Your head is gonna spin off when you see this...
That's what my husband said after he recently opened up my Explanation of Benefits (EOB) letter from our health insurance company for my bat exposure in August. Thankfully, I was only responsible for a small portion of the actual bill but it got me thinking of how ludicrous it was and how something as stupid as a bat running into your shoulder could actually bankrupt someone without the right insurance.
The back story...
I was on vacation in South Carolina. I sat down in a patio chair and when I leaned back, a bat popped out of the back chair cushion and hit my left shoulder before falling to the ground and flopping around. We think the bat had a broken wing to start with and that was why it was in the chair cushion. The bat got taken to a wildlife rehabilitation center where it recovered and was released the next week. I just so happened to be with some veterinarians when this happened, and they all INSISTED I had to get rabies shots.
Bats are rabies carriers. Unlike other animals, that means a bat doesn't have to be sick to give you rabies. The only way to test if an animal has rabies is to kill it and test their brain tissue. Even though we had this bat in our possession this was not an option with the animal advocates present.
Rabies is transmitted in bodily fluids and can be absorbed through mucus membranes - like the ones in your nose - so you don't necessarily need to be bit to have an exposure. I was 99.9% sure I did not get bit, and I also did not think I had a "significant" exposure, but everyone else present insisted I had to get rabies shots.
"Rabies shots" generally mean the vaccine. To be considered fully vaccinated you need to get a series of four shots occurring on Day 0, 3, 7, and 14. If you have a break in the skin you also get Rabies Immunoglobulin (RIG) which is a shot you get directly into the wound to immediately combat the virus since it will take a couple days for your body to develop antibodies to the virus after the vaccination. Since I did not have a break in my skin I did not need RIG.
So... I've worked in the ED in Indiana for 20 years and I have NEVER sent anyone to a pharmacy to get a rabies vaccine. I also did not think I had a significant rabies exposure and there was NO WAY I was going to an ED for this; that's how confident I was that this was not a significant exposure. However, if you get rabies, it's 99.9% fatal, so as to quote one of my colleagues, "It would suck if you were wrong."
Anyhoos... my niece who I was staying with and who is a veterinarian told me I could go to Walgreens and get a rabies vaccine. Ya, right...
She then proceeded to call the pharmacy, verify that it was available, then told me to get my butt over there.
I did as instructed, still doubting this was really going to happen.
I get to Walgreens and yep, they have rabies vaccinations... but they need a prescription.
Of course this happened on a Saturday. Time to play phone a friend.
Luckily I have an internist that is a solo practitioner who ended up essentially Face Timing the pharmacist through a telemed app and getting the prescription taken care of.
As an aside - this is why you need a doctor! I have no medical problems. I take no regular medications. I see this guy once every 2-3 years but he is my doctor so when I need something I can call and he takes care of me. Yes, I understand that not every doctor's office will do this and yes, he knows me professionally so I probably have a leg up there, but still, everyone should have a doctor.
The pharmacist hands over the vaccine.
Now the moment of truth... how much is this going to cost me?
I was ready to pay anything less than $1000, but depending on the cost, I may or may not pick up the other vaccines.
Phew!
My insurance covered it all.
The retail price was $445.99.
The pharmacy did not have all four doses on hand so they ordered in the other three and told me to come back in two days. When I returned there was a different pharmacist who insisted they could not legally dispense to me all three doses in one day and that I would have to come back on different days to pick up my other two remaining doses. F@#%!!
I had to drive back home the next day to Indiana.
The Walgreens in Indiana could see my prescription in their system but said they have never stocked this vaccine and as far as they knew, it could only be given in a doctor's office or a clinic.
I called several pharmacist friends and they too said they have never dispensed a rabies vaccine.
See? There was a reason I have never sent a patient to the pharmacy for a rabies vaccine.
You can't do that in Indiana.
I called my doctor's office back to see if they could order in the vaccine so I could get it in the office like a flu shot. They spent half the day looking into it and called back, saying it was actually on back order and they could not even find a pharmacy in the area that had it in stock. They even called the hospital pharmacy and couldn't get it.
This is why people come to the ED in Indiana for rabies shots.
You can't get it anywhere else!
I did remember though that in the ED, we give the first dose then set the patient up to go to the Infusion Center to get the other doses so they don't have to keep coming back to the ED. I suggested this to my doctor's office and they were able to arrange for me to go to the outpatient Infusion Center to get my next two doses.
So, how much did THAT cost me?
The billed amount for the rabies vaccine was $4,277.00.
My insurance covered the entire cost.
The billed amount for the nurse to give me the shot was $169.00.
The insurance discount was $60.31 and since I have not met my insurance deductible for the year, my total bill was $108.69.
Since I had to do this twice, my total out of pocket cost was $217.38 ($108.69 x 2).
Had I stayed in South Carolina this would have cost me nothing.
For someone that lives in Indiana without insurance, you would have ended up with the cost of an ED visit which would have included a facility fee, cost of vaccination, cost to administer the vaccination, cost to see the health care provider, and who know what else. This adds up to several thousand dollars.
THEN, add in three more outpatient visits which, according to my EOB, costs $4446.00 per VISIT, or $13,338.00 total. So ya, you're looking at about $20,000 total for having a bat run into your shoulder. Easily enough to bankrupt anyone that couldn't afford insurance to start.
A simple bat. Food for thought.
