In my previous post about the hardships of life on a six figure income (queue strings), I mentioned in passing that we had a $4000 veterinary bill for our dog. A couple of people mentioned veterinary health insurance. Nala was actually too old to have qualified for insurance at the time she died. We would have had to have signed her up when she was younger. After Nala died, I checked out veterinary health insurance plans, hoping to save ourselves the same ordeal with our new puppy, Chewie. When I studied details of several plans, I concluded that these insurance programs are not a good deal for pet owners.

Nala died of idiosyncratic liver toxicity from a drug called metacam that we were giving her for arthritis. Dogs and cats instinctively conceal injury and sickness, so we had only vague clues that anything was wrong with her the day before I left for a cross-country business trip. She was an elderly dog, and we weren't sure we wanted an elaborate medical care for her if she was sick (how ironic). The day after I arrived, my husband called with terrible news. Nala had vomited up half her blood volume all over the living room floor. She was a one hundred pound dog, so you can imagine how dramatic and upsetting this was. It was the middle of the night, so my husband had to drag our child out of bed, carry the dog down a flight of stairs, and throw both in the car to go to the emergency clinic. By the time the vet returned with a possible diagnosis and recommendations, the bill was already over $1000.

Let's stop a minute here to talk about veterinary expenses. I used to work for a veterinarian, and I could not believe what an attitude people had when it came to paying for health care for their pets. They seemed to think that it should all be dirt cheap, or that the doctors should provide care out of the goodness of their hearts. So when I say that the initial workup cost $1000, I can pretty much predict someone is out there, already writing a comment, probably without even finishing the article, to complain that $1000 is too much. Well, I'm here to say that for one thing, that is much less than the real cost of the same care in a human emergency room, and for another that veterinarians are highly educated professionals who deserve to get paid well. If you feel that the right way to deal with that situation was to dig a hole in the back yard while she finished bleeding out, then this post about the cost of veterinary care for your pets is probably not the best use of your time.

So we are already $1000 underwater, and in order to get Nala through until the next day and figure out what is really wrong with her and whether she can be saved or not, she needs two units of blood. That's another $800. And we are trying to make this decision over the phone, with me sitting in a hotel room San Francisco, crying hysterically. (In fact, I need to take a little break as I write this, the memory is so intense.) We go with the blood transfusion, and I try to change my flight to come right back home. This is where I learned that if you book through Expedia, you can't change your return flight once you have already departed. (I will never book anything with Expedia again.) The next day, Nala was slightly improved, and so we decided that I would finish my trip.

The next couple of days were a roller coaster. We knew her liver was failing, but the veterinarian (a brilliant, triple-board-certified expert in everything) could not give us any clear answers. At times, she seemed to be improving. She was in intensive care, getting medicines all day long, daily blood draws. The bills were racking up. Would she pull through, or not? And the whole time, I was in California. I finally got home, after a nightmare flight that left me stranded overnight in Denver, and got to see my dog and say goodbye. Six hours later, she took a clear turn for the worst, and we put her to sleep together, as a family. Our final bill was $4000. Of that, the drug company eventually reimbursed us about $1100, for the diagnostics which they were glad to have as part of their post-market monitoring program for adverse events. We put the rest on a credit card.

The most heartbreaking aspect of this, for me, is that in her post-mortem exam, evidence was found of liver regeneration. If we had kept her going longer, maybe she would have made it. But how long? The size of the bill was a part of our decision-making process. As we watched the charges mount up every day, we hoped against hope that the bleeding would stop (for us all), and we would be able to take her home. But it didn't. The bill was like a waitress, pouring your coffee, inviting you to say "when." We reached our limit and had to pull the plug. I'll never know what would have happened if we had been able to afford more care. Then again, she was clearly suffering, and ...and...well, we did what we did, and there's no going back.

Could veterinary insurance have helped in this situation? Many people think it would have. If I had enrolled Nala in one of the more popular plans, VPI, at a younger age, I would have paid about $35/month for the "Superior Plan." However, when I looked at the schedule of benefits, I found that drug toxicity is reimbursed at a rate of $258 per incident. Kind of inadequate, huh? Possibly we could have gotten an extra $236 for "stomach ulcer" as a secondary diagnosis, and maybe $150 for her ultrasound, although that test was included in the drug company reimbursement.

Ultimately, this seemed to me like chump change. To start Nala at birth and pay $35 premiums until she died would have cost $4650, and we'd still have been out $2256 for that incident alone. And that's not taking into account the time she got pancreatitis and nearly died from eating half a bag of kitten food. I see VPI's reimbursement for pancreatitis is $388. That's not even close to how much it really cost. Going back even further, Nala had heartworms when we first got her. I don't remember how much the treatment cost, but it involved a week of hospitalization. Parasites are excluded outright from VPI's plan. So we would have been out of luck, there.

There are a couple of things going on here. One is that the reimbursement schedule doesn't seem realistic compared to what the medical bills actually cost. Another is that there is progress in veterinary medicine parallel to human medicine, and that many more treatments, tests, and procedures are available now than in the past. Back in my veterinary assistant days, nobody got an ultrasound for their dog (unless maybe they went to the big veterinary college down the road), and I never heard of a dog being in intensive care. That made end-of-life decision-making somewhat simpler. Nowadays, they have chemotherapy for pets, and joint replacement surgery and MRI's and lots of other high tech treatments. The next step in Nala's care, if we had not euthanized her, would have been total parenteral nutrition (nutrition via IV drip), because her digestive system was not working. That would have been obscenely expensive. Health insurance is the reasonable and logical way to deal with the risk of being faced with these huge costs. Unfortunately, the major pet health insurers are themselves not prepared to pay those costs. Until that changes, at our house, we will be paying our veterinary costs out-of-pocket. Eventually, I would like to create a fund for pet health care, and put money into it regularly so we don't get steamrolled the next time this happens. And it will happen.