Thursday, September 1, 2011

Reasonable Expectations: Written Cost Estimates

by Nancy Kay, DVM 

This is the eigth part of a series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through five can be found at

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. 

Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.


Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?

Will you be charged $300, $800,  $1,300? 

Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  

Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?

Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

  • Actual cost is addressed in only 29% of veterinary appointments.
  • When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
  • Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
  • Written cost estimates are discussed during 14% of appointments.
  • Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  

I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill.

Why is a written estimate preferable to a verbal estimate? 

Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.

So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   

I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!

With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  

Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?


Dr. Kay  is the fortunate recipient of the 2011 Bustad Companion Animal Veterinarian of the Year Award- presented by the AVMA to the veterinarian who promotes and exemplifies the human animal bond!

DR. NANCY KAY wanted to become a veterinarian for just about as long as she can remember. Her veterinary degree is from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California—Davis Veterinary School.

Dr. Kay is a board certified specialist in the American College of Veterinary Internal Medicine and published in several professional journals and textbooks. She lectures professionally to regional and national audiences, and one of her favorite lecture topics is communication between veterinarians and their clients.   Since the release of her book,
Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy.  She was a featured guest on the popular National Public Radio show, Fresh Air with Terry Gross.

Dr. Kay is a staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, California. As a way of providing emotional support for people with sick four-legged family members, Dr. Kay founded and helps facilitate the VCA Animal Care Center Client Support Group.  She also facilitates client communication rounds for VCA Animal Care Center employees.

Dr. Kay was selected by the American Animal Hospital Association to receive the 2009 Hill’s Animal Welfare and Humane Ethics Award.  This award is given annually to a veterinarian or nonveterinarian who has advanced animal welfare through extraordinary service or by furthering humane principles, education, and understanding.  The Dog Writers Association of America selected Dr. Kay for two awards.  The first was the 2009 Eukanuba Canine Health Award recognizing
Speaking for Spot as the publication that best promotes the health and well being of dogs. The second award was for the Best Blog of 2009 (

Dr. Kay’s personal life revolves around her husband (also a veterinarian), her three children (none of whom aspire to be veterinarians) and their menagerie of four-legged family members. When she’s not writing, she spends her spare moments in the garden or riding along the beach atop her favorite horse. Dr. Kay and her family reside in Sebastopol, California.

Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
Even The Best Veterinarian Can Make A Mistake


  1. When my sweet diabetic suddenly became sick and then paralyzed, I couldn't make the leap that her breast cancer had spread to her spine without proof. She had been doing so well and her initial symptoms had been so mundane I just didn't believe it. I took her to a teaching hospital where they wanted to do an MRI of her brain and spine (bloodwork & abdominal ultrasounds had ruled out everything else). They broke down the price for just doing the spine, which is what I chose to do. It showed what looked like a huge tumor, and a cyst, and an intramuscular lipoma impinging on her spine. Even if I'd been right about her having meningitis, the other problems would limit her days and had probably already caused her pain. I had her euthanized, and then still not convinced it was cancer, I had a biopsy done afterward. It was indeed meningitis, but not bacterial. She'd have needed prednisone, and as a diabetic that was not going to be an option. I *had* to know, but I didn't have to have a full necropsy or that brain MRI. I appreciated being given a full range of options and knowing what each would cost. I miss her every day but at least I'm not tortured by the "what-ifs."

  2. Sorry about your baby! It is always hard losing them!

    I'm glad you had such a good experience with the teaching hospital and got all your options laid out for you to make your decision.

  3. DeDe and her health issues has led Jen to encounter many vets. Some were clueless about her problems. One was plain rude. The vet we use now offers written estimates with every visit that requires further action. One of the many reasons they're keepers!

  4. Sorry about Dede's experience with clueless vets. Great vets truly are few and far in between.

    Glad you found a great one now! Sound like a keeper to me also :-)