Do you want your fees controlled by the government?

"PET owners are being hit with dramatically different vet bills for the same procedures.”

This major metropolitan newspaper article begins with:"PET owners are being hit with dramatically different vet bills for the same procedures.” and mentions “regulation”, “regulated”, and “unregulated”  four times in the first few paragraphs.  

If you were one of the newspaper’s readers, would you jump to the conclusion that the government should step in and regulate veterinary fees? How about if they threw in some nice government subsidies to help:

“Government subsidies might have curbed the cost of human medical advances, but pet owners have been left struggling to foot spiraling vet bills.”

The veterinary response was to:

Blame advanced technology:

"attributed rising costs to advancements such as the rise in MRIs, CAT scans and chemotherapy for animals."

And the advent of specialty clinics:

“Animal specialists now exist for dozens of conditions, with vet surgeries able to refer pet owners to specialists in cancer, dermatology, internal medicine, diagnostic imaging and a range of other fields.”

But look at the fees the clients were complaining about:

• Vaccination
• Desexing, and
• Caesareans.

"Shop around!!! I did a phone call regarding immunisation for my cat. The difference in prices with the 7 vets I phoned was up to $70! You can't blame that on technology, immunisation is basic care."

Honestly, since when does a vaccination require a specialist? How often have you used a MRI, CAT scan, or chemotherapy to administer a vaccination or castrate a dog?

The clients have a legitimate question

Why are they being charged different amounts for what appears to be a similar service? It needs to be answered or the slippery slide to government regulation and control of fees will begin. Babbling on about technology and specialists is an ineffective diversion that only creates more confusion.

The veterinary response

Several veterinarians responded to the article with two main themes:

Don’t have a pet if you do not want to pay the fees.

"Pets are a luxury item...don't like vet bills...get a different hobby....I hear boats are pretty cheap:)"

"Pet ownership is a choice, like choosing private education for your kids."

"If you can't look after a pet properly, or can't budget for health costs then DON'T HAVE ONE."

Is this really the best response? Do you really want less pets in society? Pets ultimately use the services that generate the fees that pay your salary? If you were a client of another business and you questioned the bill – how would you feel if you got that response. Imagine paying to get a flat tire repaired, you question the bill, and the repairman says – well don’t drive your car. How would you feel?

(The response from other pet owners discussed below was to get pet insurance. It is constructive suggestion on how to help manage high costs that pop up unexpectedly and it is much more caring and less insulting then saying"don't have a pet")

The client does not understand what we are doing or why it costs so much.

"A cat desexing can vary enormously in cost to the clinic depending on the quality of suture material used, the aneasthetic gas used, pain relief used etc. Please compare apples with apples, not apples with oranges."

"Every business has different operating expenses and different standards of care. The last "Discount Vet" in Brisbane was shut down, due to dodgy work practices and using cheap materials = dead patients."

This group of responses have clearly identified the problem. Well done! Now we need to find the solution.

The response from other pet owners - Get Pet Insurance

"health issues can be managed with pet insurance"


"Pet insurance is the only way to go. Both of my 12 year old Weimaraners passed away last year. The vet bills leading up to this were horrific. I am talking mega thousands. I wouldn't consider a new puppy without pet insurance. And yes, we notice the cost because human medical care is either Govt subsidised or covered by our private insurance."


"I took out pet insurance. I would like to think that if anything big happened to him I would like to be able to afford to treat him for it, and the insurance covers upto $8000 per condition, per year."


"Get pet insurance. People are spending more on their pets. Many years ago, it was simply unheard of for a dog or cat to have chemo, surgery, hospitalization and c-section."


"I now see the need for pet insurance!"

What is interesting about these suggestions from pet owners is that:

• they seem very happy with pet insurance and are prepared to pay for it
• they have seperated the routine wellness costs that are generally managable from the much more expensive sick/critical care
• with pet insurance they are less worried about the veterinarians fee and more concerned that their pet is cared for properly.

My take away from this is there will be much less dispute about fees if:

• veterinary clinics correctly allocate their costs between routine wellness services versus sick/critical services
• veterinary clinics do a better job explaining the value of the services they have delivered and why they are important, and
• veterinary clinics help their clients manage unexpected veterinary bills by recommending they have appropriate pet insurance.

So lets get to the crux of the question.

Question: Why are there such huge differences in the fees for what the client perceives to be the same service?

Answer: Because the services are not the same

Action: Make sure your invoice clearly describes the value you are delivering when they visit your clinic.

Background: Over the past two years, RxWorks has been introducing Performance Pack to its clients on four continents around the world.

Performance Pack

Performance Pack has two key objectives:

• To help you determine a fair fee to charge your clients based on your costs to deliver the service, and
• To help you explain the value of the service you are delivering.

We can definitely attest to the fact that the majority of veterinarians we work with will go out of their way to make sure they do not overcharge their clients. They are much more likely to forget to charge for something or to be providing a service at far below its true costs. These missed charges and under charges mean the veterinary clinic cannot afford to pay their staff the same as other professions with similar qualifications. The responses to the articles had numerous vets complaining about their income as proof of this.

When we started showing clients Performance Pack, we were often shocked at the difference in what was being charged for services with the same or similar names. Take vaccinations for example – some clinics include a physical exam in the cost of the vaccination but do not mention it. Clearly that would cost more than a fee for a vaccination where the physical exam is charged separately. But to a Pet Owner – both fees are called Vaccination and the amounts are very different.

Take another example. Spaying a dog is a major piece of surgery, but for population control reasons many clinics heavily subsidize the fee they charge for a spay. They do not break out the true costs and show the discount the client has received as a professional courtesy – so the client does not realize how costly a spay really is.

Then the client comes in for a minor surgical procedure and is charged a much higher fee. The client rightly says – this does not compute. This is much less significant surgery then the spay, why am I being charged so much more? The reason is that the clinic has not properly described the services they have provided and the value of those services.  

Most of the veterinarians we know are unbelievably fair in the amounts they charge their clients – they are just really poor at communicating what they have actually done on their invoice. If your clinic is in this situation, then give your RxWorks Practice Advisor a call and they can show you through Performance Pack.

This is really a win win situation. You may be surprised to discover a lot of your clients are much more willing to pay your fees if they understand what was done, why, and the value of the service provided. Even though they may be paying more – they may be happier because they know they are getting good value for their money. Everybody likes to know they are getting good value. That extra money will let the veterinary clinic pay their staff salaries more comparable with other careers.

Call your RxWorks Practice Advisor if you would like to see some examples of how well the invoices generated with Performance PAck explain the services you are delivering.

Performance Pack will also help you calculate the cost of the services you deliver from the ground up, so you can ensure that you are not over charging your clients.

Question: Why is this article talking about MRIs, CAT scans, and chemotherapy – when the client is complaining about the cost of vaccinations and desexing? These have nothing to do with each other.

Answer: The client is right – the cost of one should not affect the price of the other.

Action: Make sure you are not using your wellness procedures (like vaccinations and desexing) to cross subsidize expensive diagnostic equipment. Make sure you are recomending pet insurance to your clients as a tool to manage unexpected sick/critical care.

Background: When calculating the cost of your fees, Performance Pack allows you to allocate costs to specific services or as a general overhead applied to all services. Electricity might be a general overhead that you allocate across all services including vaccinations. MRIs, CAT scans, and digital x-rays are example of costs that you allocate to the specific services that use them – you definitely do not want to allocate those costs to vaccinations.

Why?

Two reasons:

• Fairness – why should a client wanting a vaccination pay for an MRI? and
• Competitive Advantage. If you over load your wellness procedures like vaccinations with unrelated costs, you risk pricing yourself out of the market. You make your clinic particularly susceptible to competition from vaccination clinics.

Performance Pack helps you determine the effect a new piece of imaging or diagnostic equipment would have on the fee you charge for services that use that equipment. You can then decide if that is economically viable or are you better off referring those patients that need that specialized equipment to a specialty practice? It helps prevent you putting yourself in the situation where you have purchased a piece of equipment that cannot be economically justified in your clinic and leaving yourself in the situation where you have to raise your other fees to make up for the mistake. Raising those other fees can compound the problem if it makes you uncompetitive and you lose clients.

This analysis may also help your clinic decide what services it should be providing in house and what services are referred to a specialty clinic. Economically both you and the client may be better off by making an appropriate referral. For example, to recoup the cost of the necessary equipment, you will need to charge more per digital x-ray if you are only doing 10 a week compared to a clinic doing 100 digital x-rays a week.

Far from being a villain, specialty clinics may turn out to be part of the solution in reducing overall costs. And if the client has pet insurance, they will be able to afford it.

Question: Would government regulation make veterinary services cheaper

Answer: No. There is ample evidence around the world that it is the unregulated and unsubsidized human medical services like cosmetic surgery and Lasik eye surgery that are dropping in price while other more regulated medical costs are increasing rapidly.

Action: Communicate the value of your service better.

One last point for veterinarians who feel they are underpaid. Communication may seem relatively unimportant compared to medical science – but other countries have found it is essential to having happier clients and earning more.

At the start of the last decade in the USA, the earnings of veterinarians versus other professions had been falling for several years and they were having problems attracting good people to the profession. A number of studies were conducted to find out why earnings were so low and what could be done about it. As a result of those studies, a number of initiatives were launched to help veterinarians communicate better with their clients. As those initiatives took effect, veterinarian earnings started rising compared to other professions. So if you want to earn more – communicate better. And yes, it is a learned skill that you will need to focus on as you did with your medical studies.  

This segment appeared on television shortly after the newspaper article referenced above.

What is VetXML?

Since the VetXML meeting at the North American Veterinary Conference (NAVC) in Atlanta, I have had a few users ask what it means for them and how RxWorks is using VetXML. Here is some background and a road map for the future.

VetXML is an open set of non-proprietary standards. The standards help practice management systems talk to other veterinary systems. These standards define a data format so one system can understand the data produced by another system. The standards also define a communication protocol. This protocol allows veterinary software systems to talk to each other and actually transfer data between the systems.

You have all heard about a “10 year” overnight success story. We hope VetXML will be one. We have been working with others in the industry on these standards for many years. Now the first services based on them are just starting to capture popular appeal in the UK.

If VetXML is widely adopted by suppliers of products and services to the veterinary industry, practice management systems like RxWorks can reduce the paperwork in your practice and speed your processes. The gains could be as much as when you first switched from paper systems to a computerized system. VetXML definitely deserves your support.

VetXML allows us to develop an interface “once” for a process and be able to talk with all compliant industry members. Currently we develop a different interface for each industry member. That is very time consuming and very expensive. VetXML makes it economic to automate processes that veterinary clinics find time-consuming, leaving your team with more time to focus on their patients.

RxWorks has a long history of integrating with other players in the veterinary industry. Some examples include:

• Sending electronic orders to suppliers.
• Receiving electronic goods receipts from suppliers.
• Receiving lab results electronically from both:
  • in-clinic lab equipment, and
  • external reference labs.
• Automatically attaching lab results to the medical records.

A lot of work goes into making each of these interfaces a reality:

• Convincing the industry partner of the need.
• Getting it on the industry partner’s priority list.
• Devising a system that works with their legacy infrastructure.
• Getting the industry partner to commit the resources to develop and test their part of the interface.
• Developing the interface.
• Getting  our mutual clients trained and actually using the interface.

The founding of the VetXML Consortium

It made perfect sense for RxWorks to become a founding member of the VetXML consortium when it was first proposed. The appeal of only having to develop one interface for each process was too great for RxWorks to be anything else but an enthusiastic supporter.

Nick Lloyd BVSc MRCVS convened that first meeting in his role for the Society of Practising Veterinary Surgeons (SPVS) in the UK.  Today the VetXML Consortium operates under the auspices of SPVS (the Society of Practising Veterinary Surgeons). The current Chairperson of the Consortium is Mike Vaughan.

I still remember the first meeting. Most in the room felt nothing would come of VetXML, but a few of us who were CEOs of practice management software companies got together and said “if this is to be a reality, it will depend on our practice management systems – so let’s get it done.”

A Strategic Decision

At RxWorks, we made the strategic decision to implement VetXML standards as a priority. We wanted to ensure there were many clinics with compliant software for industry partners to see the economic value in cooperating.

Many veterinary clinics around the world are now using a version of RxWorks software that can actually read and/or write at least one of the standard formats defined by VetXML.  For example, you are using VetXML when you use the RxWorks Lab Manager.

Direct or indirect communication - why not both?

We did all this on the basis that we could communicate either directly with the industry partner or indirectly through a commercial gateway or hub. We did not want our clients locked into a commercial gateway or hub that was a monopoly. This was agreed at the first VetXML meeting.

A good gateway /hub can play a valuable role in convincing a wide range of industry players to support a standard and then enabling them to use the standard with their existing infrastructure. Gateways and hubs can be a fantastic way to level the playing field for smaller industry players and new entrants into the marketplace. Because competition makes us all better, we did not want to prohibit gateways and hubs. The principal was those gateways and hubs had to earn their business on merit rather than a monopolistic rent imposed from on high. 

VetXML goes global

Last week, at the North American Veterinary Conference (NAVC) in Atlanta, I took the opportunity to chat with Mike Vaughan, the VetXML Chairman, and Mike Fletcher, the CEO of Vet Envoy, about some of the issues we felt were preventing VetXML from being as successful as it could be. Like RxWorks, Vet Envoy was also a founding member of VetXML and today operates the only commercial gateway/hub supporting VetXML.

By the time the conference had finished, I felt we had overcome some key hurdles that were slowing progress. Here is a brief outline of the hurdles that I believe we cleared:

The independence and impartiality of the VetXML Consortium

 The Chairman of the VetXML Consortium confirmed the importance of the consortium being independent and impartial. The Consortium should not favor one commercial interest over another.

Open Standard – Communication Protocol

Writing data to a specific data format is one element in the successful integration of the IT systems used in the veterinary industry. Equally as important is the communication protocol that the IT systems use to talk to each other to pass that data back and forward.

While a communication protocol had been proposed some time ago, the VetXML website describes it as:

"A proposed open standard communication protocol for the transfer of Vet-XML data (and associated surrounding workflow processes)"

I understand from our discussions at NAVC that VetXML has now formally adopted the standard.

I plan to schedule the implementation of the communication protocol when it is formally published as a VetXML standard. This development will allow RxWorks to communicate directly with other industry players who are VetXML compliant or indirectly through gateways such as Vet Envoy.

Is the data being sent through Vet Envoy delivered securely to, and only to the intended recipient?

When you mail a letter through the post office, you expect the intended recipient to receive it unopened. You do not expect:

• The postal worker clearing the mailbox to open the letter, have a look, put a couple of photos in his pocket, etc.
• the post office to open the letter up and enter an names, addresses, phone numbers, email addresses, etc into a big database that they may or may not use for other purposes later. Or to store a complete copy of the letter just in case it may contain information they may find interesting later.
• The postal worker delivering the letter to the recipient’s door to deliver a copy to some of the other houses in the street.

Indeed the VetXML consortium has this graphic on the website addressing the same issue:

From the diagram, you can see VetXML have tried to make sure your messages are delivered securely to the intended recipient. But the devil is in the details and often broad statements hide those details. Part of your skill as a veterinarian is knowing the right questions to ask to obtain the information you need to treat the patient. A non-veterinarian may not know to even ask the questions.

With 20 years experience providing practice management software to the veterinary industry, there are important questions we ask that a veterinarian may not – simply because IT is not their field of expertise. Let me give you a specific example:

The VetXML Chairman has been urging parties to use Vet Envoy and he assured me that Vet Envoy were not storing data, but simply passing it on to the intended recipient. I asked the question because the simple storage of data opens up a whole series of risks related to the misuse or misappropriation of data – risks that I would not like to expose our clients to.

However when I took this up with Mike Fletcher, the Vet Envoy CEO, to get these assurances in writing – it turned out the Vet Envoy do indeed store data that is sent to some recipients. This placed a serious roadblock to integrating RxWorks with the Vet Envoy gateway/hub. I could not defend the storage of such data to our client base in light of the potential risks it opened up.

In order to move forward, we reached a compromise with Vet Envoy. They would inform us of the names of the recipients (now and in the future) where Vet Envoy or another third party were storing data sent. They agreed to disable communication between RxWorks and those recipients through Vet Envoy. To put it another way, RxWorks will only use Vet Envoy where we are assured the data that is being sent is not being stored by Vet Envoy or some other third party.

Is the data used solely for the purpose intended by the sender?

Reading some of the recent VetXML standards, it appears that some of the information being requested is not necessary to achieve the objective that the data is sent. Let me give you one example.

As I understand it, the usage scenario for the Dietary Advice standard is that the Practice Management System passes some information about the animal to the Dietary Advice provider who then returns a web page showing recommended diets.

I can understand the purpose of passing information like:

• breed,
• weight,
• body score, and
• certain conditions like diabetes.

It is obvious how that information can be used to customize the recommended diet for a specific animal.

What I cannot understand is why the Dietary Advice standard would include:

• the Name and Address of the owner,
• phone numbers,
• cell phone numbers,
• email addresses, etc.

Clearly I do not want our clients unknowingly sending information to third parties which is surplus to that third parties legitimate needs or is used by third parties for purposes other than the purpose our client provided the information.

Understandably Vet Envoy said they could not control what the recipients do with the data, as they are only a gateway/hub. Therefore, we agreed with Vet Envoy that we would get an agreement for the industry partners (recipients) to sign to say they will only use the information provided for the purpose intended and Vet Envoy would only enable communications between RxWorks and those recipients who had signed the agreement. For example:

• Information provided to obtain dietary advice will only be used to provide dietary advice for that specific animal and only that one time.
• Information used to register a microchip will only be used for the registration
• Information contained in an electronic insurance claim will only be used to process the insurance claim and possibly the directly associated actuarial activities used to determine insurance premiums.

Why are these concerns about data so important to your veterinary clinic?

More and more drug and food companies are either selling products that compete with those offered by your veterinary clinic through other channels like grocers, drug stores, internet pharmacies, big box retailers, etc. Some are selling direct to the clients. Remember many of these companies have many brands and labels that may target the same customer – some through the veterinary channel and some through the retail channel. Without safeguards, the information they obtain from your clinic can be used to promote any of those brands through any channel.

The information you have about your patient like their breed, weight, conditions, region, when they need wormers, what food they eat, etc. is very valuable to these companies. The information helps them target their marketing campaign very specifically – regardless of if they are promoting a product sold through your veterinary clinic or a supermarket.

Your clinic’s sales can suffer if those companies use that information to market products that are purchased through non-veterinary channels. If you do not give them the information, it is a lot harder for them to target your customers so specifically.

You need to have an eagle eye when guarding against this issue. Many manufacturers have a variety of subsidiaries offering a variety of services that may be used to gather intelligence on your customers. Other services are set up to collect pet owner’s details and then sold to direct mail agencies.  Either way, it becomes easier and easier for competitors to target your clients.

In the past, these companies at least had to pay the cost of transferring the information they wanted from paper based records into their computer system. The cost, both money and time, acted as a limiter on what they collected and used. But transfering data electronically to them makes it free and fast for them to funnel that information into their marketing database.

Since veterinary clinics are our customers, we try to avoid participating in activities that expose our clients to these sorts of risks. That is why we are asking for agreements that intermediaries or third parties will not store the data you send and that the data you do send is only used by the recipient for the purpose intended.

In addition, governments around the world are bringing in more and more data protection and privacy legislation and if you are not careful, you could unwittingly breach those laws.

Stopping "company specific" extensions destroying the standard

The appeal of and benefit delivered by VetXML is that it is a standard. Develop the interface once and it works with all VetXML compliant participants. However if extensions are made to the standard that are unique or specific to particular companies - you very quickly end up back where you started with no standard. 

If there is a genuine reason for the data, then it needs to be incorporated into the "standard" part of the standard - not by tacking on something that applies to this specific company or that specific company. As we continue to implement more VetXML standards into RxWorks - we will not provide support for company specific extensions. This is an important discipline to ensure VetXML deliver real standards.

Here is the RxWorks Roadmap for the future

• Continue to support the VetXML data standards by adding functionality to RxWorks to allow it to read and write VetXML complaint data.
• When the VetXML Communication Protocol standard is formally published and announced on the VetXML website – add that functionality to RxWorks. This will allow RxWorks clients to communicate directly or indirectly through a gateway like Vet Envoy with other industry participants who are VetXML compliant.
• Get the appropriate agreements in place with gateways/hubs and recipients to help protect the data sent by our clients and help ensure it is used only for the intended purpose.
• If necessary, update our Lab Manager Module to ensure it is compliant with the latest versions of the VetXML lab standards
• Add an Insurance Claims module to RxWorks that will support the VetXML eClaims workflow.
• Review how much support other processes have from industry, the level of demand from our clients, and update roadmap.

I am asking for your support

I hope as you have been reading this blog, you can see:

• The benefits VetXML could provide to veterinary clinics like yours
• The importance of protecting your data when it is sent via VetXML
• The reasons why we are insisting on agreements not to have your data stored by intermediaries or other third parties.
• The reason why we are insisting that recipients only use the data you send them for the purpose intended when you sent the data
• That we do not let "company specific" extensions destroy the standard.

As you discuss VetXML with your colleagues and those who supply your clinic with products and services, please keep these issues in mind. I would very much like you to lend your support to those you agree with and that are important to your clinic. For those that are not important to your specific clinic, I hope you can understand why these issues have important consequences for many Rxworks users.

I know some of our competitors in the UK have gone ahead without these safeguards. You can make up your own mind if they are putting some short term marketing advantage for themselves ahead of the long term interests of their clients. Your client records are one of your practices most valuable assets - do you really want your practice management system to treat them with such apparent disregard?

Start benefiting from VetXML now

If your reference lab is not interfacing electronically with your RxWorks Lab Manager - now would be a good time to talk to them and ask them to implement a VetXML compliant interface so it does. Look at these lab manager screenshots to see how RxWorks can turn the results into useful decision making information.

Reducing the cost of text messaging

We are currently reviewing the SMS Text Message supplier that we pre-configure for use with the Automated Message Manager module.

A brief history

When we first launched this SMS Text Message feature, we allowed clinics to select and configure any SMS Text supplier. This created many problems for clinics as they selected suppliers that took their client numbers and then spammed their clients. Other clinics had problems getting the configuration right. Others clinics thought they found a cheap price to send a SMS text message, but were then surprised by termination fees on some networks or hit with minimum monthly fees.

To address this situation and give our clients some certainty, we reviewed the market and found a supplier that promised they would not spam your client numbers. We then pre-configured the setup so it was easy for all clinics to use. At the time, this supplier’s prices were competitive in the marketplace for the service they were providing.

Simplicity was an additional appeal of this supplier as they charged a flat fee of AUD$0.22 no matter the country or network to which the message was sent. In addition, they offered some volume discounts for larger clinics.

Why we are making a change

In the last couple of years the market has matured, transparency has increased, and there is a larger choice of reputable suppliers. As the market has grown, many of these suppliers have reduced their fees. Unfortunately, the supplier we pre-configured has not and we believe their pricing is no longer competitive.

At the same time, the number of clinics using SMS text messages has increased and the number of text messages they are sending has increased. Clinics now use SMS Text Message to:

• Remind clients to withhold food the night before surgery
• Remind clients they have an appointment in hour
• Inform clients they are running behind schedule and ask them to delay their arrival to reduce waiting times
• Remind clinics to muzzle or sedate their pets before they bring them into the clinic
• Remind them to give their pet a wormer or flea treatment

This increased volume of messages combined with the price differential is now making a significant difference in cost to some clinics.

Do you have any suggestions?

Therefore, we are reviewing the market to identify a more competitive supplier. As part of the review, I wanted to ask you for any feedback or suggestions you may have. Simply submit a web case with the link to their service plan,

Likely costs going forward (unless you have a better suggestion)

From the review we have conducted to date, the likely replacement supplier offers a pricing plan that is a little more complex, but offers some very significant savings depending on the region and network. In practice, we think the operation will be as simple as the solution we currently offer. Their pricing set out by region and receiving telecom network is currently quoted as:

Australia (+61) $AUD

• Telstra 0.068
• Virgin Mobile 0.054
• Vodafone 0.054
• Vodafone Hutchison (Hutchison 3G) 0.054
• YES Optus (Singtel) 0.054

Bahamas (+1242) B$

• BTC Bahamas 0.049

Botswana (+267) Pula

• Botswana Telecommunications Corporation (BTC) 0.325
• Mascom Wireless 0.325
• Orange (Vista) 0.325

Canada (+1) Canadian Dollar

• Alliant Telecom (Mobility) 0.096
• Bell Mobility 0.096
• Fido (Microcell) 0.051
• Ice Wireless GSM 0.096
• MTS 0.096
• Rogers AT&T Wireless 0.051
• Sasktel Mobility 0.096
• Telus Mobility 0.096
• Thunder Bay 0.096
• Virgin Mobile 0.096

HongKong (+852) HK$

• China Motion Telecom HK 0.377
• CSL 0.377
• Hong Kong Telecommunications (HKT) Limited (PCCW) 0.377
• Hutchison (CDMA) 0.377
• Hutchison (Orange 2G) 0.377
• Hutchison 3G 0.377
• New World PCS 0.377
• Peoples 0.377
• SmarTone 0.377

Ireland (+353) Euro

• Eircell (Vodafone) 0.032
• Hutchinson 3G 0.032
• Meteor 0.032
• O2 (Esat Digifone, Tesco) 0.032   

Netherlands (+31) Euro

• KPN Mobile The Netherlands B.V. 0.088
• Orange Nederland N.V. 0.066
• T-Mobile Netherlands B.V. 0.066  
• Tele2 (Netherlands) B.V. 0.044  
• Telfort (O2) 0.088  
• Vodafone (Libertel) 0.088

New Zealand (+64) NZ$

• Telecom New Zealand 0.087
• Telstra New Zealand 0.069
• Two Degrees Mobile Limited 0.069
• Vodafone (BellSouth) 0.069

Singapore (+65) S$

• M1 0.068
• SingTel 0.068
• StarHub Pte Ltd. 0.068

South Africa (+27) Rand

• Cell C 0.3
• MTN 0.3
• Virgin Mobile 0.3
• Vodacom 0.3

Swaziland (+268) Emalangeni

• Swazi MTN 0.378

UK (+44) GB Pounds

• BT (PSTN) 0.055
• Hutchison 3G UK Ltd 0.055
• O2 (BT Cellnet) 0.055
• Orange 0.055
• T-Mobile 0.055
• Vodafone 0.055

USA (+1) USD$

• Alltel (text only) 0.04
• AT&T Blue (text only) 0.04
• AT&T Orange (Cingular - text only) 0.04
• Bluegrass 0.04 Boost CDMA (Nextel - text only) 0.04
• Boost iDEN (Nextel - text only) 0.04
• Cellcom (text only) 0.04
• Cellular South (text only) 0.04
• Centennial (text only) 0.04
• Cincinnati Bell 0.04
• Dobson (text only) 0.04
• ECIT (Cellular One of East Central IL) 0.04
• Farmers Wireless (text only) 0.04
• IVC 0.04
• Nextel(text only) 0.04
• nTelos (text only) 0.04
• PACE 0.04
• Silverstar 0.04
• Sprint CDMA (text only) 0.04
• Sprint iDEN (text only) 0.04
• Suncom (text only) 0.04
• T-Mobile (text only) 0.04
• US Cellular (text only) 0.04
• Verizon (text only) 0.04
• Virgin Mobile (MVNO:Sprint - text only) 0.04
• West Central (text only) 0.04

Please provide your feedback by Feb 28th, 2010

I am going to leave the review open until the end of February before we go any further. During this time, if you know of an alternate supplier that you would like to suggest, simply submit a web case with the link to their service plan, pricing, and we will check it out. While price is a very important consideration, it will not be determinate. We will consider other factors like coverage, spam policy, reliability, etc.

If you have suggestions, please get them in now so we can make the best possible choice for you.