The notification popped up Tuesday morning, between two phone calls at work: claim paid, $6,023.70. I read it twice, walked into the break room, and read it again. Then I sent a screenshot to Caleb, who replied with a thumbs-up, which from him is basically a parade.
Hank's TPLO was on January 8. I submitted the claim from the sofa on January 9, the night he came home, and it paid on January 27. That's 18 days. Here is every number, because while I was waiting I would have loved to see someone else's.
The bill
The final surgery bill from the practice in Blaine was $6,840.00, inside the $6,200 to $7,400 estimate. Itemized:
- Pre-op bloodwork: $186
- Anesthesia and monitoring: $968
- TPLO surgery, including plate and screws: $3,920
- Surgical suite and sterile pack: $216
- Post-op X-rays: $312
- One night of hospitalization: $410
- Pain management in the hospital: $386
- Bandage and incision care: $148
- Take-home medications: $214
- Rear-support sling ($62) and soft cone ($18): $80
What counted, and what didn't
Our insurer treated $6,760.00 as eligible. The $80 for the sling and the soft cone was not, which I expected. They're useful, but they're equipment sold at checkout rather than veterinary treatment, and Hank's policy (like most I've read at work) draws that line. Everything medical on the invoice counted, including the take-home meds and the hospital night. Hank has been insured since December 2022 and had no knee history before he hit the ice, so there was no pre-existing question to sort out.
The deductible and the 90 percent math
Hank's policy year runs December 1 to November 30, with a $500 deductible and 90 percent reimbursement. I sent the two earlier bills from this same knee in with the surgery claim, and they went entirely to the deductible:
- December 29 exam and sedated X-rays at my clinic: $288.00, after my staff discount
- January 2 surgical consult in Blaine: $145.00
That's $433, which left only $67 of deductible to come out of the surgery bill. Here's how the $6,023.70 came together:
- Eligible charges: $6,760.00
- Minus the remaining deductible: $6,760.00 minus $67.00 is $6,693.00
- Times 90 percent: $6,023.70 reimbursed
And here's what was left to us on the surgery bill: the $67.00 of deductible, our 10 percent coinsurance of $669.30, and the $80.00 for the sling and cone. Total, $816.30.
When I did the math on the estimate earlier this month, I figured our share would land somewhere between about $680 and $800. I forgot about checkout items. That's the extra $80, and it's exactly the kind of thing I'd warn someone about at my own desk. So much for practicing what I preach.
How the money moved
The deposit and the balance both went on a credit card. The day the reimbursement landed in checking, it went straight onto the card, and our $816.30 came out of the pet fund, along with the $264 we spent on recovery supplies (runner rugs, lick mats, a snuffle mat and a second baby gate, none of which insurance covers, nor should it). The fund is now lower than it's been since we opened it. That gets its own post.
From the front desk: the claims I've seen go smoothly almost always include two things, an itemized invoice rather than just a total, and the medical records, which for a surgery means the surgical report. I asked for both at pickup, before we left the building, and uploaded them that night. I can't promise that's why ours took 18 days, but it didn't hurt.
On the pet tab of our budget spreadsheet, there's a running line for Hank's policy: premiums paid against money back. Before this month it had reimbursed $126 in three years. In August, when we came up two dollars short of the deductible, I said I was still glad we had it. I'm not going to pretend I'm not gladder now.
None of this predicts what your policy would do. Deductibles, reimbursement rates, limits and exclusions vary a lot from plan to plan, so the sample policy and a phone call to the company are where your real numbers live.
Hank, for the record, is unimpressed by all of it. He would like to file a complaint about the soft cone.
