Veterinarians resist pressure to advocate for pet insurance

AVMA policy asks practitioners to discuss third-party payers with clients

Published: September 30, 2019
By Jennifer Fiala

New policy by the American Veterinary Medical Association that endorses pet insurance and enourages practitioners to educate their clients about it is receiving pushback from veterinarians who consider the topic of third-party payers to be outside their purview. 

Some decry pet insurance altogether. Others support the use of pet insurance, but might hesitate to promote it.

Pet insurance in the United States

The AVMA House of Delegates revised its pet insurance policy in August to say it "encourages veterinary healthcare teams to proactively educate their clients about the existence of such resources." At least a dozen companies offer pet health insurance in the United States, each with a variety of programs for insuring pets. The AVMA policy does not ask veterinarians to recommend one policy over another. Some state laws forbid those kinds of discussions.

Rather, the policy recommends that veterinarians inform clients that such programs exist. Supporters of the new language say it's a "small" deed that can have a big impact, elevating the health of pets because owners of insured pets can afford more care. Veterinarians, the AVMA says, are uniquely suited to talk about pet insurance because they're viewed by owners as authority figures. "Studies also show that pet owners are more likely to have pet insurance if it is brought to their attention by their veterinarian," the AVMA says in a recent blog post.

Some veterinarians applaud the change. One is Dr. Clayton MacKay, a former practice owner who's now a practice consultant in Ontario, Canada. "Wonderful," he wrote in response to the blog post, "this important step towards improving veterinary care for our patients should be followed by every veterinary organization!" 

However, many veterinarians in practice say that just because they know medicine doesn't qualify them to promote pet insurance. For weeks, debate has played out on a message board of the Veterinary Information Network, an online community for the profession and parent of the VIN News Service, where talk of the policy has been met largely with annoyance and exasperation, although some veterinarians tout its merits.  

Dr. Summer Hedges, a practitioner in Raleigh, North Carolina, considers insurance to be a powerful tool worthy of promotion. As a pet owner, it's allowed her to make medical decisions for her pet with few financial limitations. "I have had to make economic decisions in the past," she wrote on VIN. "I greatly appreciate the change in my life from needing to keep my finances in the back of my mind in making decisions to having the only financial concern being, 'which credit card can handle the balance?' "

But discussing it with clients makes Dr. Trae Cutchin of Flowery Branch, Georgia, uncomfortable. 

"For me, it's simple," Cutchin wrote on VIN. "Insurance of any ilk falls under the heading of personal finances. It is not a medical issue. We have no business telling clients about their finances and what they should or should not do. That's what insurance agents are for."

Dr. Chiara Switzer in Toronto, Canada, considers the idea that a veterinarian should have a financial management talk with clients to be "utterly preposterous."

"Their money is their business, and I think it's really wrong for the profession to provide unrequested advice about how they should spend their money," she wrote.

Others in the VIN discussion expressed disdain for an insurance industry that has shackled human health care by dictating patient treatments and fees while raising premiums and denying claims, and they don't want to help third-party payers proliferate in veterinary profession.

"I would literally quit being a vet if we have to deal with insurance on a regular basis. It's one of the reasons I'm not a human doctor," wrote Dr. Megan Ellis of Sanford, North Carolina. … "I am NOT going to be talking about pet insurance except to say DON'T DO IT."

Others surmised that the AVMA's motives for pushing veterinarians to discuss pet insurance with clients might reflect ties between the association and insurers. 

Policy's evolution 

Dr. Rena Carlson, chair of the AVMA Board of Directors, addressed the criticisms in the discussion, posting that by amending the policy, the AVMA hopes more veterinarians will educate clients about options that can help defray the cost of care. 

"The recent amendment is the result of rigorous data and research that demonstrates that pet insurance can be a good way for clients to afford the care their pets need, and that the lack of awareness of pet insurance by owners is a barrier to access to care," she wrote on VIN. "… This recent amendment is intended to raise the awareness of the potential benefits of pet insurance and that resources exist, in order to support client understanding of what pet insurance is, how it works, and to determine if it is right for them."

In a statement to VIN News, the association expanded: "The AVMA is not encouraging veterinarians to market pet health insurance to their clients. Instead, the intent of the policy revision is to recommend that the availability of pet health insurance be included as part of the thoughtful discussions with clients about options for paying for veterinary services. Ideally, such conversations take place proactively during regular visits before clients are faced with a veterinary medical crisis they haven't prepared for. Hopefully, these types of discussions and preparations may reduce heartbreaking decisions that may include being forced to choose 'economic euthanasia.' "

Carlson explained on VIN that the policy was the result of "rigorous data and research that demonstrates that pet insurance can be a good way for clients to afford the care of their pets need, and that lack of awareness of pet insurance by owners is a barrier to access to care." 

The research, she said, was led by agricultural economists with Mississippi State University in collaboration with the AVMA Veterinary Economics Division. "It was conducted completely independently of insurance companies and the AVMA does not have a partnership with any pet health insurance company. The results of the research demonstrate the benefit of pet insurance towards enhancing the level of veterinary care received by animals and the economic sustainability of the veterinary practice," Carlson said.

She added that the research also supported the idea that veterinarians have an important role in consumer decisions regarding pets when it comes to pet insurance. "Specifically, the research found that pet insurance results in more care being delivered to the pet. It is also important to note that we believe that pet health insurance is an important tool to help reduce the frequency of economic euthanasia," she wrote on VIN. 

Michael Dicks, former AVMA chief economist and a co-author of the study, told VIN News the research conducted in 2015 by Mississippi State  "sought to understand how pet owners might act, not how they did act.

"There is no research that compares identical groups of pet owners and pets that measures how they actually did act," Dicks said. "Thus, I am very uncomfortable with the statement that pet owners will spend more at the veterinarian if they have pet health insurance — this is not an accurate statement based on the current research."

Dicks, who retired from the association last year, said he previously suggested that the AVMA develop a statement to the effect that "veterinarians discuss the health risks for the animal and the associated financial risks for the pet owner at the first visit."

The reason, he said, is that "Veterinarians have the best knowledge of problems associated with specific pets and local disease issues. It may be beneficial for the veterinarian to discuss alternative strategies for preemptively addressing the potential health issues and preparing for the financial burden.

"The point I often make," he continued, "is to insure that the pet owner has the most informed expectations. Getting caught in the situation where the pet owner finds out that their pet breed has a history of certain problems, after the problem occurs, will reduce satisfaction with the veterinarian's services." 

As for the Mississippi State-led research, Dicks said it was "statistically reliable and there was much information to glean" but the work was "not robust enough to warrant a conclusion that having pet health insurance will in all cases increase spending on veterinary services, and further, I am aware of no such available research that would validate this hypothesis."

Insurers respond

This is not the first time that the AVMA has taken heat over pet insurance. In 2008, a deal between the AVMA Group Health and Life Insurance Trust (now AVMA Life) and Pets Best Insurance imploded when veterinarians objected to the association's exclusive promotion of the insurance company in exchange for royalties on premiums.

Still in operation, Pets Best is owned by American Pet Insurance Company, the only property and casualty insurer in the U.S. solely focused on marketing and underwriting pet health insurance. The company also owns PetPartners, Inc., which is the American Kennel Club's brand of pet insurance; and the nation's second-largest brand, Trupanion. 

A Trupanion sales representative saw the AVMA policy change as an opportunity last month to solicit meetings with veterinarians. The representative, a contractor known as a territory partner, sent an email to say that the AVMA was "changing their 'best practices' " to encourage veterinarians to discuss pet insurance with clients.

Some veterinarians who received or heard about the email criticized Trupanion for using the AVMA policy to promote the company.

Trupanion Chief Executive Officer Darryl Rawlings told VIN News that the promotional email was sent by a single territory partner in the Northeast. Trupanion as a whole, he said, has no plans to send similar marketing materials.

Asked why, Rawlings noted that pet owners already are aware of insurance. The challenge, he said, is public acceptance. "They [pet owners] are aware of the concept, but they're not seeing it used in a regular way. They think it's an outlier," he said.

No policy can normalize the concept of pet insurance more than veterinary practices can by proactively asking clients at check-in who their insurer is, as is done in dental and medical clinics, Rawlings said.

He also said the AVMA policy, while "nice," could do more to differentiate between pet insurance products. "If AVMA had asked me, I would have added the words 'high quality,' " he said. Telling pet owners to "Just go buy any pet insurance" isn't advisable because "some of them are garbage," he added.

Rawlings acknowledged that suggesting pet insurance to clients can be uncomfortable for veterinarians and staff, who might fear that the clients will question their motives: "People in pet hospitals don't want to proactively bring up something that seems weird. Like, 'Are you getting paid for this? Why are you asking?' "

Margi Tooth, Trupanion's chief revenue officer, said one aspect of the AVMA policy change that the company wholeheartedly supports is that it "reinforces the fact that [insurance] helps to overcome the challenge of the cost of care."

Whether the policy will encourage more owners to purchase insurance is yet to be seen, but TJ Houk, chief data officer for Trupanion, said that at a minimum, there will be more conversations about planning for veterinary care. "The result is going to be more clients being better prepared, which will help the veterinarians in the long run," he said.

That outlook is shared by Dr. Carol McConnell, chief veterinary medical officer at Nationwide, the nation's largest purveyor of pet insurance. McConnell said by email that she's "delighted that the AVMA continues to recognize pet health insurance as an important component of companion animal practice."

"Of particular significance is their revised wording that encourages veterinary professionals to discuss pet insurance options with their clients," she wrote. "This aligns with both AVMA sponsored and pet insurance industry data that consistently shows that pet owners who have pet health insurance visit their veterinarian more frequently, and their pets receive more care during those veterinary practice visits. This is great news for pets, pet owners and veterinary practices."

Edie Lau contributed to this story. 

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