Posted by Laura on Tuesday, August 31, 2010 at 07:55 AM | Permalink | Comments (0)

Monday, August 30, 2010

Measuring my cats' body mass index - the FBMI

A couple of weeks ago, I came across an article by Dr J (though twitter) on the Feline Body Mass Index. It's the same concept as the human BMI measurement where you look at a person's weight and height and work out the percentage of body mass made up of fat.

Being the math geek in me, the article had a formula for calculating a cat's body mass index so I thought I'd give it a whirl for my two 1 year old indoor cats, Rocket and Rosie (who will forever be known as The Kittens in our household).

Here's your cat’s FBMI calculation:

While your cat is in a standing position, with the legs perpendicular to the ground and the head upright (good luck with that!):

Measure the circumference of your cat’s rib cage. (The level of the 9th rib is ideal.)
Now measure the length of the lower back leg from the knee to the ankle and write down both numbers, because with what is coming, you probably won’t remember them.

Calculating the FBMI

Divide the rib cage measurement by 0.7062 and subtract the length of the leg.
Divide that answer by 0.9156.
Subtract the leg length from that number, and that is your cat’s BMI.

And here it is in action for Rocket and Rosie (it was not easy to get them to stand still for the measurements - tape measures look like fun dangly things to feisty young cats):

BMI calculation	Rosie	Rocket	Plump
(1) Rib cage	15.0	15.5	32.6
(2) Leg	4.0	4.0	4.0
(3) = (1) / 0.7062 -(2)	17.2	17.9	42.1
(4) = BMI = (3) / 0.9156 - (2)	14.8	15.6	42.0

Since a cat is considered overweight, or plump, at a FBMI score of 42 or more, I also worked out what waist my cats would have to have to be considered overweight - the "plump" column in the table above.

Instead of 15-16 inches it is now, they'd have to double their girth to be considered overweight. Quite frankly, I'd be worrying well before that and putting them on a diet much sooner. I might consider the double girth as obese, not just overweight, but that's just me.

So instead of relying on a formula to know if your cat is overweight, follow the following rule of thumb:

If you can't feel your cat's ribs when you run your hand down her chest, she likely needs to lose a pound or two.

Some other tips from Dr J on managing your cat's weight:

feed high quality food (we feed the kittens Wellness canned twice a day and some Core dried kibble to go with it)
limit free feedings (we do free feed some Core during the day but only enough for both cats to be done during the day before night time feeding)
exercise freely (both are indoor cats but we have play time in the evening and they love racing up and down their cat tree and chasing puff balls around the house)

It's hard keeping an indoor cat trim but definitely worth the effort I think. How do you manage with your cats?

Posted by Laura on Monday, August 30, 2010 at 08:04 AM | Permalink | Comments (1)

Friday, August 20, 2010

Other interesting changes in the Embrace Pet Insurance policies

You'd think that after the last 6 posts on the pawsome changes to our policies in our move to RLI (see Embrace has a new insurance partner - A+ rated RLI Corp), I'd have exhausted the list by now but there's still more:

you can now get a policy for a 6 week old pet and up (used to be 8 weeks)
we have new deductibles, including a $1,000 a year deductible. The premiums on these sweet policies are really really low
and did I mention we cover prescription diet cat and dog food in our Wellness Rewards Plus plan, as well as gastropexy, OFA and PennHIP x-rays, and umbilical cord repair? I probably did but I really like those new additions! :D

OK, back to work now. Just thought you'd like these nice extras to wrap up the week.

Posted by Laura on Friday, August 20, 2010 at 08:09 AM | Permalink | Comments (7)

Thursday, August 19, 2010

Embrace Continuing Care Sublimits have gone!

No more sublimit on the Embrace continuing care benefit for those Embrace policies with RLI as underwriter (see Embrace has a new insurance partner - A+ rated RLI Corp).

Yesterday, I talked about cleaning up some niggling things about the Embrace Pet Insurance product, specifically the Embrace dental illness coverage.

Today, we talk about the old Embrace continuing care sublimit of 25% of the annual limit in the second year of the condition.

I've never liked the sublimit but it was something that Lloyd's felt strongly about so that is what we offered. Now that we have some claims experience under our belts, RLI agreed with us that we could remove the sublimit if we added a lifetime limit of $50,000, so we agreed - woohoo! I'm thinking that a $50,000 lifetime limit is more than enough for any one dog or cat, don't you think?

So, what does mean for those of you with Lloyd's policies. To set the stage, there are 23 RLI states at the moment, with more coming every week (see Lloyd's and RLI states here). I can't guarantee when all the states will convert over but we're working hard to make it ASAP with a little fairy dust and Department of Insurance good will (please please please DOI ...)

[as an aside to those of you not in the insurance industry - you have no idea how inefficient the process of filing in 51 jurisdictions is (I'm being polite since I really want our policies to get approved!)]

But I digress...

In summary:

If you bought a Lloyd's policy recently, likely you will renew into an RLI policy. The good news for you is that the continuing care sublimit will have no impact on you since it only comes into effect in the second year (and you'll be cozy with RLI by then)
If your renewal is coming up and you are in one of the RLI states, you also will have no continuing care sublimit (list of RLI states)
If your renewal is coming up and you are in a Lloyd's state, chances are you are going to renew into a Lloyd's state and continue on with your policy as it is now (list of LLoyd's states). But when you renew in 2011, you will move to RLI at that time.

The interesting thing about the continuing care sublimit is that is had very little claims impact in the grand scheme of things but people felt it very restrictive (can't blame them - I agree!) so I'm glad we got rid of it.

Any questions?

Posted by Laura on Thursday, August 19, 2010 at 07:45 AM in Embrace Pet Insurance, Embrace products, pet insurance , pet insurance news, RLI Corp | Permalink | Comments (2)

Wednesday, August 18, 2010

Anyone interested in some Embrace Dental Rewards? Pick me, pick me!

Introducing the new Embrace Dental Rewards Plan, which covers the prevention and treatment of cat and dog dental disease!

Since Embrace launched in 2006, a few small things have been niggling me about our Embrace Pet Insurance policies, one being the way we covered dental illnesses:

Dental accidents are covered in the base Embrace health insurance product, just like in the human world, but our dental illness treatment coverage was lumped in with our prescription drug coverage - many people wanted to buy them separately
our dental illness treatment did not cover teeth cleaning, which disappointed pet parents :(
and dental illness is generally preventable so it felt odd to have coverage for the illness without the prevention (the teeth cleaning)

So, when we worked on moving our policies over to our new insurance partner, RLI (see Embrace has a new insurance partner - A+ rated RLI Corp), we decided to do the whole thing over and the Embrace Dental Rewards Plan came about.

Here's what it covers:

Dental Rewards is just like the Wellness Rewards Program in that it is not insurance but something more akin to a health spending account for the prevention and treatment of pet dental illnesses.

There are no sublimits on each procedure - you get to chose how you spend your money.
There are no deductibles, no copays, and no waiting periods so you can use it right away.
If you pay upfront for the year, you pay $101 less than the $400 benefit you can use so if you know you are going to have your dog or cat's teeth cleaned, you would make money on it. For monthly policies, the gain is about $53. (that's why it's called a Reward :) )

We like preventing dental illness in our dogs and cats - don't you?

Posted by Laura on Wednesday, August 18, 2010 at 07:24 AM | Permalink | Comments (0)