RubyRoo, I am in England and I can honestly say that my vet has never asked if I am insured. I admit that sometimes they mention things that I don't consider to be strictly necessary but when I say no they don't push. When my previous dog developed a swelling in his mouth, the vet was honest, didn't push for lots of tests, confirmed that it was terminal (bone cancer) and offered advice and pain relief until the time came to bring his pain to an end. He was very kind and his charges were not excessive.