View Full Version : Heart enlargement diagnosis/implications

16th April 2006, 07:52 PM
Because Zack is a cavalier, before i got him, i made sure he would be covered by health insurance for MVD because i'm not well off enough to be able to afford treatment and testing out of pocket. I got a policy that covers everything.

The policy did not cover any illness in the first 30 days and would not cover any illness that was noted in the first 30 days.

Zack had diarrhea, and then later, vomiting, during the first month i had him, which was during the first 30 days of the insurance, and i took him to many vet visits and to the emergency room for those gastrointestinal symptoms. These symptoms and treatment were noted in his medical records, and submitted to the insurance company. Any diarrhea related to what he had in the first 30 days is now excluded from coverage. That was to be expected.

When i had him at the emergency room, they did abdominal xrays. The ER vet showed me what appeared to be a small foreign body in zack's stomach. He then said that Zack had an "enlarged heart" and he pointed to a bulge on the side of the heart. In his notes, he reported the GI symptoms, the foreign body and 'heart enlargement'. He said the next day they would call me after having the radiologist read the xrays, to give me her report.

The attendiing vet called me the next morning and said the radiologist had read the xrays and did see the foreign body, and said that i should take Zack right away to his regular vet for follow up xrays to see if the foreign body had moved. I said "What about his heart?" The vet said "Oh, his heart is fine. The bulge was just caused by the position he was in when xrayed." I was glad to hear that.

In the notes submitted to the insurance, on the first day, the vet writes "enlarged heart." In his notes of the following day, he summarizes the radiologist's reading and says "heart likely within normal limits."

After the 30 days, when the plan was fully in effect, i called the insurance company to ask about any exclusions on the diarrhea. I was told Zack has a permanent exclusion related to enlarged heart.

I have been trying to straighten this out. I told the insurance company what happened, how apparently the first doctor made a mistake in his reading and the radiologists said the heart was normal and i was told there was nothing to worry about. I was asked to get a letter from the radiologist. She wrote a letter saying that abdominal xrays were taken and that abdominal xrays can't allow evaluation of heart size or shape.

The insurance company told me that this was not what was needed to remove the exclusion. They said that the radiologist had not ruled out an enlarged heart and that i would have to take him to have thoracic xrays done at my expense to rule out enlarged heart.

After this, the radiologist called the insurance company and was asked for a second letter. In her second letter she said that when zack was examined in the ER, no abnormalities in heart sounds, rhythm or pulse were identified. She then states that i would like 'enlarged heart' removed from Zack's records.

I'm now waiting for the insurance company vet to read these letters and come to a decision about whether to remove the permanent exclusion.

I know that MVD doesn't show up or develop until later. I'm wondering if it did show up later, might the insurance exclude it from coverage based on this erroneous enlarged heart diagnosis?

I find it very upsetting that i might have to pay hundreds of dollars for more xrays or an ultrasound to prove that Zack doesn't have an enlarged heart. What would be the simplest cheapest diagnostic method of assessing heart shape and size? I contacted a local cardiologist, Dr Barrett, and was told that what they would do for this purpose is an ultrasound that costs $500-$600. :( I already am in debt for $1100 from Zack's vet bills in the first month i had him for something that probably could've been cured with a simple cheap deworming medication given near the beginning of his symptoms. I am paying a high monthly premium for this very thorough insurance coverage.

If they refuse to ever remove the exclusion for 'heart enlargement,' what sort of conditions or symptoms down the line might they refuse to cover because they might be related to this supposed heart enlargement?
This is scary for me.

20th April 2006, 12:05 AM
That's really unfortunate, especially as you took out insurance for this issue specifically. It can be very hard to get an insurance company to budge though on anything they see might need to be an exclusion. MVD can result in an enlarged heart as it progresses.

It's really hard to know what they will do until presented with a situation, so it is hard to say with any certainty what they would do if Zack has MVD severely enough to require any costly treatments. generally though most insurance companies will use a clause like that to avoid paying for coverage. You could ask them directly if they will now exclude all heart-related complaints and what they would do if he presents with MVD, which would not be related to any enlarged hearrt diagnosis given now. You could attend a cardiac clinic (low cost ones are often given by local and regional clubs at shows) and get a clear cert from a cardiologist and ask that that be written in to his policy as evidence that he is MVD-clear and therefore would be covered for MVD-related heart complaints in future. Whether they will do this is hard to know but you could try.

If they aren't willing to do this, I'd consider whether to take him off insurance and start to put the equivalent amount into a savings account each month. Given the cost of insurance in the US this may well easily cover him for anything MVD-related. On the other hand that doesn't cover him for the mutlitude of other things that could happen.

In general, insurance is all about how risk averse someone is and how willing and able to cover costs out of pocket if needed. I view insurance as emergency coverage really, for something catastrophic, not so much for MVD. I wanted both boys covered for SM as well. I have never claimed in 2.5 years, even though they have been in for extra treatments, but all have fallen below the deductible of euro 40. That does make me wonder from time to time whether it is worth keeping them on insurance, but one serious accident or one serious surgery would more than cover what I pay in over their lives.

If I had more than three dogs I'd probably put the insurance equivalent into a savings account rather than pay insurance.

21st April 2006, 06:38 AM
That makes sense, to obtain clear evidence from a cardiologist that Zack doesn't have MVD, and does not have an enlarged heart as well. I am going to look into finding such a clinic right away.

An update on this situation--the radiologist wrote two letters and made a phone call to the insurance company to clarfiy that an enlarged heart was not diagnosable based on what was seen at the ER and that there were no clinical signs of heart abnormality. The underwriter vet at the insurance company evaluated the letters and then removed the permanent exclusion but a temporary exclusion remains for one year. Next February I can offer evidence that Zack doesn't have any heart abnormalities and hopefully have the temporary exclusion removed.

On the one hand, i am relieved about this because i don't expect him to have abnormalities that soon even if he does get MVD, but on the other hand, i'm still bothered by the vulnerability of the exclusion--if he does get a murmur or something, then that will be it for him having coverage of heart problems.

So i'm thinking I may want to pay out of pocket for some thoracic xrays to show that he doesn't have an enlarged heart. Hopefully that would get rid of the temporary exclusion and i can finally proceed with Plan A which was to have Zack well covered by insurance and have the peace of mind that comes with it, and to not have the worry hanging over me.

Your suggestion does make sense, if i can't get him covered for heart disorders, to just put the premium in to a savings account for future treatment needs. but as you say, that wouldn't cover him for all the other stuff, ingestion of foreign body, accident, and all the various illnesses and complications he might get. I've had my cat insured for many years and have never made a claim, thank goodness, shes been healthy, and hasn 't seen a vet for a long time, and is going on 14. but i am paying for the peace of mind to know that if she needs some expensive cancer treatment or some expensive diagnostic procedure odyssey in search of the cause of some nonspecific malady, i can feel free to get treatment for her right away, not postpone it, and get whatever she needs without hesitating because i can't afford it. and for my peace of mind i need that for Zack too.

I just registered Zack with the AKC and they offer a free 3 month trial insurance policy, and i was wondering if i might just switch over to that company. There's no need to submit the records from the ER to them. His GI illness is documented in his regular vet records, i would not want to try to hide that, but i could then avoid having the erroneous enlarged heart diagnosis affecting his coverage elibiity. The only hesitation i have is that the plan I have now has 100% coverage, no copayment, $6000 per incident of illness, and the AKC plan has only 80% coverage, with $5000 per incident, for the same premium. So i don't know, bu i'm thinking about it.

21st April 2006, 01:20 PM
Hi ya, I would write and moan to the complaints department and cc it to the Ombudsman - on the way this has been treated - if you moan enough they may give in.

21st April 2006, 07:03 PM
That's good advive from Claire. Also I'd not worry for the next year. MVD is progressive and doesn;t show in dogs til at least a year, more like 2-3 years old. You can see if a clearance from a club cardiologist exam will give him an all clear.

7th June 2006, 03:19 AM
Hi ya, I would write and moan to the complaints department and cc it to the Ombudsman - on the way this has been treated - if you moan enough they may give in.

Inspired by cavalier talk feedback, i wrote a 5 page letter to the underwriting manager, telling why i didn't understand the reason for the exclusion and why it was unreasonable. I included a link to an article I found on the web entitled "Why Is Cardiac Radiology So Difficult" by Christopher R. Lamb, MA, VetMB, DACVR, DECVDI, MRCVS, ILTM Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, in which, among other things, he points out that Cavaliers have higher mean vertebral heart scale scores than other breeds so that normal cavalier hearts may be larger than those of other breeds, leading to false positive diagnoses. The article discusses various ways that veterinarians may misdiagnose enlarged heart in dogs. I thought it was an interesting article. If anyone wants to read it, it's at http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2004&PID=8633&O=Generic

Anyway, this was all overkill shock and awe ammo in my letter. Really the crux of it was just that abdominal xrays do not provide information about heart size, and the doctor that provisionally diagnosed enlarged heart based on such xrays was mistaken, and he corrected and revised this diagnosis after consulting with the board certified radiologist.

so, they contacted the radiologist today and then they removed the exclusion on Zack's policy for enlarged heart and are sending me updated policy documents.


For whatever reason, back in early April that same radiologist wrote them two letters and made a phone call to them and they still gave him a temporary exclusion. I'm glad i talked to you guys about it, because i was feeling demoralized after that and in need of some fresh energy to fight the thing.

thanks :flwr:

7th June 2006, 03:33 AM
I'm so glad that they lifted the restriction! Good for you, judy! :thmbsup:

7th June 2006, 07:36 AM

I had a similar problem with my first Cav Tilly. Weeks of scratching as a pup and then garden rest due to a possible "sprain" later on (3 years) excluded me from all cover related the her SM including MRI scan costs and meds etc, her notes noted skin allergy/sprain but they tied it up neatly to exclude any payment. The cover was a superb "life long condition cover" that was their only answer, the condition had been there from the first consult.

Never once was I offered a neuro consult or was anything ever suggested that there was anything much wrong. I wrote and complained to both company and practice etc but never received anything. When I did return to the practice in person to complain to the practice manager I was "escorted" to the door and asked to leave!

Good on you for pushing for a result!

Alison, Wilts, UK.

7th June 2006, 08:00 AM
I'm so glad that they lifted the restriction! Good for you, judy! :thmbsup:

Kendall--thank you for the word "provisional". I heavily laced my 5 page letter with it. :D

7th June 2006, 08:04 AM
Alison, that is maddening. the scratching and the "sprain" were 3 years apart. And what does skin allergy and sprain have to do with SM anyway?
There ought to be national health for pets. Maintaining health should not be a profiteering enterprise. IMO.

7th June 2006, 09:40 AM

I guess they tied in the allergy scratching with SM scratching and the sprain with limb weekness etc.
Thats the reason I re-visited the vets practice to ask why we hadn't been refered to a neuro but at that time they hadn't heard of SM so when I told and informed them about it they got a little funny and asked me to leave, on reflection perhaps they realised that they themselves made the error.

I hound them now, always dropping in leaflets with Cavalier info etc, LOL.

It just makes you extra carefull to be sure to read the small print of all policies.

Alison, Wilts, UK.

7th June 2006, 08:26 PM
There ought to be national health for pets. Maintaining health should not be a profiteering enterprise. IMO.

Oh, please, no. I will leave the profession (that i haven't even entered) it if becomes a form-filling, HMO run system like human medicine where I am told what I can and cannot do because someone else (insurance) is paying for it.

7th June 2006, 08:44 PM
But the HMO is a purely for-profit enterprise and has nothing to do with National Health systems as are available in every other Western democracy except the US, and much of the rest of the world too! :) National health systems are quite different. Not perfect by any means, but a far better health system than that of private care and HMOs in the US. My father, who was Canadian but was a prof of medicine at Stanford and UCDavis, has argued all his life for a national health system in the US to remove the inequities by which people are held captive to their employers to get health insurance, charged ever-increasing premiums if they aren't covered by employers, and are dumped dumped out of the system if they don;t have it. He argued for this before Congress and wrote to presidents supporting this direction. A key reason I do not feel I could return to the US is the health system -- I do not want to be dependent on an employer for health care!

Right now I can go to the hospital here for treatment in ER and I will be charged under $15 for the visit. All my health care is covered, whatever happens to me, for all my life on the national health scheme though I carry insurance (at much lower cost than the US and at a flat rate) to get upgraded care -- eg a private room when I had surgery a few years ago, and immediate treatment rather than being wait-listed (the latter is the worst aspect of national health schemes and in many countires doesn;t apply. I get more choice thru insurance -- but I'd prefer to pay more taxes for a better national health system. Unfortunately in the UK and especially Ireland there are waiting lists for many procedures if you don;t also have insurance). If I travel anywhere in the EU I am also covered to be cared for under their national health programmes.

My father taught his interns and residents in a huge county hospital that got the poor, the derelict, those with no insurance. Regularly, other hospitals would refuse to treat them no matter how ill they were. That made national health a campaign for him all his life, *especially* after the advent of that insurance company delight, the HMO. I truly believe the US will implode under the weight of an increasingly elderly population with no health insurance. Those older voters will likely be the eventual force of change -- the thought of needing procedures you cannot possibly afford and the end of the job-for-life will mean reform of the existing healthcare system or a widening gap between those who have, and those who do not. Basic healthcare should be a right, not a purchased privelege.

Ok off the soapbox now! Though must add I do not agree that vet care should be nationalised, though I think it should be subsidised in some cases, especially spay/neuter.

And Judy just wanted to say I am delighted for you.

8th June 2006, 01:23 AM
Oh, please, no. I will leave the profession (that i haven't even entered) it if becomes a form-filling, HMO run system like human medicine where I am told what I can and cannot do because someone else (insurance) is paying for it.

I'm with you on that, that's not what i'm advocating. i'm advocating for a system where insurance companies don't have the power to exclude conditions. How many pets are euthanized simply because owners can't afford the medical bills for life saving treatment or preventive care?

It bothers me that illness conditions are excluded from affordable coverage, but i can't blame the insurance companies, they are in business to make the biggest possible profit they can make. If the law will allow them to refuse to cover the care that an animal needs most, i can't blame them for taking advantage of that. It's not like their highest priority is health care, it's making money.

I would rather remove profit making interests from control over health care allocation and delivery, and have people who prioritize health care rather than profit maximization in control, people who have nothing to gain from denying care.

As for national health, most (not all) Canadian patients and doctors whose comments I've heard express approval for the Canadian system of national health. There are better and worse examples of such an approach to health care delivery. My Japanese friend spoke very highly of the Japanese national health care system, she was very appreciative of it. She was treated for stomach cancer which she eventually died of, but she experienced the system over several years and had only good things to say about it. I don't know how Japanese doctors feel about it.