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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 11/7/2020 Examination $ 42.00 IL Y $ 42.00 11/7/2020 Radiograph Abdomen $ 159.44 IL Y $ 159.44 11/7/2020 Chem 5 (5-6 Tests) $ 60.70 IL Y $ 60.70 11/7/2020 Total Body Function $ 143.00 IL Y $ 143.00 11/7/2020 Ova/Par-G 1 yr $ 53.00 IL Y $ 53.00 11/7/2020 Fluid Therapy Set Up $ 92.40 IL Y $ 92.40 11/7/2020 Fluid 1st Bag $ 0.00 IL Y $ 0.00 11/7/2020 IV Catheter $ 0.00 IL Y $ 0.00 11/7/2020 IV Administration Set $ 0.00 IL Y $ 0.00 11/7/2020 Fluid Pump $ 18.95 IL Y $ 18.95 11/7/2020 Hospitalization $ 77.00 IL Y $ 77.00 11/7/2020 Occupancy $ 0.00 IL Y $ 0.00 11/7/2020 Nursing Care $ 0.00 IL Y $ 0.00 11/7/2020 Prof Care $ 0.00 IL Y $ 0.00 11/7/2020 Intensive Care Level 1 $ 15.45 IL Y $ 15.45 11/7/2020 Exam Pre-Anesthesia $ 0.00 IL Y $ 0.00 11/7/2020 Preanesthes/Induction $ 57.85 IL Y $ 57.85 11/7/2020 Gen Anes 1st 1/2 hr $ 118.60 IL Y $ 118.60 11/7/2020 Gen Anes Add. 15 min $ 53.30 IL Y $ 53.30 11/7/2020 Anes Monitoring Lv 2 $ 63.20 IL Y $ 63.20 11/7/2020 Hernia -Inguinal $ 494.35 IL Y $ 494.35 11/7/2020 Nursing/Injections $ 59.00 IL Y $ 59.00 11/7/2020 Ampicillin $ 19.48 IL Y $ 19.48 11/7/2020 Injectable Buprenorphin $ 27.07 IL Y $ 27.07 11/7/2020 Amoxicillin $ 20.80 IL Y $ 20.80 11/7/2020 Metronidazole $ 50.70 IL Y $ 50.70 11/7/2020 Tramadol HCL Compounded $ 34.30 IL Y $ 34.30 11/7/2020 Intest HE K9 14oz Can Qty 10 Y $ 25.80 MI N $ 0.00 11/8/2020 Day Hospitalization $ 46.20 IL Y $ 46.20 11/8/2020 Intensive Care Level 1 $ 15.45 IL Y $ 15.45 11/8/2020 Fluid Therapy Nursing $ 15.45 IL Y $ 15.45 11/8/2020 Oral/Topical Nursing $ 9.60 IL Y $ 9.60 11/8/2020 ChlorhexiDerm Flush $ 19.20 IL Y $ 19.20 11/8/2020 Gentamicin/Clo $ 26.18 IL Y $ 26.18 11/8/2020 Medical Waste Fee $ 4.99 IL Y $ 4.99 11/10/2020 Metacam $ 32.48 DD N $ 0.00 11/7/2020 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 InsuranceClaim example: orthoscopic surgery to fix cranial cruciate ligament rupture in RottweilerGuest post: number one pet health problem is obesityMeasuring my cats’ body mass index – the FBMIClaim Example: Inguinal Hernia Repair in a Dachshund
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