Is this a normal bill?

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Mau's Mom

Mau's Mom

Member Since 2013
Hello to this wonderful forum!

I have been lurking for a while, reading mostly, and really enjoy hearing all the great advice and stories on this site. Maui has been doing very well these past few months, maintaining good control of his BG on his 2x daily PZI, but yesterday we had a scare. I had been traveling for work more than usual these past few weeks, so he's been with the sitter. It is the same sitter every time, my cats know her very well and she sends lots of photos and video so I know all was well during her care. However, yesterday morning, Maui didn't look right and didn't want to eat breakfast (very unusual for him.) He had been spitting up a bit of saliva - like they do when they eat a bit of grass - and was acting lethargic, so I took him in to the vet.

The vet, who is a feline specialist, suspected pancreatitis and decided to hospitalize him. He was put on IV fluids, and given Cerenia for nausea, buprenex for pain, famotidine and ampicillin as well as Carafate. He was in the hospital overnight and was significantly improved this morning. They wanted to keep him again tonight but the clinic I use closes at 2pm on Saturday and is closed all day Sunday, and I was not comfortable leaving him without supervision for such long periods of time so I decided to bring him home where I could monitor him. They sent me home with some Bupe, Cerenia, fluids (subQ) and Famotidine to use tonight and tomorrow, with instructions to return on Monday morning.

I was very surprised when I checked out to find the bill was over $1600. He was only there one day and while they did blood work (($120) and a Lipase test ($140) they did not do any other significant diagnostics - no X-ray, ultrasound etc. That bill seems *really* high to me for one day/night on fluids.

Am I out of touch or is this normal? How do regular people afford this??
 
Was he being monitored round the clock while there? That kind of bill is similar to what I've experienced at MedVet in Columbus, OH, which is one of the 24 hour emergency veterinary services as well as being a referral center for complex cases. And they charge accordingly.
 
BJM said:
Was he being monitored round the clock while there? That kind of bill is similar to what I've experienced at MedVet in Columbus, OH, which is one of the 24 hour emergency veterinary services as well as being a referral center for complex cases. And they charge accordingly.
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No, not monitored around the clock and it is not an emergency clinic, just a regular vet office. There are techs there from 8 am til 6 pm on week nights, 2 pm on Sat. They are closed on Sundays, and while someone comes in to feed/clean AM & PM, they are basically alone the majority of the day and all night.

He was getting normal supportive care - IV fluids, some Cerenia for nausea, and they would have syringe fed him if necessary (I did the first round of feeding, and he ate on his own last night.) When I arrived this morning at 7:45, I found they had bandaged the IV too snugly and his paw was swollen, something they hadn't noticed - and although they assured me they would correct it "immediately" ... it was not addressed until 1:30 in the afternoon when I came to pick him up. (They were in the process of starting a new line in his other leg when I told them not to do another IV as I wanted to take him home.)

I just thought $1600+ was a HUGE bill for one day of care that did not include diagnostics other than blood work; the estimate I was given when I left him was $900 so I was very surprised to find such a big increase without so much as a phone call, particularly when nothing about the treatment plan had changed.
 
I would definitely review the itemized bill - request one if you didn't get one. I know I've often found double charges, etc. But that does seem excessive to me - though admittedly, some vets are much more costly than others. Still... My dog was just hospitalized for 4 days recently and my total bill was around $2400 - and that DID have a LOT of labs/tests/blood checks/IV/intensive stuff. She wound up with Parvo. Made a full recovery, but not cheap. We went home with over a hundred dollars worth of medication -Cerenia was one of the more expensive, but that still sounds high to me if all they did is what you've stated. I know with my dog, they had to do blood tests several times (at $120ish each time) to check progress - so maybe they had to check it multiple times??

One day of hospitalization with minimal testing - I'd definitely want a thorough explanation of the charges and question anything that doesnt sound right.
 
JenM said:
I would definitely review the itemized bill - request one if you didn't get one. I know I've often found double charges, etc. But that does seem excessive to me - though admittedly, some vets are much more costly than others. Still... My dog was just hospitalized for 4 days recently and my total bill was around $2400 - and that DID have a LOT of labs/tests/blood checks/IV/intensive stuff. She wound up with Parvo. Made a full recovery, but not cheap. We went home with over a hundred dollars worth of medication -Cerenia was one of the more expensive, but that still sounds high to me if all they did is what you've stated. I know with my dog, they had to do blood tests several times (at $120ish each time) to check progress - so maybe they had to check it multiple times??

One day of hospitalization with minimal testing - I'd definitely want a thorough explanation of the charges and question anything that doesnt sound right.
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Thanks, Jen, I did get an itemized bill and the only double charge I found was for the hospitalization itself - they charged me for 2 days ($162/day) even though he was only there 24 hours. I am sure they will remove that item when I bring it to their attention. The rest seems to be accurate, if expensive. I would have expected a rate more similar to what you describe - $2400 for 4 days, or $600/day, while not cheap, is more what I would expect for regular hospital care. Given that we only ran one "big" blood panel - and all of his blood work was fine - I really feel like $1600 is way over the top.

I've been on the fence about this practice for a while, and I think they have just pushed me over the edge. Sigh.
 
When Tink was diagnosed, that was nearly $3k. That vet too was not good about explaining what their treatment plan was (probably because they didn't really have one) but were adamant that he needed to be there, despite that THEY kept messing up - which they admitted - and weren't monitoring him like I could have. Long story short... they got my month's pay, but not my repeat business. The vet that treated my dog, on the other hand, were VERY communicative. They called me twice daily, letting me know status and any changes to the plan. They let me know my bill as it started getting larger so I could know what I was dealing with and make decisions with all the info. I really appreciated that. The old vet just acted like it didn't matter. I mean, YES, I love my animals - but I'm by no means rich! I NEED to know these things! With Tink it got to the point where he HAD to come home. Either to get better or... well... not. It wasn't happening there and I knew that. At least with my dog... I know she NEEDED to be at the vet and was getting quality care. Finding a good vet is hard. Good luck to you!
 
JenM said:
When Tink was diagnosed, that was nearly $3k. That vet too was not good about explaining what their treatment plan was (probably because they didn't really have one) but were adamant that he needed to be there, despite that THEY kept messing up - which they admitted - and weren't monitoring him like I could have. Long story short... they got my month's pay, but not my repeat business. The vet that treated my dog, on the other hand, were VERY communicative. They called me twice daily, letting me know status and any changes to the plan. They let me know my bill as it started getting larger so I could know what I was dealing with and make decisions with all the info. I really appreciated that. The old vet just acted like it didn't matter. I mean, YES, I love my animals - but I'm by no means rich! I NEED to know these things! With Tink it got to the point where he HAD to come home. Either to get better or... well... not. It wasn't happening there and I knew that. At least with my dog... I know she NEEDED to be at the vet and was getting quality care. Finding a good vet is hard. Good luck to you!
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Thanks, Jen, I am glad your Tink got well!

I think you hit the nail on the head about the communication issue. I was given the $900 estimate yesterday so I was expecting a bill of somewhere near that amount. Given that nothing changed about the treatment plan we agreed on - fluids, the anti nausea meds, and some pain meds - it makes me wonder if the estimate was deliberately underestimated. I would have appreciated at least a phone call when they knew it was going to be almost double the amount they led me to expect.

I am kind of in the same position you describe with respect to bringing Maui home. I have been unemployed for more than 6 months and money is really tight. We budget down to the penny these days and an unexpected expense of that magnitude was really tough to take. As you say... I love my animals too, but I have to be responsible to my family also. Having the vet's office act like, oh, yeah, it turned out to be more, here's your bill ... really sucked.

And the bummer is after all that $$$$, he is clearly still nauseous so the cerenia didn't get the job done and he's spitting up some of the food I got down him earlier. I do have one more shot of cerenia that they gave me to shoot tomorrow, but thinking about giving it to him tonight to try to get ahead of the vomiting. I hate that he is feeling so icky. He was doing so well earlier today, ate well when he got home and seemed in good spirits.
 
I sure hope they ran an fPL test which would confirm if it is pancreatitis. I'm in Los Angeles where vet bill are high so I can say that bill is crazy high.
 
tiffmaxee said:
I sure hope they ran an fPL test which would confirm if it is pancreatitis. I'm in Los Angeles where vet bill are high so I can say that bill is crazy high.
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Hi,
Yes, they did run the fPL ($140) but as of yesterday when I picked him up they had not gotten results back yet. I guess because it is a weekend.
As best I can tell, about $300 of the charges relate to the drugs I was given to bring home with him (ampicilin, cerenia, carafate, famotidine and buprenex.) So the "in house" portion of the bill was about $1300 which still seems pretty exorbitant given the lack of big time diagnostics.

I am torn about whether or not to try a new vet. I like the main vet (owner) of the current practice, and I like that they are a feline only group. I don't like the two other associate vets there as much, and I have not been particularly impressed by the nursing (tech) staff. The lead tech is very good, IMO, but there seems to be a lot of turnover in the rest of the tech staff. I was really, really ticked that the tech who messed up the IV yesterday morning didn't fix it as she promised to do (and I brought it to the attention of the vet on duty as well, so clearly there is a lack of supervision going on that I find very concerning.) Luckily this morning, that paw is greatly improved so I don't think there was any permanent damage.

If anyone has suggestions for a good vet in the North Atlanta area, I would be grateful for a referral.
 
Where did they send the fPL? What lab does your vet contract with? IDEXX is a one day turn around where I live but when Max was first diagnosed it didn't do the test and it took a few days for the results. I still think that bill is crazy high for one night. Do you always get your meds from your vets? I know this was an emergency but other than those situations I get scripts and get my meds elsewhere. I also try to buy larger quantities as it's cheaper that way. It's a law in many states that they must write a script but not everywhere. I too would be suspicious of a practice where the techs keep changing. Why antibiotics? Pancreatitis normally doesn't call for them. Why Carafate? This seems like overkill to me. Generally we start with cerenia or ondansetron, fluids, buprenex for pain.

Edited for my lousy typing on my iphone!!
 
tiffmaxee said:
Where did they send the fPL? What Jsn dies your vet contract with? IDEXX is a one day turn around where I live but when Max was first diagnosed it didn't do the test and it took a few days for the results. I still think that bill us crazy high fir IBD night. Mid you always get your meds from your vets? I know this was an emergency but other than those situations I get scripts and get my meds elsewhere. I also try to buy larger quantities as it's cheaper that way. It's a law in many states that they must write a script but not everywhere. I too would be suspicious of a practice where the techs keep changing. Why antibiotics? Pancreatitis normally doesn't call for them. Why Carafate? This seems like overkill to me. Generally we start with cerenia or ondansetron, fluids, buprenex for pain.
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I am not sure where they send the fPL to, actually. I was told that it usually takes 24 hours for them to get results but it could be 48; given that there is no one at the clinic today (Sunday) it will be Monday at the earliest before I hear anything on that issue.

I do normally get my medications from the vet - because they are not very willing to write scripts so I can purchase elsewhere, although I suppose they might do it if I insisted. Maui isn't on anything other than insulin so it hasn't been a huge issue so far, and as you say, in this case there was no time to go elsewhere anyway. He is getting the antibiotics because the initial blood work indicated a higher than normal white cell count. I believe the Carafate is for his stomach...

Right now he seems pretty comfortable and has been hanging out with me on the back patio for a few hours. He does not seem painful at all so I am reluctant to give him anymore buprenex since I know from previous experience that it suppresses his appetite - which is already a problem. I am going to give him the cerenia now as it has been 24 hours, and hope that that will help with his willingness to eat. He ate very well when he first got home yesterday afternoon (shortly after getting the Cerenia at the vet's) but by last night was clearly nauseous again.

Thanks for the help :)
 
Carafate is usually given if a gi bleed is suspected. Was the HCT a little lower than normal? Max has chronic pancreatitis which is why I know quite a bit about it. It sounds like your vet is being very cautious and trying to nip this is the bud.
 
tiffmaxee said:
Carafate is usually given if a gi bleed is suspected. Was the HCT a little lower than normal? Max has chronic pancreatitis which is why I know quite a bit about it. It sounds like your vet is being very cautious and trying to nip this is the bud.
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I was told the HCT was normal... but I agree the vet was being cautious. The weird thing is that the main vet stressed how important it was for him to eat and despite the fact that he was not eating much, they did not give him any appetite stimulant nor did they seem particularly aggressive about controlling his nausea. :roll:

I ended up taking him to a different vet today, at a friend's recommendation. Luckily this practice is open on Sundays! The vet there was super; she reviewed what was done by vet #1, suggested a different nausea med and also the appetite stimulant. She took quite a bit of time to understand M's history, explain various options, and discuss her recommendations with me. She sent me home with the two new meds and within two hours, I had an entirely different and much happier cat on my hands! He ate pretty close to a normal dinner, drank fine, and seems perfectly comfortable; in fact he is curled up on the bed next to me as I type this. I am so relieved, and will be switching over to this vet going forward.

Thanks for all the help and advice!
 
Just curious, which appetite stimulant, mirtazapine or cyproheptadine and what dose? What did you get for nausea? I'm so glad both are working. Nausea is the number one problem for most cats with pancreatitis. Once it is under control you won't need any appetite stimulants. Sounds like you found a keeker vet!! :smile:
 
Call the vets office and ask them to explain why the big difference between the estimate and the actual bill. Maybe someone entered the bill at the wrong rate and it was supposed to be entered under a different code to match what you were quoted.

When Smokey had her mastectomy at the UofMN she had to be in the intensive care section of their overnight care because of her diabetes, it cost about $20/hour.
 
Myself, I would simply call and say "Hey this bill wasn't quite what I was expecting. Would you ask the doctor to call me back and go over it with me and help me understand?"

That gives them a chance to look into it and perhaps take off some charges before they ever speak to you. If you go in there and confront them in front of other clients they are going to be very defensive.
 
You should not only have a copy of the detailed bill, but also a copy of the handwritten notes made at the vet office during your cats stay there. A copy of your cats medical chart. That should give you some useful information on what was done to monitor your cat during the time he was there.
 
Very few vets still use handwritten notes. Almost all just enter it in the digital medical record for the pet. You can ask for a printout out of the medical record.
I myself ask my vet to email the paperwork. I retain digital copies.
 
Hi all,

Thanks for your thoughts and sorry for the slow reply; I have been traveling for work without very good internet access.

I did speak to the vet about the charges and I do have an itemized bill; I don't think there is anything on there that Maui didn't receive, they're just a very expensive practice. There were a few things I suppose I could argue about - for example they sent us home with a half dozen syringes of buprenex for $84, which ended up not being needed. But I think you could easily argue that he *could* have needed that medication. When I told the vet I was unhappy about not being called about the significantly increased charges compared to the estimate, particularly since the treatment plan never changed, he basically said I "should have advised them if I had financial limitations." He then said that he felt strongly that based on the fPL, I needed to bring Maui back in to have a feeding tube put in. I said I didn't understand why that would be necessary, as he's now been eating, drinking and using the litter box pretty normally for several days (thanks to vet #2 who prescribed a better anti nausea drug and appetite stimulant, though I didn't say that!) The vet said it was really the only way he would get better. Ugh.

Fortunately I do have copies of all the medical records from the practice, as I make sure to get a copy at every visit, so I can easily transfer them to the new vet. She saw Maui today when my husband brought him in and said she felt he was doing really well, advising us to keep on doing what we are doing and as long as he continues to do OK, we can just bring him back in in a month or so to have the fPL rechecked.

Thanks again for taking the time to share your thoughts. I greatly appreciate it!
 
I'm sure glad you questioned the feeding tube. When a cat is not eating and it is impossible to get enough food in they can be wonderful. I would never go that route when your cat is eating. What was the fPL? Having a cat that has had pancreatitis for 4 1/2 years, the number in no way corresponds with how sick they are. Max had been a 50 and not acted as sick as he has with a 25. He has never had a feeding tube. Once I got him on the right dose of nausea medication he didn't even need an appetite stimulant. My vet happens to be very expensive too but he is also conservative. I'm glad things are improving.
 
A great vet is worth her/his weight in gold. We are so lucky that ours actually recommended this site to us and even uses the food lists here herself. I am glad to hear you found a new one who really cares for you and Maui. Taking the time to really listen and understand both the problem and the lifestyle of the household and to encourage our involvement in treatment (after all...we see our kitties the other 23 hours of the day) is at least as important as lab tests in finding the correct combination of treatments that works best for both you and Maui. Remember, a good vet works for you...a great vet works with you.
 
What state/city are you located? I am in NJ and the prices are crazy high. Not that that is an explanation or excuse to pad or overcharge.

What I suggest when you have time is to call the office and pretend like you are a new patient shopping around and ask them what their fees are for x, y, z - like - office vet, overnight stay, fluids, etc. See if they will give you any prices via phone and this way you can find out (sneakily) if they just are high priced or what.

PS - I had a girl Maui and you have a boy Maui -- how did he get his name?
 
So glad you've found a good vet now. It really makes all the difference in your cat AND in your sanity! It was SOOOO overwhelming having to argue every point with the vet. I'm glad you refused the feeding tube as well. WHY on earth they'd want to do that with a cat who is eating and drinking is beyond me. Tink had a feeding tube in when he came home... but he was not interested in eating or drinking on his own. It was either the tube or syringe feeding and I felt the tube was FAR less stressful for him as he really hated the syringe feeding. It was great - I knew exactly how much food was going down (as opposed to guessing how much went down versus how much went all over him, me and the wall) and it was SO much easier - well, at least until the stinker pulled it out a couple days later. :roll: But yes, absolutely not reason to do that if he's eating. Oh... and for what it's worth... I'd have happily informed him that the OTHER vet gave him the RIGHT anti-nausea meds and he's doing GREAT under THEIR care. But I'm kinda snarky like that. :lol:
 
Hello everyone,

Sorry again for the slow reply. When I travel for work I only have internet thru my phone and it's just too hard to post using that!

Maui is still doing very well and although we have some days where getting him to eat enough is a challenge, it really seems like the new medications have us on the right track.

I did end up having a rather frank conversation with vet #1 who was calling to insist we bring him back in for a follow up "and to revisit the feeding tube issue," which led me to finally just say that I had decided to use a different practice going forward, as they had been able to solve the issue with the correct medication and we would not be returning. I got quite an earful at that point, as you might imagine. But life is too short and all that. I just said that I preferred the new vet's approach and let that be that.

Tiff, the fPL was 13.3. We will do another in a few more weeks (with the new vet) just to make sure we are keeping things under control.

Hillary we are in GA, just outside of Atlanta. I can't take any credit for Maui's name as it was my husband's choice and I think he picked it out of the blue!!! It does suit him though :)
 
The first time Max was diagnosed, we kept checking and did get him back to normal numbers. Unfortunately he ended up having chronic pancreatitis so we only test if he isn't acting right and to rule out others causes for it. I hope this is a one time thing for Maui and that you found a vet you can work with going forward.
 
Thanks very much!

We took Maui back to the vet yesterday because it seemed like he was getting nauseous again. The vet agreed and so now we are doing both the oral anti nausea meds plus a shot of the cerenia. So far I would say it is somewhat improved but still not enough to create much of an appetite. We are going to give him one more round of the oral meds tonight and if he isn't eating more by morning, back to the vet we will go. This pancreatitis stuff is not for the faint of heart, I am exhausted.
 
That sounds like a lot. Our dog was in the PetER just before he passed, and it was $1400 for overnight monitoring. At an emergency clinic in the Baltimore area. Including bloodwork, x-rays, some medication, and an IV in addition to the monitoring.
 
It certainly takes time and hopefully, he will be feeling better very soon. This happened to my civvie and it took a good week before she would even look at food.
 
There have times that Max was on ondansetron for over 3 months, nonstop, maybe longer. I tend to forget. Sometimes a novel protein helps, sometimes grain free. In our case it is stress induced. All I can say is it is best not to withdraw meds until they return to normal and then just one thing at a time. One of my pancreatitis list friends whose cat was biopsied and has IBD is on prednisolone and it has really helped. P'itis is just as frustrating as diabetes at times.
 
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