9. Practice information, fees and animal insurance

Practice information

9.1  Under EU Directive 2006/123/EC, service providers, which include veterinary surgeons, must give clients relevant information, such as their contact details, the details of their regulator and the details of their insurer. Certain information must be provided on request, such as the price of a service or, if an exact price cannot be given, the method for calculating the price.

9.2  In addition, in accordance with the following guidance, veterinary practices should provide clients, particularly those new to the practice, with comprehensive written information on the nature and scope of the practice's services, including:

1. the provision, initial cost and location of the out-of-hours emergency service;
2. information on the care of in-patients;
3. the practice's complaints handling policy;
4. full terms and conditions of business - to include for example:
1. surgery opening times;
2. normal hours of business;
3. fee or charging structures;
4. procedures for second opinions and referrals; and
5. access to and ownership of record.
5. the practice’s privacy notice – to include for example:
1. the practice’s contact details;
2. how client data will be used and processed;
3. the purposes for which the client data is being processed and the legal basis for doing so;
4. the circumstances in which personal data may be shared with third parties e.g. debt recovery agencies, laboratories etc;
5. the data retention period or how such period is determined; 
6. the client’s rights as data subject (e.g. the right to withdraw consent to the processing of his/her data, the right to access the data, the right to rectification or erasure, the right to data portability and the right to restrict processing); and
7. the data subject’s right to lodge a complaint with the Information Commissioner’s Office. 

Freedom of choice

9.3  Veterinary surgeons should not obstruct a client from changing to another veterinary practice, or discourage a client from seeking a second opinion.

9.4  If a client's consent is in any way limited or qualified or specifically withheld, veterinary surgeons should accept that their own preference for a certain course of action cannot override the client's specific wishes, other than on exceptional welfare grounds.

Fees

9.5  A veterinary surgeon is entitled to charge a fee for the provision of services. The RCVS has no specific jurisdiction under the Veterinary Surgeons Act 1966 over the level of fees charged by veterinary practices. There are no statutory charges and fees are essentially a matter for negotiation between veterinary surgeon and client.

9.6  Fees may vary between practices and may be a factor in choosing a practice, as well as the practice's facilities and services, for example, what sort of arrangements are in place for 'out-of-hours' emergency calls (eg are emergency consultations at the practice premises, or by another practice at another location). It may be helpful to explain to clients the factors that influence the determination of the level of fees.

9.7  Pricing practices should comply with the Consumer Protection from Unfair Trading Regulations 2008 and other consumer protection legislation, and should not be false or misleading. 

9.8  Veterinary surgeons should be open and honest about fees for veterinary treatment. Clients should be provided with clear and easy to understand information about how fees are calculated and what it is they are being charged for. Clients should be furnished with sufficient information about the fees associated with treatment to be in a position to give informed consent to treatment.

(Communication and consent)

Estimates

9.9  Discussion should take place with the client covering a range of reasonable treatment options and prognoses, and the likely charges. If the animal is covered by pet insurance, it is in the interests of all parties to confirm the extent of the cover under the policy, including any limitations on cost or any exclusions which would apply to the treatment proposed. Insured clients should therefore be advised to contact their insurers to verify their cover at the earliest opportunity.

9.10  Veterinary surgeons and veterinary nurses should offer clients a realistic initial estimate (which may be for a defined period of time if appropriate), based on the best available information at the time, of the anticipated cost of veterinary treatment. The estimate should:

a. cover all likely charges in the time period covered, including ancillary or associated charges, such as those for medicines/anaesthetics, diagnostic tests, pre- or post-operative care, follow up or routine visits and should include VAT;

b. include a clear warning that additional charges may arise, eg if the treatment plan changes or complications occur;

c. be offered before treatment is commenced. If an estimate is declined, this should be clearly recorded;

d. be the subject of clear client consent, except where delay would compromise animal welfare;

e. preferably be provided in writing, especially where treatment involves surgery, general anaesthetic, intensive care or hospitalisation.

9.11  It is recommended that veterinary surgeons should include any estimated charge or fee on the consent form. If it becomes evident that the initial estimate or a limit set by the client is likely to be exceeded, the client should be contacted as soon as it is practicable to do so and informed, and their additional consent obtained. This should be recorded in writing by the veterinary surgeon.

9.12  Veterinary surgeons should clearly inform clients that due to the unpredictable nature of clinical work, and variations in the way that each individual animal may react to treatment, treatment plans and the initial estimate may change. There is no reason a veterinary surgeon may not give a fixed price ‘quote’ for treatment but should only do so on the understanding that this is an offer that once accepted may be binding in law.

Discounts on veterinary fees

9.13  Veterinary practices have the commercial freedom to offer discounts on their fees on terms set by them. This might include discounts for members of staff, discounts for early settlement and discounts for certain clients e.g. students, pensioners etc. Discounts generally are acceptable, but it is never acceptable to present a client with inflated fees so as to create the fiction of a discount. 

9.14  Discounts should be clearly recorded and transparent for all parties liable for payment of an account. Where there is an arrangement that more than one party is liable for payment of an account (eg insurance companies where client pays the excess), it is not reasonable to apply a retrospective discount for the benefit of one party only.

Invoices

9.15  All invoices should be itemised showing the amounts relating to goods including individual relevant medicinal products and services provided by the practice. Fees for outside services and any charge for additional administration or other costs to the practice in arranging such services should also be shown separately.

(Fair-trading requirements)

Re-direction to charities

9.16  Where a client cannot afford to pay the fee for veterinary treatment, the veterinary surgeon may wish to discuss the availability of charitable services or assistance with the client.

9.17  All charities have a duty to apply their funds to make the best possible use of their resources. Clients should contact the charity to confirm their eligibility for assistance. The veterinary surgeon should ensure that the animal's condition is stabilised so that the animal is fit to travel to the charity, and provide details of the animal's condition, and any treatment already given, to the charity.

9.18  If the client is not eligible for the charitable assistance and no other form of financial assistance can be found, euthanasia may have to be considered on economic grounds.

Securing payment for veterinary services

9.19  A client is the person who requests veterinary attention for an animal and veterinary surgeons and veterinary nurses may charge the client for the veterinary service provided. Where the owner is not the client (assuming there is an owner) it should be borne in mind that they may not have had an opportunity to consent to treatment.

9.20  Veterinary surgeons are entitled to ask for payment of fees in advance and in full. Veterinary surgeons may also ask the client to pay a deposit prior to the commencement of treatment and to pay any remaining fee at a later point in time, eg at the completion of treatment or on discharge.

9.21  Veterinary surgeons are not under any obligation to offer clients a payment plan, but may do so if they wish. A payment plan may amount to a credit agreement. Firms that offer credit agreements may need to be registered with or authorised by the Financial Conduct Authority (FCA) as a consumer credit provider. Veterinary practices should seek advice from the FCA or obtain independent legal advice in relation to whether this is the case.

Unpaid bills and fee disputes

9.22  Where the fee remains unpaid, a veterinary surgeon is entitled to place the matter in the hands of a debt collection agency or to institute civil proceedings. The sharing of client data with a debt collection agency does not require client consent given the practice’s legitimate interest in so doing.

9.23  In the case of persistently slow payers and bad debtors, it is acceptable to give them notice in writing (preferably by recorded delivery) that veterinary services will be no longer provided.

9.24  In the event of a fee dispute, whether a client must pay a bill is a matter to be resolved between the parties or by the civil courts, therefore, in most cases, disputes about the level of veterinary surgeons’ fees fall outside the jurisdiction of the RCVS.

9.25  Irrespective of payment, a veterinary surgeon on duty should not unreasonably refuse to provide first aid and pain relief for any animal of a species treated by the practice, or to facilitate the provision of first aid and pain relief for all other species. 

Holding an animal against unpaid fees

9.26  Although veterinary surgeons do have a right in law to hold an animal until outstanding fees are paid, the RCVS believes that it is not in the interests of the animal so to do, and can lead to the practice incurring additional costs which may not be recoverable.

Prescriptions 

9.27  Veterinary surgeons may make a reasonable charge for written prescriptions. (Prescriptions for POM-V medicines or veterinary medicinal products prescribed under the cascade may be issued only for animals under the care of the prescribing veterinary surgeon and following a clinical assessment of the animals.) Clients should be provided with adequate information on medicine prices. Clients should be informed of any significant changes to the practice’s charges for prescriptions or medicines at the earliest opportunity to do so.

9.28  Clients may obtain relevant veterinary medicinal products from the veterinary surgeon, or may ask for a prescription and obtain medicines from another veterinary surgeon or pharmacy. Veterinary surgeons may wish to direct clients who are considering obtaining medicines from an online retailer to the VMD’s Register of Online Suppliers of veterinary medicines. 

9.29  The Supply of Relevant Veterinary Medicinal Products Order came into force on 31 October 2005 and is enforced by the Competition and Markets Authority. It implements recommendations from the Competition Commission and provides that veterinary surgeons must not discriminate between clients who are supplied with a prescription and those who are not, in relation to fees charged for other goods or services.

 (Fair-trading requirements)

Advertising fees and competitions issues

9.30  All advertising and publicity in relation to practice information and fees should be professional, accurate and truthful, and should comply with the UK Code of Non-broadcast Advertising, Sales Promotion and Direct Marketing (CAP Code). Any price comparison should be accurate.

9.31  A veterinary surgeon or group of veterinary surgeons should not enter into any agreement that has the effect of fixing fees. The Competition Act 1998 prohibits anti-competitive agreements, meaning businesses must not agree to fix prices or terms of trade, and must not agree price rises with competitors.

(Advertising and publicity)

Animal insurance

9.32  An animal insurance policy is a contract between the animal owner (the client/policy holder) and the insurer and as such the only person that has the right to submit a claim under the policy is the client/policyholder. The veterinary surgeon may invoice the insurer for the submitted claim when authorised to do so by the client/policyholder. The veterinary surgeon’s role is to provide factual information to support the claim, and/or invoices if authorised. Animal insurance schemes rely on the integrity of the veterinary surgeon, who has a responsibility to both the client and insurance company.

9.33  Veterinary surgeons must act with integrity in all dealings with an animal insurance policy. They must complete claim forms carefully and honestly. A veterinary surgeon who acts dishonestly or fraudulently may be liable to criminal investigation and/or disciplinary action.

9.34  The existence of animal insurance is no excuse for charging inflated fees or any other activity which enables a veterinary surgeon or veterinary nurse to profit dishonestly or fraudulently. When completing the insurance claim form, the veterinary surgeon should include the amounts actually paid or, in the case of direct claims, the amounts actually charged, with any additional or administrative charges shown separately. In the interests of transparency, any discounts that have been or will be applied should be accounted for on any paperwork sent to the insurer. Any material fact that might cause the insurance company to increase the premium or decline a claim must be disclosed. Failure to complete claim forms in this way may raise suspicions of dishonesty or fraud, and may result in a complaint being made to the police and/or RCVS. A veterinary surgeon in any doubt as to how to complete a particular claim form accurately should, wherever possible, discuss this with the insurance company.

9.35  In cases where the veterinary surgeon is treating an animal with a long-term or ongoing health condition under an animal insurance policy, the practice of asking clients to pre-sign blank claim forms for subsequent completion and submission by the veterinary surgeon may expose the veterinary surgeon to suspicions of dishonesty or fraud. If the veterinary surgeon adopts this method, or indeed in any situation where the veterinary surgeon will send the claim directly to the insurance company, it is good practice to send a copy of the completed claim form to the client before submission so that they can check the details of the claim. In the reverse situation, where the client submits the claim form directly to the insurance company, it is advisable for the veterinary surgeon to keep a copy of what they send to the client so that there is a record in the event of any subsequent queries. Additionally, veterinary surgeons should not sign blank insurance claim forms.

9.36  Particular care should be taken when the veterinary surgeon is treating their own animal, or an animal belonging to a family member or a close friend, and that animal is covered by an animal insurance policy. Generally, such conflicts of interest should be avoided. For that reason, it is advisable to get another veterinary surgeon to complete, sign and submit the claim form, wherever possible. Where this is not possible, the veterinary surgeon should state on the form the ownership of the animal.

9.37  Animal insurance may enable relevant veterinary investigations or treatment to be carried out in circumstances where fees might otherwise be unaffordable for the animal owner. A veterinary surgeon should, however, ensure that the investigation or treatment is appropriate and is in the animal’s best interests.

9.38 The advising on, arranging, or selling of general insurance products are regulated activities under the Financial Services and Markets Act 2000 (FSMA). This means that veterinary surgeons and veterinary nurses must not carry out these activities unless they are authorised to do so by the Financial Conduct Authority (FCA) or fall within one of the exemptions cited in FSMA.

9.39 It is acceptable for a practice to display promotional material, however it is prudent to display a range so as to avoid any implication of bias, financial advice, or brokering. Veterinary surgeons and veterinary nurses should not be seen to favour or endorse any insurer unless they are properly authorised by the FCA.

9.40 Where veterinary surgeons and veterinary nurses are properly authorised by the FCA, they should ensure that any arrangements giving rise to a real or perceived conflict of interest are disclosed to the client before any arrangement is entered into. Where commission is to be paid in the event a particular policy is taken out, this should also be disclosed to the client prior to the policy being taken out. Veterinary surgeons and veterinary nurses should not enter into arrangements capable of bringing the profession into disrepute.

9.41 Further information, including the Perimeter Guidance Manual (PERG) which provides guidance on when authorisation is required, can be found on the FCA’s website.