By Amara Osei

More than seven million pets were insured across North America at the end of 2024, according to the North American Pet Health Insurance Association (NAPHIA) — a figure reflecting a decade of sustained double-digit market growth. Yet the vast majority of companion animals remain uninsured, and many pet owners first confront the real cost of modern veterinary medicine in an emergency room, estimate in hand, with no financial plan in place.

That gap is the subject of a new commentary by Chelsea McGivney, DVM, MBA, executive director of operations at Caring Pathways, a multi-practice in-home end-of-life veterinary company. Writing in Veterinary Practice News, she argues the profession's discomfort with money conversations — not the cost of care itself — is the more fixable problem.

What does the timing of the conversation change?

Consider a case McGivney lays out: a healthy two-year-old Labrador retriever passes his annual wellness exam and leaves with a year of heartworm prevention. Six months later, the same dog is rushed to an emergency hospital after swallowing a sock. Surgery is recommended, the prognosis is excellent, and the estimate runs several thousand dollars. The medicine is straightforward. The financial decision is not.

McGivney's point is structural. Referral medicine has expanded dramatically over the past 20 years. Advanced imaging, chemotherapy, minimally invasive surgery, rehabilitation and specialty critical care are now standard options clients expect. But most families meet the cost of that care only at the moment of crisis, when emotions are high and they must absorb complex medical information while making major financial decisions simultaneously. Veterinary teams, meanwhile, absorb their own strain: a 2018 survey of North American veterinarians by Moses and colleagues (J Vet Intern Med, 32(6):2115-2122) documented ethical conflict and moral distress when financial limits block what clinicians believe is the best medical option.

Communication research supports moving these talks earlier. Studies cited by McGivney — including work by Coe and colleagues and Shaw and colleagues in JAVMA (2008), and an integrated review by Pun in BMC Vet Res (2020) — consistently show clients value clear communication, empathy and transparency as much as clinical expertise. When financial discussions begin during wellness visits or new-client appointments, they function as preventive care and shared decision-making rather than a transactional pitch.

How should practices talk about pet insurance?

Many veterinarians avoid the topic for fear of appearing to sell a product. McGivney reframes it: educating clients about insurance is no different from educating them about parasite prevention, nutrition or dental care. Practices should stay neutral on specific insurers, and she offers a model script:

"One of the things we discuss with all new pet owners is how they plan for unexpected veterinary expenses. Some families choose pet insurance, some build a dedicated savings account, and others prefer financing options if they ever need them. There isn't one right answer, but it's much easier to make those decisions before an emergency happens."

That framing, she notes, avoids assumptions about a client's finances and signals the discussion is standard for every client, not a judgment of any one family.

The clinical stakes are real. Treatment decisions are often shaped as much by financial constraints as medical considerations — owners declining advanced imaging over cost, delaying surgery, or electing euthanasia because recommended treatment is out of reach. Viewed from the exam table, McGivney argues, insurance is less a financial product than an access-to-care tool that lets clients choose what is medically appropriate rather than what is immediately affordable.

What should clients know before enrolling?

Policies differ substantially, and McGivney advises practices to push clients toward careful comparison rather than a specific brand:

• Most plans exclude pre-existing conditions, making early enrollment a key consideration
• Premiums, deductibles and reimbursement percentages vary widely
• Annual coverage limits, waiting periods and exclusions differ between policies
• Even insured clients remain responsible for deductibles, co-pays and uncovered services

Beyond insurance, third-party financing programs let clients spread costs over time while practices are paid promptly — though McGivney cautions financing should never be presented as the expected solution, and clients should review repayment terms, promotional periods and interest charges. Staged diagnostics or phased treatment plans can also let clients proceed within financial constraints when medically appropriate.

Who owns the conversation?

McGivney's practice-level prescription distributes the task across the team:

• Client service representatives ask whether a pet is insured when setting up a new account
• Veterinary technicians revisit the topic during wellness appointments and preventive care reviews
• Practice managers post educational resources on the website and in new-client materials
• Veterinarians handle where financial considerations intersect with medical recommendations

A simple written protocol identifying when insurance, payment options and estimates are discussed — a one-page document is enough — keeps the conversations proactive rather than crisis-driven. Even a one-minute elevator pitch or a handout at a wellness visit, McGivney writes, can prevent a far harder conversation years later.

Communication technique matters as much as timing. Open-ended questions such as "What concerns do you have about today's treatment plan?" surface information that would otherwise go unspoken. Statements like "We have these conversations with all of our clients because unexpected illnesses happen to pets at any life stage" reduce embarrassment and signal no client is being singled out. Present the medical recommendation first, then costs and options, to reinforce that recommendations follow the patient's needs.

As diagnostics, therapeutics and specialty services keep advancing, every clinical gain arrives with a price clients must plan for. Making financial conversations routine rather than reactive, McGivney concludes, is ultimately about preserving access to care — for the families veterinarians serve and the patients entrusted to them.