Hi and welcome to the Animal Welfare Junction. This is your host Dr. G and our music is written and produced by Mike Sullivan. Today we have Suzanne Cannon with us, the co founder of Vet Billing. So welcome Susanne and thank you for coming to the Junction.

Thank you for inviting me to be on.

So how about to start you let us know about what got you started, your background and where you are today.

Sure. Um, let me try to make a long story short, um, because my journey to get where I am today was unplanned and it's surprising. So my prior professional background is in pastoral counseling. I have a graduate degree and pastoral counseling, and I have worked in the past as a hospital chaplain and a hospice chaplain and a pastoral counselor. in an AIDS clinic, um, and in a methadone clinic. So, um, clearly I didn't start out with the idea of, of being in veterinary, but I've always had dogs and horses. So, veterinarians figure prominently in my life, um, because we're there a lot when you have multiple animals. So I've always had a super close relationship with my, my vets, um, because I rely on them so much. So the seeds for the idea of vet billing were actually planted nearly 20 years ago when I was going through a divorce. Um, so I had to move back in with my mom and I was in my early 40s. So that's not something like you plan on happening to you. And during this time, I, one of my dogs got pancreatitis, one of my schnauzers. And schnauzers are prone to pancreatitis, which I knew, so they were on prescription diet food, they didn't get table scraps. I mean, I was very conscientious about, you know, preventing pancreatitis, but sometimes you just can't. So, of course she got sick on a Saturday night, late, and I had to take her to the emergency vet. And it turned out that she had, you know, quite a severe case of pancreatitis. And, um, she ended up having to stay at the emergency vet for a couple of days, as opposed to transferring her back to my regular vet because they didn't feel she was stable enough. So, um, that meant that when she was finally okay, for which I was enormously grateful, um, I then had a vet bill of about 4, 000. Now, when I say 4, 000 now, that sounds like, like a bargain compared to some of the emergency prices that I, that I see working at vet billing and what they've become in the last couple of years since the pandemic. But nonetheless, 4, 000 was an enormous amount for me at the time. Um, previously been married to a physician, so I didn't have, um, the financial constraints then that I found myself in at this particular time. The other thing I think is important to say here that had a lot to do with the creation of vet billing also is that I had pet insurance at the time. Um, I had had a pet insurance policy for both of my dogs for close to 10 years by then. And what I came to find out was that the fact that Insurance is mostly a reimbursement model. Um, meant that I didn't have any help to cover that 4, 000 upfront. Like I was still responsible for coming up with that money in advance. And then I would have had to file a claim. And this was back when there was. Only two insurance companies. Mine was VPI, which then eventually got rolled into Nationwide. It was the very first pet insurance company out there. It was founded by Dr. Jack Stephens. And the only other one then was Trupanion, I think. And, um, so, I, I thought, well, I can't rely on my pet insurance to help me pay this 4, 000. I didn't have the money in my bank account. Um, I didn't have a credit card with enough of a limit on it that I could put the 4, 000 on that. And so the receptionist, seeing my distress and worry, said, Oh, don't worry. She said, we have this thing called Care Credit, and you can apply for that, and then you can make payments over six months. And I was so relieved, my knees almost buckled. I was like, Oh, thank goodness. Okay, everything will be okay. And back then, The vet office actually processed the care credit application. It wasn't like today with the smartphones and everything um So she went in the back or something and and did my application and she came back and she said i'm so sorry But you were declined So in that moment, I had a lot of feelings. I felt embarrassed. I felt ashamed. I felt confused. I was like, why, why was I declined? And so they're going, do I have credit? I'm trying to think if there were bills I hadn't paid and I didn't really, I didn't really use credit. Um, so at the time I was completely confused and then I was scared. Like, what am I going to do? I felt very helpless and very vulnerable. And, um, of course as many pet owners do in a similar situation, I asked about making payments because I was working and I could have made payments and I would have willingly made payments. I even sat there thinking to myself, okay, if I need to take on a couple of other jobs in order to manage this expense, I will gladly do that. And then I realized, well, even if I do that, I'm not going to have the money right now, you know, that's going to take me time. So ultimately I was saved by my mom who paid the 4, 000 on a credit card. Then I paid my mom back over the next couple of years while I was getting back on my feet after the divorce. And. When I left with my dog that day, I remember thinking, I cannot be the only pet owner that has faced this situation where you've tried to really do everything right, and you've tried to be very responsible, and you suddenly find yourself facing an unexpectedly large expense. Um, and my dog was eight at the time and otherwise very healthy and a schnauzer. I mean, we're going to expect her to live for another five or six years, which, which she did. So the idea of euthanasia over money. Was untenable to me. Like I, I couldn't even, I could not imagine making that decision. And I thought to myself, what do people do if they don't have a mom to turn to or a relative, a dad, you know, somebody in their family or a, a very close friend that can help them overcome that upfront expense and, you know, be able to move forward. So. That happened, like I said, many years ago. And then later I met my partner who is my life partner and business partner now. And he had spent the last few decades building a professional accounts receivable management firm and doing electronic processing of payments. Starting back when electronic transactions were still kind of new. So when we met, I said. I wonder if we can adapt what you're doing to veterinary and give people an alternative to if they're declined for credit, but not because they have a poor payment history or anything like that. I wonder if we can apply that to, um, to helping fill the gap for people that aren't helped by traditional credit solutions.

I worked at an emergency practice and I saw that quite a bit and we have always had an affordable model, right? So we try to keep all of our costs low so that we can help the majority of people and affordability is something that it means different things to different people, right? So we would get individuals that went to an emergency, a regular emergency clinic first, they would be given like a 5, 000 estimate. They come to us and. It was a 1, 200 estimate. So it was a lot cheaper and they were really happy and pleased to see it. But that 1, 200 would be a lot for some other individuals. And there, you know, to your point, there is that, that feeling of shame of guilt of not being able to help your pet because you feel inadequate financially. And then having somebody look into your, Finances and then it automatically judge you like you have no credit. So you must be a piece of dirt, right? Because they don't know what's what's happening I as a business owner my credit has gone Really really low because of business expenses and business things and and different things and I can afford my payments but credit worthy wise I may not be credit worthy and The credit system is so flawed that it just goes up and down, up and down for no reason sometimes. So it's really, we're making decisions for people based on things that are somewhat arbitrary. How does your company, well, actually let's start with what are the different reasons why people may not get approved for credit?

I love this topic because um, it's something that I wasn't aware of until I started researching this when I was contemplating launching VetBilling, which at that time didn't even have a name. Like I didn't know what I was going to call it. and I wanted to understand to begin with, like, why was I declined? And, um, So, what I found out by my research is that I fell into a category called credit invisible. And I learned about how much credit inequality there is in our country. I had never heard of credit invisibility before. It has a companion called credit unscorability, um, they're slightly different. But when you're credit invisible, it means basically you haven't established a credit footprint. So why would that have been the case for me since I was in my early forties by then? Well, what I now know is that all the credit that I ever used during my marriage was connected to my husband as the primary account holder. When I applied for care credit that night at the emergency vet, I applied in my own name. Essentially, I had no credit footprint, only in my own name. So that meant that I was credit invisible. Um, a company like your credit or any sort of financing company is gonna, make an inquiry of the credit bureaus and they're not going to find a lot of data to tell them anything about you. And as a result, they'll say their algorithm will say, you know, this is too much of a risk. This is an unknown. Like we don't know the degree of risk involved with extending credit to this person. So essentially, that doesn't have anything to do with whether you would honor your financial obligations or it's, it's not a personal decision. It's a decision that is made by an algorithm that has been created by underwriters who determine risk at a large financial company. So, essentially, it's kind of, it's taking it out of the hands of the vet, who knows the client, who knows the patient, who knows the case, and knows the situation, and kind of going, okay, um, we're not going to help this client pay. The third party company is saying we're not going to help the client pay. And now the vet feels like, oh. Well, we can't help you either. So, credit Invisibility is something that impacts, um, people of color much more often than whites. It's about double the rate of credit invisibles among minority groups in our country. And there's various reasons for that that have, again, nothing to do with actual credit worthiness. Um, different cultures perceive credit differently. Um, a lot of African Americans are not very trusting of the entire U. S. credit system because they know about redlining and they know about reasons why they haven't been able to access credit in, in the past. Um, and same with other groups. So they're actually penalized when they suddenly need to access credit in an emergency, like for their animal. In order to get credit, you have to have credit. It reminds me of that old thing, like when you're first out of school and you're trying to get a job and no one wants to hire you cause you have no experience experience, right? Well, how do I get experience, you know, and you know, unless you give me a chance and it's kind of the same thing with credit, like, okay, well. I haven't established credit yet, so what am I going to do? And these people are really left in the cold, and there is a very large number of Americans that are credit invisible or credit unscorable, and they're the ones that are falling into that black hole. At the same time, they probably don't need charitable funds because they probably earn enough that they can make payments. And my other thought with creating vet billing was, why are, if, if people are declined for a tool like care credit. Why are we then tapping into the nonprofits that already have limited resources and those resources should be reserved for people who are truly like insolvent, like they have no other way to pay. But what about all the middle income earners out here who live paycheck to paycheck, not because they're irresponsible, but because life is expensive. And they, you know, they need to be able to bridge that gap. So, I mean, that was. A lot of the goal of what vet billing wanted to alleviate was to help provide a safety net for people that found themselves in kind of that gray area between the ability to access traditional financing versus having to seek charitable funds, which is a lengthy arduous process, and it takes a lot of time. So if you're in an emergency, it's not ideal to be trying to apply for grants. And the average award amount for grants is about 500. So, if you have a 5, 000 bill, you're gonna have to tap into multiple funds to try to get together enough money.

I had a client that, when I was working in an emergency, that came to us with her dog. Her dog was very sick. And she was kind of middle income. She had a good job. She was living paycheck to paycheck. And she did not qualify for financial assistance because she made enough money, but she was living paycheck to paycheck. And she was trying to find help. But of course, there is limited help for individuals that are, that do not qualify for financial assistance. So our hospital was open to everyone, right? So our prices were the same to anyone, regardless. Like we did not have, uh, People did not have to qualify. So it was. It was really sad to be dealing with somebody that's doing the best that she can to not have to go into government assistance because she feels that she can work hard and she can still produce and everything else, but she'll still did not have enough money to take care of her dog and this was around the time of covid. So she had been making really good money and all of a sudden she was struggling and there wasn't anything really to help her with with that and she could not get credit. So, you know, it's like people like that. And in her case, because we were open, we were able to help her out and get the diagnostics and stuff for the things that she needed. But I have met so many people that have had to make the really difficult decisions of euthanizing their pet or surrendering their pet to a shelter just because they don't have enough money to take care of it.

Right. And that, that breaks my heart. That was another big motivation for VetBilling is I hate hearing those stories because I can imagine myself in, in that situation. And I don't want anyone to have to make that sort of terrible choice because it causes a great rupture before the human animal bond, it ruptures the family bonds. It is. painful for the veterinarian, um, who suffers moral distress from having to be in these situations where you have a treatable animal with. Potentially a good prognosis. Um, I mean, it's one thing to euthanize for financial constraints if the animal has a very poor prognosis. Like one of my veterinary friends, her name is Kate Boatwright. She writes a lot on spectrum of care issues. And, um, you know, she mentioned to me that there are cases that fall in a gray area. Like she had, um, a client whose dog had a septic abdomen and that There, the prognosis wasn't very good, and the animal was going to require some additional surgeries. There was no guarantee that the surgeries were going to, you know, prolong the animal's life. And the clients were very financially constrained. And in that situation, they made the decision to go ahead and euthanize. Um, but I said that to me is different than purely economic euthanasia, where it is a treatable animal and you can treat that animal and expect to continue seeing that animal in your clinic for the rest of its lifetime, which also represents All of your downstream revenue from the life of that animal. So if you want to look at it from a business perspective, it makes more sense to treat. Um, but you know, there are always cases where You know, euthanasia due to finances combined with a poor prognosis would, would make sense. Um, it's still painful, but, um, I just, I hate hearing that for lack of, um, the ability to come up with all of the upfront money today that an animal is put down or surrendered because a lot of these pet owners. Um, can pay over time, the obstacle they're facing is, there is kind of what I refer to as a legacy payment model among veterinary clinics, which is still that, you know, your entire amount is due up front, um, and, or you can't proceed with treatment unless you come up with 50 percent of the high end of the estimate or something, that's insurmountable for people. And then treatment can't begin. And that creates anguish for the pet owner, and it creates anguish for the team. Um, although I certainly feel that veterinarians, in order to survive, um, the pain of that, the ethical and the moral distress, have had to, um, move to a place where they protect themselves by telling them it's the owner's fault. Um, you know, if only the owner were more prepared, if only they had insurance, I hear the thing about having pet insurance all the time and it drives me crazy because one of the reasons we only have 3 percent of pets insured in the United States is that the vets aren't paid directly. So the owner pays premiums, but they're still on the hook for that upfront cost. And if you don't have 4, 000. You don't have 4, 000 tomorrow. I mean, I look at pet insurance as kind of being more like asset protection for people that can already afford the bill. Um, they can pay the 4, 000. They can wait to get it back. Um, so they are recouping their loss, but The one exception to this is Troupanion, which will do direct payments to the vet, but they have to, the vet has to have the claims processing software in order for that to happen. And I have Troupanion policy, so despite my frustrations with the pet insurance model, I still have a policy for my dogs. But neither vet that I go to has that claims processing software. So I'm still in the reimbursement model situation for any bills that I have as well. I still have to pay up front and wait to be paid back. And I, I just hear pet insurance discussed so often as if it's a panacea and it's the ultimate solution to access to care. And now you have complete peace of mind. You'll never have to worry about treatment costs again. That's not accurate. And I, I just want us to talk more candidly about that as well, and that we need other options out there, um, apart from pet insurance.

And some people fail to read the, the small print, because I know I have a, I have a friend who has a Dachshund and the Dachshund had back problems and he went ahead and you know, he had all his stuff up to date and he submitted his claim and they said, sorry, but Dachshunds with disc problems are not covered in this insurance. And he was like completely like, and this was years and years ago, I believe that the insurance that he's used that he was using then is now covering it. But at the time they didn't because a lot of insurances will not cover certain genetic predispositions for, for diseases. So dachshunds with disc problems, Maine Coon cats with heart problems, uh, you know, Dobermans with heart problems. So they will not cover things that they. kind of know are going to happen. So, you know, you, you have people that they don't necessarily read that fine print. They just see, okay, you know, you get 80 percent of the, of the reimbursement and, and that kind of stuff. And then when you have the emergency, then you're just, you know, shocked to find out that you have planned, you have tried, and then you have not, you're still not able to, to afford the care that your pet needs. Last, last week I interviewed Dr. Michael Blackwell on One Health. And one of the, the case that he said kind of turned him was having to euthanize a dog of a veteran that had a treatable condition that could not be treated because of costs and it had to be euthanized. And he said that it felt wrong. And I have been in that position of feeling wrong about having to euthanize. A patient that, you know, it, I don't know if it can make it or not, but there is not that option because of, you know, funds and I have been very, very lucky to have owned my own practice and be able to, to offer affordable care so that euthanasia due to financial reasons is not necessarily a thing that we had to do, but it's so, it's so hard to know that it happens. And I think that it is a huge cause of compassion fatigue. You know, we're losing so many veterinarians and technicians that are just leaving the field because they went into this business wanting to help animals. Uh, plus minus wanting to help people because so many animal people don't necessarily like people, but you know, we go into this field to help animals and then it literally is, we can't help this animal. Not because we can't not because we don't have the, the ability or the education, just because this person doesn't have the funds.

Yes, and I knowing like my personality and temperament if I were a veterinarian and I were in that position. I. I don't know how long I would last, you know, um, facing that. There is, um, a wonderful YouTube video out there from a TED Talk that you probably might know of, um, by Melanie Bowden. She's a veterinarian. I think she's currently working with veg. But she made this, um, she did this TED Talk a few years ago. And it's called, What it Really Takes to be a Veterinarian, and she sort of busts all the myths for people out there who assume that it's all playing with puppies and kittens all day and, oh, this must be the happiest job ever. And one of the things she talks about is the inability to treat animals because of owner financial constraints. And the way that she described it, the term she used, Is soul crushing and I thought that that was such an apt description of it. I think it over time it literally has to do something to your insides to be able to cope with that. Um, you can't go to work and, you know, function if your soul is crushed every day. So you have to develop some sort of internal defense mechanism against that. And, um, and that is what sometimes I think can turn into resentment of clients or, or client bashing, because where, where does that blame go? Where do all those feelings go? Um, when we have them, it's, it's It's really very painful. So, and by the way, Melanie, um, Bowden wrote a book that came out a year or two ago that I love. I highly recommend. It's called, What the F Is This Vet Med? It's about sort of her baptism by fire into like leaving vet school and then going into the actual field. And, and as you're saying, you know, veterinarians don't go into this. With any idea when you're dreaming of being a veterinarian, you're not also dreaming of client financial limitations, like nobody starts thinking of being a vet if they're eight years old or 10 years old and they're like, Oh, I'm going to treat all these animals, but there's going to be a lot of people that can't pay. I mean, nobody is thinking that. And so, you know, I think that she touches on that and in her book of her experiences with that and. what she has done to try to cope with that, um, so that she can have a sense of wellbeing and make sure that she cares for herself properly.

I'm going to have to check that book out because yeah, it's when we go to vet school, we're, we don't go through business management classes, right? We go through classes on how to identify diseases and how to treat conditions and that kind of stuff. Realistically, we don't even get like human resources type classes. And I know that some of the universities are kind of. Reworking the way that their curriculums are because they are recognizing the need for spectrum of care. But even so, I mean, we we don't graduate knowing how to how to be a business person. And you have to be a business person to to be in any kind of business. So it's really difficult. And you get into into that point of whose responsibility is it to take care of any individual animal. And clearly, yes, the responsibility lies on that, on that pet's owner or caretaker, because they took on the responsibility of their care. But I also feel that as veterinarians, like we take an oath to help animals in society and animal welfare. And it doesn't say that we have to take care of affluent society. It just says society, right? So we, we kind of have to figure out. Ways outside the box. And I'm not saying this to, to tell people, you know, we, we should do everything for free because things can not be done for free. We have to be compensated for what we're doing, but we also have to recognize the fact that the cost of veterinary care has increased exponentially in the last several years. So you can have people who got their animals back when, you know, you could go and get your yearly examinations and everything for 75, a hundred dollars. five years ago or even eight years ago and the same dog going to the vet right now would be five eight hundred dollars so yes the cost of care has increased it doesn't mean that these people are bad owners like you can't plan for for things like that and then the cost of emergency care has also gone up exponentially and the veterinary field has increased, like, leaps and bounds, right? From when it used to be. When I started 24 years ago, it was a stethoscope and a microscope, and that's what we had, like, stethoscope, microscope in our hands. And now we have CTs, and we have x rays, and we have MRIs, and we have all of these amazing advantages. And with those come with increased costs, but we have not allowed enough time for people to kind of be able to adjust to those changes. Right. So all of these expenses are are literally unexpected

Yes, they are. And a friend of mine who has worked in various, um, companies over the years, developing new diagnostic systems for for veterinarians. He said to me once very thoughtfully, he said, you know, it occurred to me at one time that, you know, here we are like happily creating all these advanced diagnostics and stuff. But we haven't stopped to think about whether the cost of putting those in practice is pricing pet owners out of care. And I said, yeah, that's, you know, that's a really interesting thing to think about. And I think about, you know, the kind of veterinary care. That was available when I was growing up as a kid, which was really a long time ago, really a long time ago. But, you know, I feel like what I remember is... You know, seeing the vet maybe once or twice a year for vaccines, like the core vaccines, and I'm sure that back then we didn't even have some of the vaccines that we have today. And I, I don't even really remember my dog that I grew up with getting sick very much. Maybe we didn't pay as much attention to her, but I mean, like if she was throwing up or she had diarrhea, it's like, oh, she's sick. But I also remember that a lot of times we, she would get over it. So I wonder if as. Um, you know, we've brought pets more and more into our families as full fledged members of the family. Um, we've increasingly sort of medicalized, um, what they're going through, and we go to the vet a lot more. We notice things a lot more. But, I mean, the dog I grew up with lived a long, healthy life. And I think, you know, you go into PetSmart now, I am overwhelmed when I walk down the dog food aisle. There's too many choices. Um, pet owners get very confused about all of this and then there's social media telling you what you should feed your animal and one post that I saw saying you should use this green juice. Literally, it was green juice to treat something in your animal. And then of course, those same people that see that walk into the vet clinic and say, Oh, I'm using the green juice for my pet and veterinarians are just.

That's great. I know from Dr. Google. We, the veterinarians hate Dr. Google.

Right. I know. I mean, I, I kind of hate Dr. Google too. I kind of wish it would go away because, um, well not go away, but for, for some reasons, because before we were so much reliant on Google for things, my veterinarian was the absolute authority on anything about my animals. Like I didn't. second guess anything that I was told by my vet. Um, and now it's too easy for people to do that. So there are times when I've gone to the vet and, um, she might suspect, she might tell me a couple of differential diagnosis about what's going on. And I tell myself, do not go home and look that up. Like, don't, don't look it up because I'm going to focus on the scariest words, and also you have to be very careful about the source from where you're getting your information. And I think I'm lucky because I work with veterinarians, I kind of know what the reliable sources are, but a lot of people don't. So, you know, if I put in the name of a disease or something, and the first result that comes up is from a website called Wag Walking, I'm probably not gonna read that, even if it was, they say it was, Approved by a veterinarian or, you know, something, but I just, I just don't want to go there because I don't want to scare myself and I don't want to second guess my, my vet, I mean, there's nothing that can take the place of actual clinical practice. Things do not go the way that they are written out in Google. You know, you have this richness of experience that you can never get by looking up something on the internet.

Yeah, people get confirmation bias, right? So they get something in their head and they want to believe that their pet has or doesn't have something. So they look, and if you look hard enough anywhere, you're going to find something that agrees with what your, what your thought is. And, uh, I have a family member that used to post kind of funny things. He would get a symptom and say, I had a, I had a blinding headache today. I checked out. One of the medical websites. So I may even have a migraine or a tumor in my brain, right? So it's kind of like all these extremes that can happen just thinking. And when we have an ailment, we can think about. Okay, do I feel chills? Do I feel hot? Do I feel tired? Do I feel achy? But our pets depend on us to, to know things without them saying, without expressing. And animals, especially like cats, they're great at hiding things. So it is really important to have that education, to be able to examine the pet and be able to do things. But yeah, we, we have We have gone from one extreme to the other, from zero diagnostics to all the diagnostics, and the in between has kind of gotten a little bit lost. So I do agree that, you know, if If, as, as a veterinarian, me personally, if a patient, if a client comes in with their patient and I give them my, my opinions, my diagnosis and everything else, I'm okay with them, you know, going to a second opinion, getting, going to a specialist or going to somebody else or thinking about it, especially when it's something very difficult, I don't take offense to it because it's something that I would do myself if somebody told me that myself or my child has something serious. Thank I want to, you know, I want to, I want to find out about it. So as veterinarians, nobody should really be offended about getting that second opinion. And then, and getting, getting something done.

That's true. Although circling back around to the issue of financial access, sometimes Going to a specialist is out of the question for some people, which is another complicating factor and something that Dr. Blackwell said in the interview that you did with him on your previous podcast was He said something along the lines of veterinary medicine is not equipped with a system for dealing with these financial Challenges and I think he's really right about that. I mean there has only been sort of one system for 25 years, which has basically been care credits. And I don't want to like pick on care credit, but they are the most predominant financing option offered by most vets. Um, I mean, there are other options that operate similarly to care credit, like Wells Fargo, all of them.

And we used a scratch pay as well. Yeah, it was something similar, but, but the same as care credit, it's all dependent on, on credit.

It is. And then I will say though, scratch pay differs from credit and that it's a short term installment loan. It's not revolving credit. And I think one of the nice things about scratch pay is that clients aren't dealing with that promotional, um, that promotional window of deferred interest where if you pay off your bill within six months, Um, you don't have to pay any interest. So a lot of people say, Oh, it's zero interest. Not technically, not really deferred. So if you miss one payment or you are late with one payment by a day, that's going to throw that deferred interest out the window. And what it's going to trigger is retroactive interest on your entire original balance. And that APR on that is like 28. 99%. So what happens to people sometimes. Um, is they end up owing more than their original invoice was. And this is by a lot. Yes, by a lot. And it's called getting into a debt death spiral. Like you, you just cannot get ahead of it. So you have to be very, um, conscientious about using those, um, type of financing products and that, you know. The vet staff would make sure to make it clear to your clients that you make sure that you make all of your payments on time and that you pay off your balance by six months and that making the minimum payment is usually not going to be enough to pay off your balance, you're going to have to pay more so that you're, you don't have that risk. So that was another thing that we did with vet billing. Um, vet billing basically is a tool that allows. Veterinary clinics to extend their own credit and make their own approvals based on the client, the patient, the situation so their hands aren't tied when something like care credit doesn't work. And, even though most vets are, are terrified of payment plans and extending in house credit, it, that's basically because they have done it for years, but they haven't done it well because there isn't a system. Um, there's always a lot of, uh, sort of patchwork approach to this. Like you use a promissory note, one vet uses promissory notes. Another vet is holding postdated checks. So the client's writing six checks that they have to hold and deposit one a month. You get to check number three and it bounces. And then, you know, the vet staff is like, okay, what are we going to do? They're not trained to do all that follow up. Um, another thing that's common is simply sending monthly statements. through the client hoping they're gonna pay off their bill, which leaves a lot of, um, too much control in the hands of the pet owner over whether and when they're going to pay that. So what we did with vet billing was create a system where all the payments are automatically drafted. We provide the clinic with the contract. You just set it up by logging into our online platform. So you have a standardized contract, you set up the payments, they're automatically drafted, and then if anything happens with those payments, if there is a payment failure, a transaction failure, Then it's our team that follows up on that. So we have software that reprocesses payments, but we also have a team of humans that reach out to pet owners because the goal is to keep them on track with their payments. The idea was to give vets, um, sort of a backup system that was going to mitigate any financial risk that they were taking on. By us handling the entire plan for them. And that's why we have about a 90 to 95 percent repayment rate on all of our plans. It's kind of like if you give clients an easy way to comply, um, they do comply. And, um. And then that way we can support vets as well because that's equally important to us is, reducing some of that moral and ethical distress that they're feeling that their hands are tied like, oh, we can't move forward with this case because they were, they were declined for care credit.

I can completely understand where vets are coming from because we had in our hospital, we would extend credit and people would burn us. And, and some people would pay like once or twice and then that was it. They will leave a credit card and then they would cancel the credit card. So it is, it's really difficult as a veterinarian. And then you don't want to get into that whole, ordeal of having to go after people in small claims court and that kind of stuff. First, it's expensive, it's time consuming, and it doesn't look good to be going after somebody for money after, you know, it was to, to help their patient. So it's not a good public relations thing. So I think that, that something like this sounds great for especially emergency stuff. Most people can potentially You know, you have a whole year in between wellness visits to come up with however much money you need for a wellness visit. But the problem really comes when your dog all of a sudden is vomiting or it, you know, it ate a sock. It, it accidentally got out of the house, got hit by a car. Now it has a broken leg or whatever. And you have this, this emergency and you can't afford it. And you have the money to pay it. You just don't have the money to pay it now. And, it is really hard as a veterinarian to, again, we didn't go to business school to kind of figure out what the best way to manage those things are.

No, that's true. And then like what you said about most veterinarians have experience with being burned when they've extended payments to clients, that's really true. Um, and we want to prevent that, but it's really hard, um, to sort of convince. Veterinarians who are understandably skeptical about the system we offer that this doesn't function like any payment plans They have probably done in the past at your clinic Do you know what so you said people would like leave a credit card number to run? Did you guys do anything else as far as all the payments?

No, like, so all that we would do is get information like from the owner, like a driver's license, some kind of government identification. And then, yes, they would leave, uh, usually a credit card because we tried doing the checks things and then the checks would not go through. Um, so we would try doing a credit card and then having somebody run the credit card. And yeah, so that, that was basically it.

Yeah. Yeah. And what we have built into our system as well is that when you set up a contract. Um, the owner has to provide a primary payment method and a secondary payment method. So if the first one You know doesn't go through then we can automatically Withdraw from the secondary payment method. Not everybody has two payment methods. It depends on the client. It depends on the demographic but um if There are two payment methods that protects against, you know, any additional risk as well. So there's a lot of things that are built in to our system, like address verification, bank card verification. So people can't put in a fraudulent address, they can't put in a fraudulent bank card. The system will pick it up and say that it isn't valid. Providing a, a soft credit check is an option that you can do, which basically is there for the veterinarian just to have an idea of the degree of financial risk involved in extending a payment plan to this particular client. So it's not like a pass fail system, like your credit is, like you're approved or you're not. This comes back with a series of letter grades from A through F. And a recommendation for the minimum down payment you should get from the client and the optimal payback period so you're not waiting, you know, too long to get your money, like, overall, our average payback period across all payment plans is about seven months, six to seven months, so it's not anything crazy. The average finance amount is 800 to 1, 000. So people need a lot of help in that area between like 500 and 2, 000. Um, we do work with a lot of emergencies as well, and they have much bigger bills. So they may extend payments to 18 months for some of those clients, but generally they do 12 months. And, um, we have. Very, they have very good payment compliance. We have a emergency in the Dallas area that we've worked with for several years and they send us tons of payment plans and they have about a 97%. Repayment rate, um, but they have really created protocols in a system around it, like up to invoices up to 500. You can get a maximum of a 6 month payment payback period. A thousand dollars you can extend to 12 months. So they created policies and then. They will make exceptions on a case by case basis, in collaboration with the doctor and the team. So, that works really well. So we try to, you know, guide the clinics we work with in helping them set up protocols around offering payment plans. You're not just offering them willy nilly. Like, we want you to have a policy in place and Then, if there's a case that is really pulling on your heartstrings, you really want, you know, you can always make an exception, but have protocols in place and then it's gonna work better for you.

Yeah. As a business owner, I, I always thought of, let's say that it's an emergency and it's a thousand dollars. I'd rather make a thousand dollars over six months than make zero dollars. and not help this patient as a veterinarian, right? Because we have, again, to think about both sides of it, we have to Keep the doors open. We have to, to pay our bills because we can't, we can't tell our electric company, sorry, you know, I didn't charge these people. So I want to pay you in, in like the, the love that I gave this animal, but you know, like it doesn't, it doesn't work like that. Like we have to pay, we have to pay our bills. And unfortunately as veterinarians, we have. A lot of loans and a lot of, a lot of payments, our supplies, everything is, is really expensive. So there are, there are costs, but being able to help the owners afford their, their pets. realistically is good business sense, right? Like we don't, we don't make money out of not treating our patients. So if we can, if we can help our patients, you know, taking away the, the emotional part of it, treating our patients is good business. And then again, as veterinarians and helping our staff deal with compassion fatigue, being able to tell a staff member, Hey, you know what? Fifi's going to be able to get treated for the bladder stones, even though Mrs. Smith doesn't have the money right this second. And that staff member that has been the one primarily, because, I mean, as veterinarians, we're not the ones dealing with the owners primarily, right? It's the receptionist, the technician, the assistants, they're the ones that are spending all this time and bonding with these people. We go in the room, we see them for five, 10 minutes, we do our diagnostics, our medical stuff, and we leave. And then the staff is left with having to tell the owner, this is the cost, this is the estimate, this is what's happening. No, there's no, there's no options. Like, you know, you got to make a decision. So it's really, really difficult on, on the veterinary staff. And then when that owner has to make a difficult decision or when that owner gets irate and says you don't care about my pet. That's all going on that, you know, veterinary staff, not as much on the veterinarian. So I think that, you know, being able to find creative ways to help pet owners. with their, with their pet care is also a way for us to help as veterinarians to help our staff deal with the difficulties of our job.

Yes, and one of the most gratifying things that, that I hear from a lot of our partner clinics, which tells me that vet billing is working exactly as I hoped. Um, in the beginning is that they say it reduces a lot of stress for their staff, um, and really contributes to their emotional well being because they no longer feel helpless and powerless, like they don't have another solution to fall back on. I had one hospital administrator tell me that prior to using vet billing, she said some of her staff would get so upset and they would come to her crying and say that they felt personally responsible for euthanasia or the surrender of that animal because they couldn't. Give them an option yet. It wasn't up to them, but it still was a very personal experience. And I think that's because almost I would say 100 percent of vet staff all have animals themselves. Um, many of them have multiple animals, you know, and They can empathize with what it would, would feel like to be in that situation. I think all of us that love animals, our heart immediately goes out to someone that is struggling to pay for care. And we want to be able to fix that. Um, you know, we, we don't want to have to say no, we don't want to equate money with the value of a life. On the flip side, though, what I have also heard from veterinary staff from time to time is, I think, I think you might have talked about this, Dr. Blackwell, this, this saying about, if you can't afford your vet bill, you shouldn't have a pet, and pets are a luxury, not a right, and another thing I've heard is, oh, well, you wouldn't go to the grocery store and ask to make installment payments, or you wouldn't go get your car repaired, and And ask to make installment payments, although financing is on the rise and car repair businesses, but what I will say, I don't think that those are good comparison because groceries and your car are inanimate objects. They're not like members of your family. I mean, they're, they're necessary things are the same thing with furniture, like being able to. The finance furniture as opposed to paying in full for it. But when you're talking about an animal, you are in most cases talking about a family member that is loved. And that intersection of emotions and finances is like a powder keg. It's very volatile. So, um, so we have to remember that there's an extreme emotional investment in that animal when we're talking about money. So you, you can't, it's really not the same. Like my, I could have a, a car accident tomorrow, heaven forbid, and my car is totaled. And, um, am I going to be upset? Yeah, I'm going to be upset. I'm probably going to be mad because of the inconvenience and worried about the expense and the cost. Am I going to be grieving for my car? No. But if it was my animal that I had to put down over money, you better believe I'm going to be grieving. So, you know, that's really kind of the difference.

And we have to, to understand and respect the human animal bond, especially in people that are underserved because they need those animals, right? And animals live in these underserved communities, too. So we cannot be judgmental of people that have no resources to affordable and accessible care when there are animals in their community. Where are these animals going to go? And the, the other thing that I, that I see a lot is the, the problem that shelters are having with shelter overpopulation and people dumping animals. And there are people that dump animals because they're irresponsible and they didn't know what they were getting into and that's on them. But there are quite a few people that surrender animals because of medical conditions, because they couldn't afford it, because they, they have to move because of evictions. I mean, life situations that they don't want to part with this, with this animal, this animal is their family, but they have to give them away. And we have, on one hand, somebody that doesn't want to Get rid of their pet. And on the other side, the shelter that is so oversaturated with animals that they're having to euthanize animals. And the solution, like I spoke with Dr. Blackwell, is a difficult solution because so many people have to come together. We have to figure out a way to keep those animals home with their owners. And then we are helping the shelter population as well by decreasing the intake number. I mean, how amazing is that for the person that gets to keep their pet and for the shelter that doesn't have to euthanize the dog because of space?

Yes, absolutely. I mean, one of, one of my favorite quotes is, um, it's often attributed to Desmond Tutu, but I think it's potentially at Various sources. It doesn't matter. But the quote is at some point we have to stop pulling people out of the river and go upstream and find out why they're falling in in the first place. So there are a lot of antecedents or upstream ways that we can address this problem instead of on the back end where we're reactive. The animal is being surrendered. Then, you know, it already had a loving family and now it's going to go in the shelter Now it's going to potentially be adopted by a new family And then there's no guarantee that the new family won't be faced with this situation themselves of an unexpected vet bill And that animal could end up back in the system again like because we're not addressing the initial problem or we're not coming up with Um, enough effective solutions for managing that problem to keep it from happening in the first place. It's like what I call a vicious. circle, just going around and around again and that I think we have a choice about whether we want to continue to perpetuate that circle or not. When it's better to keep that pet in his loving home. I have a, I have a veterinarian friend. Who also said once she, she hurt her ankle, she broke her ankle or something. And she said, the problem with financial obstacles for clients and then surrendering an animal over money, she said, that would be like, for me, if I went to the hospital and I couldn't pay, you know, for the cost of having my. Ankle set and repaired and whatever. And they said to me, oh, well if you can't afford to pay, would you like to go and live with this other family, Who can, who can pay your bill? And she said, honestly, no, She said, I would rather have my broken ankle. I'll just walk around with a limp and you know, crutches or whatever. 'cause I don't wanna go to another family. And when we sort of. flip the script and we think about these things in a different way. It's like, what if this was happening to a human? It's like laughable, but also sad. It's like, gosh, yeah. Why, why are we doing this this way?

If, if there are any veterinarians or veterinary managers listening to this episode and they want to get more information about vet billing, how does the process work for them?

Oh, it's really easy. The first thing I can do is find our website is vet billing. com. So it's really easy to remember. And you can explore the website. We work with non profits as well as for profit clinics, too. So they can explore the website. There's a form that they can submit, request more information. They can schedule a demo so they can actually see how the platform works and what it looks like to set up contracts and, and things like that. And then we're also active on social media. So we have accounts on Facebook, Instagram, and LinkedIn. And we do a lot of, like, educational type of content, for example, things about credit invisibility, credit inequality, the value of financial triage, putting some kind of financial triage system in place so that you can match clients with the payment solution that is going to be most appropriate for them in whatever financial situation they're, they're, In, um, human hospitals do this, do financial triage, and it helps them know from sort of the get go where this client is likely going to be and whether they can use, um, they can pay in full, whether they are going to need support from a traditional financing system, whether they're going to need an in house option or whether they're going to need charitable assistance. So it just sort of helps you conceptualize that. One of the things we have talked about on our social media is whether or not your clinic has clients like ALICE. Do you know about ALICE? Have you met ALICE? I have not. So ALICE is actually an acronym for Asset Limited Income Constrained and Employed. Asset Limited Income Constrained and EmpLoyed. So an Alice client, we'll just call her Alice. So I created an Alice icon on one of our social media posts. So Alice earns income that exceeds federal poverty level, but she still struggles to meet basic expenses. Um, Alice and clients that are like Alice come from all races, ages, ethnicities, and abilities. But... Households of color are disproportionately A. L. I. C. E. clients, if you are A. L. I. C. E., you most likely live paycheck to paycheck, you probably work two or more jobs, and it's likely that you have a family member or members that need care and assistance that you're providing. And the other thing for really bringing this home is that we all probably know an Alice, whether we realize it or not. They're in our lives or we work with them, we know them, maybe they're our friends. So, when Alice comes into your clinic, she's going to be the one that's most likely to need an accessible option for paying over time for veterinary care. And she's not likely to qualify for traditional financing, because of her situation. but what we like to tell people is that you can help Alice. without giving away services or sending her off with a list of charities and saying, you know, here, you know, go find this, that vet billing is ideally suited for helping clients like Alice that fall in that area where charitable assistance isn't really ideal, but they're not going to qualify for traditional financing. I learned about Alice actually from Another veterinarian that wrote about this and the acronym ALICE was developed by United Way of New Jersey. So I went and looked into the information they had on Alice. So they have all sorts of programs to help Alice clients. So again, asset limited income constrained, but employed, and that describes a lot of people. So that was one thing I really wanted to mention because I'm sure you work with a lot of Alice clients.

Yeah, I do. And I mean, just listening to that, I know. times in my life where I have been Alice, right? Even when I was in school and I had a job, but I was in school, so it was difficult to, to make ends meet. And I had a cat, so I was very lucky that my cat never needed any emergency care, but had my cat needed emergency care at that time, it would have been, it would have been very difficult for me to, to have given him the care that he needed. So, but, but I would have been able to arrange something because I did have a job. So I would have been able to pay. I just would not have been able to pay everything at once. And I think about even, veterinary personnel, like veterinary technicians, they're professionals. And they make decent money, but I know a lot of veterinary technicians that could not afford bills at the veterinary clinics that they work at. And I don't think that any veterinarian is going to say that their veterinary technician should not have a dog or a cat, right? That they're, you know, if you can't afford it, you can't have it. Uh, but yet we do have some veterinary technicians and assistants, uh, that come to our clinic because we are, more affordable, even with their discounts and everything else. Unfortunately, they can't, they can't afford it. So, and the concept of affordability is a little bit different from one place to another, and we just have to eliminate that judgmental idea that if somebody can't afford an animal, they shouldn't have it. Also, there are the vast majority of animals go through life without needing emergency care, without needing thousands and thousands of dollars. So are we going to tell everybody that cannot afford an emergency bill that they shouldn't have an animal just in the case that they would have to, need that that emergency money?

I agree. I mean, that's like saying, um, you know. You manage to take good care of your animal until they're five or six years old. And then at five or six, this really happened to a family that I worked with. Um, you notice one day that suddenly your dog can't pee. Okay, what's going on? And that she seems lethargic and like she doesn't feel well. And it's a Sunday. So the only option you have is you're very worried because this is an emotional support animal, say for you, you're on SSDI, your husband has a traumatic brain injury, again, this comes from real life. You go to the emergency, and you spend nearly 1, 000 in diagnostics to find out that the dog has bladder stones and that there's a stone blocking the urethra. And then the second estimate that you get to treat that Is 7, 000 and there is just no way, that you can do that. So I, this was a family that I actually guided through getting charitable assistance, but should we have told that family, you shouldn't have had that dog all along, even though he's so important to your, your husband who was a veteran and had a traumatic brain injury. Um, and so important to your family. She's been receiving veterinary care, preventive veterinary care all along. We all know that bladder stones can not have any symptoms until there's a bladder infection or until there's a blockage and it just, like, kind of happens. And, you know, if you're going to your regular exams, you're not getting radiographs of the bladder to see if there's stones and you're not gonna, you know, if there's not a problem, you're not gonna bring it up. So it suddenly happened. So all along this dog has been well cared for and well loved, but because of a 7, 000 estimate, we want to tell them you shouldn't have had that dog in the first place. Like you're saying, it doesn't make any sense. It's very reductionist and very short sighted and There's no nuance in that sort of statement, and every situation is different, and I would hate to see people deprived of the companionship of animals because of that reason. Yeah, because of the what if. Yes, because we don't know, we don't know what we're signing on for when we bring them home as an eight week old puppy, like when I got my miniature Schnauzer Finch, but I have ever imagined my wildest dreams that he would end up suddenly paralyzed at the age of five. There was no, that was not even on my radar. Even with all the things I've learned from working with vets for 10 years and all the journals that come to my house, even though I'm not a veterinarian, and all of these horrible cases that I read out of curiosity and then go, Oh, stop it. Now, now, now your dog has any symptom you're gonna think it's this weird case. But even with knowing all that, I, I had no, I had never heard of a Schnauzer that had this. I now know that there are others, but... Not totally unexpected. You don't get that puppy and go, Oh, I wonder what will happen if in five years they're paralyzed and they need a wheelchair and I need to learn how to express a bladder. You, you sign on for what it is, you know, that's what commitment is.

So for pet owners, is there a way for pet owners to find out if there are clinics that are, uh, with vet billing?

Yeah, we do have a directory page on our website. So you could just type in to Google, uh, vet billing, find a vet. Um, or go straight to our website and there's a participating veterinarians page so you can search by city and state or zip code to see if there are vets like within 50 miles or 100 miles or, you know, however far from you. And if you, if your vet isn't on there, there's a form that you can submit to us to recommend that your vet consider a partnership and then we will certainly reach out to them and provide information and we do actually on board a number of clinics that way. It comes from a recommendation from their own client that would like them to participate. So, um, they can of course always call us, um, there's an 800 number on our website and you can call and talk to our team because we'll have the most updated information about, um, who participates as a vet billing partner because we're adding new clinics all the time and sometimes there's a lag between when we add them and when they show up on our website.

This has been really great information. It ties into the topics that we have talked about the last few weeks, as far as the importance of One Health, affordable and accessible care, decreasing shelter euthanasias by decreasing intake. So anybody that's listening, vetbilling. com, you know, if you're a veterinarian, part of the veterinary team. Look into it because I think it's going to help your, your practice and help your clients. If you're a client, then, you know, you can, you can mention it to your veterinarian so that hopefully they can give more options for people to, to afford care because it's pet ownership should not rely on people's financials. It should rely on the ability to give an animal a good home, especially with the overpopulation and the. And the great value that animals have to people, the human animal bond So thank you, Suzanne, so much for being part of this conversation for taking the time to go over your guys's history and why your company and thank you so much for having a company that offers the services to individuals.

Thank you. Thank you for inviting me on. I can talk to you for probably four hours. Yeah,

this is, this is a never ending conversation. I'm sure that we'll probably have other, other topics to talk to as we, as we move forward. So thank you so much for being part of this and to everybody out there. Thanks for listening and thanks for caring.