Yves here. In any other country, this sort of price gouging, let alone for not-expensive rabies shots, would be regarded as criminal. Here it’s just business as usual, made to see logical due to the insane and arbitrary insurance network system. I have an indemnity plan, and I can’t fathom how I’d function if I had to deal with a network or an HMO. And even then, the network hassle presupposes insurance and not-insanely-high deductibles.
By Caitlin Hillyard. Originally published at Kaiser Health News
I was just petting an orange tabby cat in my Falls Church, Va., neighborhood, a cat I’d never met before. He was very cute. And he was purring and butting his head against my hand. Until he wasn’t.
He sunk his teeth into my wrist, hissed at me and ran off. So began my personal episode of Law & Order: Feline Victims Unit, complete with cat mug shots and weekly check-ins from local animal control and public health officials. And rabies shots. Multiple rabies shots in the emergency room. And more than $26,000 in health care costs, an alarming amount considering I was perfectly healthy throughout the whole ordeal.
What I learned, besides fascinating facts about rabies, its transmission and the horrible ways one can die from it, was that any one of us is a mere cat scratch away from financial peril if we aren’t lucky enough to have good health insurance. Our confusing health care system makes it too easy for a person who should get medical care to postpone it or avoid it — even when that decision could be fatal.
After the encounter with the cat, I headed to a nearby storefront urgent care clinic, where a nurse handed me a form to fill out, which the city uses to track animal bites. She faxed the form to the health department and a police officer visited me as soon as I returned home.
I was asked: “Do you know the cat?” After some sleuthing in my neighborhood Facebook group, I developed a suspicion about whom he belongs to. But I couldn’t be 100% positive.
Which is why three days after the bite I was in the waiting room in the emergency room. When an animal bites someone, the procedure is to quarantine it for 10 days. If the animal doesn’t develop rabies symptoms during that time, it’s safe to say the bite victim won’t develop the disease either.
But if the animal can’t be identified or captured, the recommendation is to begin post-exposure preventive treatment for rabies. I’d need a one-time injection of human rabies immune globulin and then four injections of the rabies vaccine over two weeks.
An estimated 40,000 to 50,000 people get such treatments each year following exposure to potentially rabid animals, according to the Centers for Disease Control and Prevention.
I did consider taking my chances and skipping treatment. The odds the cat that bit me was rabid were, I’d guess, almost zero. He was probably someone’s pet and didn’t appear to have any symptoms. But rabies is fatal. That was the line my doctor, the animal control officer, my friends and public health officials kept repeating. A small chance is not the same as no chance.
I tried to be a responsible health care consumer and research cost-effective options. The ER is the only place that can administer immune globulin, so I knew that was my first stop. But I hoped to go elsewhere for the next three appointments, where I would receive the rabies vaccine.
I sat on the phone with insurance company agents while they tried to find an in-network provider that stocked the rabies vaccine. They found nothing. My primary care doctor told me people generally ended up doing the follow-up doses in the ER. The urgent care clinic staff told me they didn’t keep the vaccine in stock but could have ordered it ahead of time if they had known I would need it. Since I hadn’t anticipated being bitten by a cat, I neglected to call ahead.
The staff at the ER told me that specialized clinics for travelers can administer the vaccine, but the procedure is not generally covered by insurance. Also, to adhere to the strict vaccination schedule, I needed a location with Sunday hours, which I was unable to find.
The Fairfax County, Va., public health department said the county does not administer rabies vaccines at its clinics. Two hospital urgent care clinics also told me they couldn’t provide the vaccine, even though one of those clinics is on the same campus as the ER.
Which left me back where I started.
Although my insurance picked up the full tab for that first emergency room visit, the hospital bill came to $17,294.17. My insurance provider negotiated that bill down to $898 and paid it.
For the next three visits, I received doses of RabAvert, made by GlaxoSmithKline. Even though I received the same treatment for each of these visits, the hospital billed my insurance slightly different amounts each time: $2,810.96, $2,692.86 and $2,084.36. (If I could have bought it from a pharmacy, it would have cost about $350 a dose.)
Rabies is not the only possible complication of a cat bite. Many bites become infected, which is why I left my urgent care visit with a 10-day supply of amoxicillin, an antibiotic. According to the police, the cat who bit me is likely a repeat offender. A neighbor recently developed a nasty infection after a bite from a large orange tabby — no one is sure if it is the same cat — and has since needed surgery. She also underwent the rabies treatment.
I was lucky not to develop an infection, but my insurance company did have to pay one final bill — $206 to see my primary doctor after I developed a rash, likely from the antibiotic. If you’re keeping score at home, that brings the grand total to $26,229.35.
I had hoped to donate my blood, now rich with rabies antibodies, to be used to create more immune globulin for future bite victims. Unfortunately, my level of immunity likely isn’t high enough. Most people who give their plasma for this purpose have undergone the rabies vaccine many times. A public health worker said he recommended plasma donation to an acquaintance of his who studies endangered bats — a career I’m unlikely to go into. In fact, if I get bitten by any wildlife in the future, I will still have to trek back to the ER for two more rounds of shots.
So, I leave this experience behind with modestly increased immunity, little understanding of how medical bills are calculated and a new fear of outdoor cats — but also with a new appreciation for public health workers.
As for the cat, the police told me he was put under house arrest.
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damn, my enthusiasm for petting unfamiliar animals has waned considerably. there are so many ways our medical system can screw people, it’s impossible for foresee.
Same here, and I love orange cats, who knew. Orange cats are indeed notorious for this behavior. My guy attacked my mother’s ankles drawing blood. He did that to people who ignored him. But, as in the article, he might bite after being very affectionate. As a young cat he once attacked a lit candle and a moving hammer (I was repairing something).
I miss him every day.
my cat used to knead my arm (or any convenient part of my body) with its claws extending and retracting, i guess i was a convenient scratching post, but it was occasionally painful. never bit me though. maybe orange cats are like gingers/redheaded humans, who who are purportedly excitable and aggressive.
We had a cat that would always end a warm petting session with a sudden mauling. Petting, petting, petting and after awhile you’d think OK she’s not gonna do it this time. And suddenly your arm was in a spiky vise and teeth were sunk deep into your hand. Still purring, maybe even moreso.
She just liked the contrast, I guess.
Checked for how much this would cost in France:
ER visit: 18 euros
Immune globulin: Free
Rabies vaccine: 53 euros x3 – likely free in your situation. This one normally isn’t covered by public health because it’s primarily given to travelers to rabies zones (mostly developing countries)
Administration of rabies vaccine (nurse): 11 euros x3
Total: 210 euros
If you have “mutual” coverage in addition to the public coverage, the whole deal would likely cost you nothing.
I think my calculations are right – if anyone wants to confirm or correct, please feel free to do so.
My former boss’s grandson was scratched by a rabid fox over a dozen years ago, when his family had no insurance at all and GoFundMe wasn’t a thing yet. The family ended up declaring bankruptcy; not just because of the tens of thousands of dollars of medical debt, but it was the last straw.
Also in Va, and yeah, the exact same ER visit protocol for his treatments.
Sorry, this was meant to be a stand alone comment! Didn’t mean to bogart your thread!
I was bitten by a dog a few years ago here in Ireland – I went to the local hospital and got a tetanus booster shot for free. If I’d gone to a GP it would have been the GP fee (usually 40-70 euro) plus the shot (30 euro). There is no rabies in Ireland so it would not be a standard shot for any animal bite unless there was a suspicion the animal was not local. A private emergency clinic is usually 120 euro for a visit, usually 100% refundable if you have insurance.
Rabies shots for travel are not covered under most countries schemes, apart (I think) from the NHS in the UK. In Ireland a private clinic charges 40 euro for each of the three shots (so far as I’m aware, its the same shot for vaccine and for prophylactic).
PK, the initial post-exposure immunoglobulin is the most expensive part.
Also, there probably is no difference chemically between the shots for pre and post-exposure, but I am not sure. In my case, the ER charged about $1000 just for each shot, and a state website had told me I could only get it post-exposure from the ER.
Yes, you can get rabies vaccination on the NHS if you’re visiting a country where it’s a risk. £120-180 for a full course of the vaccine https://www.nhs.uk/conditions/rabies/vaccination/ so let’s say $140 to 240-ish.
The costs are probably a bit out of date now, but a few years ago I got a pet passport for my dog, to be able to take her to France from England, which then required 2 rabies vaccinations, plus boosters now and again. The entire procedure, including blood tests to ensure the antibodies were in the dog’s system was about £200 or so, from memory. And that is from a vet, which is entirely private in England, unlike the NHS.
I live in France. A couple of years ago I was bit hard on the hand by my neighbor’s cat while petting him. Big surprise because this cat lived part-time at my home for years and was my friend (!). Well anyway, in about 10 minutes, my hand had doubled in size and took on rainbow hues. Pretty scary.
I drove to my GP’s office. The receptionist took one look at my hand and put me in the next slot. My usual GP was on vacation so I saw her replacement, who, not being familiar with cat bites in the south of France, called our region’s rabies helpline (how I love the healthcare infrastructure in France!). After a serious phone conversation with an on-call doctor, she was able to tell me that cats in southern France DON’T CARRY RABIES! but that I would be taking a course of antibiotics.
On my way home, I stopped at my local pharmacy, ordonnance in hand and was given a box of antibiotics. My friendly pharmacists both gawked at my hand, confirmed that southern cats don’t carry rabies and we exchanged innocent catbite jokes.
The next day my hand was almost back to normal. My neighbors were amazed when I told them how our ‘shared’ and much-loved cat actually bit me. Turns out that he had recently injured himself, was pretty much healed, but I must have really rubbed him the wrong way. Live and learn.
And oh yes, total cost – probably 1€ for gas for the car.
I’ve seen where some cats do not like to be mindlessly petted for more than a minute or so. We had an old cat (also an orange tabby) who would gently bite your hand if you petted his head for too long. If you continued, you might be scratched as well. He had pretty much trained everyone in the house, but visitors would occasionally get the surprise bite.
The Europeans on here are just really rubbing it in.
I shouldn’t be ungrateful: it’s useful to know how a proper medical system works.
So the author of this article could have flown to France for treatment and come out $24K ahead.
Have bought asthma medication in France for 10 euro (as tourist, no insurance) that I would have had to pay 130 for here (with insurance). I have seriously considered traveling just to buy meds.
“the hospital bill came to $17,294.17. My insurance provider negotiated that bill down to $898”
I don’t get this. That is 95% discount. That sort of discount is applied to defaulted debt and stolen goods, can’t think of anything else.
If the insurances can “negotiate” this discount, it can mean only two things:
– if majority of the treatments is insurance-paid, then the insurance amount must at least cover the costs. The “full amount” is then how the hospitals make profit, on the few unfortunates who do not have the insurance.
– if majority is fully paid, then the insurance is free-riding (*gasp* socialism?).
I suspect that the former is more likely, in which case I’d really like to see how profitable the insurance-paid treatment is for hospital and how much of their profit comes from the full-charge.
It reminds me of some negotiations I had with a windows company few years back. “The cost is X”. “WTF? It’s twice your most expensive competitor, get out.” “Ah, but we can do you a special discount of 60%”. Except that everyone who asked got the “special” discount. But I bet some (say foreigners) didn’t.
It reminds me of the car hire insurance scam. You are charged X (X being invariably the deposit you put on your card) for a little scratch on the car when you hand it back. But if you have a separate care rental insurance, you refer it to them. I was told by someone in the business that these insurance companies almost never pay out, they just deluge the rental company with paperwork until the company just surrenders and doesn’t charge anything but a token sum. Hence they can cover you for very little cost.
I believe Maryland is the only state to have outlawed this. The challenge is that hospital groups are very big employers and lobbyists and the public does not depsise them like they do most lobbying industries. Matt Stoller tweets about this constantly.
Yes, I too had to laugh, although it’s no joke, when the author wrote:
… which, as I would have translated, is “the hospital tried to perpetrate a blatant billing fraud but gave in to the insurance carrier with whom they didn’t want to get into a legal battle against, but if you or I was an uninsured walk-in case paying rack rate, we’d have just had to jolly well pay up or risk the highly convoluted legal proceedings ourselves.”
This is a “normal” initial charge for ER visits in the US (more or less, since the amount varies by hospital and location). To illustrate, my mom has IBS, which means her stomach hurts sometimes. A couple of years ago, she called me and wanted to go to the ER, which we did. She had two ER visits for the same condition, same day. The bill was $17k, “adjusted” by Medicare down to $1k. If I had gone in with the same condition with my crap insurance, I’d expect the bill to be cut in half ($8500). If no insurance, the hospital would expect me to pay the entire $17k.
Conclusion: there’s nothing “real” about ER bills.
There has to be a reason for this mark-up. It can’t just be a Dutch auction for ER medical services – but it looks that way. It has to be a paperwork thing – both the hospital and the insurance company can record an initial billing of 17K. Then the ER/hospital can also have a huge loss of 16K. So why isn’t this fraud?
Can the 16k be considered a “loss” for tax purposes to set off profit for fee for services provided at full cost???
Because Hospitals in the US can be either for profit or not for profit.
Minor quibble, and maybe you know this already, but non-profit does not necessarily mean honest. Non-profits can avoid having “excessive” profits by paying their executives huge salaries and bonuses, paying inflated rent to investors, or hiring a for-profit “management” firm to do their office work. What charter schools commonly(?) do.
When will the UK see the light, sell the NHS to the USA, and allow its citizens to taste the benefits of medical insurance?
Unfortunately we’re, if not half way there, then maybe 10 to 20 percent the way there. While I use NHS dental and primary care, plus obviously would use ER provisions in an urgent situation, I’ve seen enough personally (and heard enough first-hand — I’m a trustee of a patient group for the likely-genetic eye disease I have) to know that, while it doesn’t routinely fail patients, it fails them enough that I should have a fall-back. It’s depressingly easy to fall down a bureaucratic rabbit hole caused by encroaching neoliberalism. I can probably get myself out of it, but sometimes it ends up being intractable.
I get insurance through my employer and access to a HMO. But if I had to pay “off the street” then costs are just as bad as the US (for the last time I didn’t rely on the NHS, a primary care appointment was £250-400 (the cost seemed randomly allocated), a specialist consultation £500, anesthetic (general) £800, surgeon fee £1,500, inpatient admission £2,000 per day. And so on, you get the picture.
That’s cheap for the US.
That caught my attention right away as well. Interesting how insurance companies can negotiate a 95% discount but individuals apparently cannot.
This same thing happened to me, only with a bat bite!
I was Googling whether it made sense to get the shot and talked it over with family. I really did not want any contact with a US emergency room. My mom tried to talk me out of getting the shot. Dr. Google convinced me that virtually the only rabies cases in the US today are from bat bites and the symptoms do not appear for months afterward followed by a horrific death. I thought seriously about getting on a plane for the Caribbean or Mexico to get the shots there. But I had gold-plated insurance that few Americans can get, so I decided to risk it.
In my state, only emergency rooms keep the post-exposire shots which are supposedly somehow different from the pre-exposure shots vets get.
I had excellent international insurance (I had just ended a job outside the US) which covered everything, even the ER doctor’s balance bill, but the coverage ended before the final of the follow-up shots and I had a gap in coverage before my US HMO started. The final shot cost over $1000 nearly all for the shot itself, the cost of administration was something like $50.
Btw, these are not the 20th century rabies shots. They are newer, less painful, but unfortunately patented. I would have preferred the physical pain.
Oh, and they actually turned me away from the emergency room when I went for shot no. 2. I had to seek out a different ER, more headache. Because you the patient are neither customer nor patient in a US emergency room, just an annoyance.
I hadn’t heard that the only risks in the US were from bat bites. I believe there are also rabid raccoons.
Bats are the most common cause of exposure, not necessarily the most common rabid animal. Normally one of two situations. #1 Bat is found flopping around in a bedroom or in the sheets. “Capable” adults are allowed to determine if they’ve been bitten, with seniors or children it’s assumed they’ve been bitten and shots are recommended. #2 Child finds bat at school. Shows it to a bunch of friends who all handle it. Teachers find out eventually, but can’t recover the bat for testing. All kids even potentially involved get the shots.
I spent a few years doing rabies surveillance in apparently healthy, free-flying bats. Depending on the species, it’s about 1% of them that are actively shedding virus in their saliva. The obviously sick bats kids pick up on playgrounds run about 50%. A bat’s teeth are so sharp and tiny it’s really hard to tell if you’ve been bitten. For us we’d turn our nitrile gloves inside out and check for traces of blood if we thought we were bit.
Besides bats, foxes, raccoons, and skunks are major reservoirs of the rabies virus in the U.S. In our “hot zones” USDA along with state agencies actively sample and test road killed animals and do aerial drops of vaccine baits.
Pretty much any mammal can get rabies and pass it along through a bite. Worldwide, something like 99% percent of all cases are from dog bites in countries that don’t have the resources to vaccinate pets.
2008-2017, all known transmissions of rabies to humans with a known cause within the United States were due to bat bites, except for two cases of raccoon bite. No domestic dog or cat bites. Personally, I would not have risked the emergency room bill for that, not to mention all the indignities of our healthcare system.
In other countries, it is more often stray dogs. Not because they can’t afford to vaccinate them but in hyper-unequal countries any kind of public spending is difficult to achieve.
If even the ER had to special order a dose, why couldn’t an in-network doctor’s office do the same? Ask one’s doc to order the vaccine. At this point my frustration with our scammy healthcare has boiled over, and I’ve taken to complaining to the insurer about price gouging and balance billing. On occasion that’s worked and bills “forgiven”. The person on the other end of the phone is also mired in this insane system, so it’s not working for them either.
Here’s hoping you are not one of the 3 known human rabies cases annually in the US.
But don’t blame the Greatest Health System on Earth®!
Because we simply can’t anticipate that any patients would appear anywhere but overpriced ER ‘s with bites from unknown cats.
And because we just can’t figure out the logistics of moving a dose from the suppliers, pharmacies or down the street from ER to urgent care or family doc. Fast-acting, potentially fatal bat-born infections lack sexy! Or profits! Markets!
Why o’ why we don’t have more pro-active self-reliant Health Consumers® doing their homework before getting cat bites, especially with the transparency of supply, pricing and Choices® at your disposal.
Clearly, the billion dollar hospital and pharma corps have no agency in the matter. Patient lack of Personal Responsibly® is the culprit.
Irresponsible, Entitled® Free-riding® over-utilization of unnecessary health-care is responsible for rising health costs. Why should all of us non-bitten Responsible Consumers® have to pay for your health problems? Huh?
Perhaps grandmas Rabies Poultice® will do the trick?
“the hospital bill came to $17,294.17. My insurance provider negotiated that bill down to $898 and paid it.”
That kindof says it all, doesn’t it?
Imagine this sort of thing happening in other fields. “Just bought a new Honda Civic last week – dealer price was $500,000 but I engaged the services of a professional buyer and they haggled them down to $26,000!
…maybe the cat is owned by the *health care* system???
WoW –
For any American visiting Denmark, they should perhaps consider to pop into one of the vaccine clinics operating here and get some shots – it is 820 DKK, about 130 USD, for Rabies.
Have to stay a week though, it’s two shots one week apart for best protection. But a weeks vacation will be much cheaper than the 26000 USD, even with nice hotels and restaurant food in Copenhagen every day!
Hospital charges in the USA are a cruel joke similar in an odd fashion to somebody ‘winning’ $26k worth of garbage they would have never bought themselves, on a game show, for which they are on the hook for, tax-wise.
Yeah, and you get hit with both State and Federal gaming taxes.
I believe that the game shows screen for ability topay potential taxes on winning and so, we never see too many “poor” people on those shows. That and classism of course.
“As for the cat, the police told me he was put under house arrest.”
Just last week the Indiana State Department of Health sent all physicians and veterinarians in the state a decision tree guideline for the management and treatment of animal bites and rabies risk assessment. It isn’t stated in the essay when the cat was caught and placed under “house arrest”, but after a cat bite the preferred course would have been to observe the cat for 10 days after the bite. If the cat remained healthy without symptoms of rabies, there would be no need for the human to receive rabies prophylaxis. If the cat were to become ill, it would be euthanized and its head sent to the Board of Health for testing for rabies. There may have been no need to continue with the treatments once the cat was found and quarantined for observation. If the cat had been found and quarantined within the first day or two, there would have been no need for any rabies prophylaxis at all, just tetanus booster and wound care.
We recently returned from an extended trip to our own beloved orange tabby dying in the laundry room. He passed within 10 minutes of us getting home, and managed to bite my wife as we tried to rush him to the vet. As we were gone for 4+ weeks, we could not rule out rabies (it was a perfect storm of doubt). So we, too, started in on this same journey.
Ours was a bit different though. My wife is on a Kaiser Platinum plan (thanks to my wife contracting an autoimmune disorder that runs $10-15k/month thanks to the flu shot required to get her Green Card, but that’s another story…). Anyway, we were advised to go to the ER which administered the immunoglobulin shot ($120-ish for the ER co-pay).
Each of the 2 subsequent shots were performed by her GP’s nurse in-office (she didn’t require the full course of shots as our cat was tested and cleared) and as the nurse administered it we had no co-pay.
Our total out of pocket was around $120 plus gas. We never saw the ER bill for services rendered so no idea how much of a discount the $120 co-pay represents.
This compares to another recent ER visit for me on a Kaiser Silver plan. Broken collar bone during an ice hockey game (dude got a 2+10). Ambulance ride was billed out at $2400, ER treatment was over $4000 and ER XRay was $2700.
Now… The ER XRay was done at 12:30am Saturday morning by a junior staffer (based on age and demeanor) with no assistants. The following Monday afternoon I received a second set of XRays ~300 ft away from the ER machine on the same campus for a $70 co-pay, staffed by a senior tech (again, based on age/demeanor) with 2 assistants.
All told, this episode will cost me out of pocket 4 * $70 (office XRays co-pays) + 6 * $40 (Ortho Dr co-pays) + $2200 (Annual Deductible for ER trip) + $250 (Ambulance co-pay). ER visit itself represents a 33% discount (based on deductible + co-pay versus billed amount) and I’m not 100% sure if the $2400 Ambulance ride will only cost me $250 yet (as the 4(!) bills I’ve received for it thus far do not agree on the amount).
My take away has been how totally screwed the billing systems are. I’m with Kaiser, and save the ambulance ride, everything was done on their campus with their services and doctors, and I’ve received nearly 10 billing statements over this single incident, half of which are conflicting bills for the ambulance ride. It seems no one knows how the billing system works!
“my wife contracting an autoimmune disorder that runs $10-15k/month thanks to the flu shot required to get her Green Card, but that’s another story…”
That’s a surprising and very interesting story. How do you know that’s what caused it?
It’s a diagnosis by exclusion (as the disease is not well understood thanks to so few patients; a recent 5 year span had 25 or so reported cases in Oz). Her neuro stated that the triggering event was likely the flu shot due to timing. Further, that was the first year Australia had 4 strains in their flu shot and there was a marked uptick in autoimmune disorders among flu shot recipients.
Guillain-Barre syndrome is the acute version while CIDP is the chronic presentation of the disease (and she has the chronic version which is more rare than GBS).
(Now retired but with nearly 20 years experience as an ED doc) I cannot imagine why your spouse needed even one Xray. And the cat’s vet should have contacted the state board of health and sent the head packed in dry ice to the state lab by FedEx to be examined for rabies. Your spouse would not have needed the rabies vaccination should your cat have been determined not to have rabies (as it probably did not).
Apologies for not making it clear; the Xray was for my collar bone break.
And yes, our poor boy’s head was removed and tested, but due to timing Kaiser decided to start the course. The test returned within 4 days (thanks to our county outsourcing their testing to a neighboring county) and it was indeed negative.
Hear hear on Kaiser Billing. Don’t send Bill’s and don’t post on website…then they send you to collections. Was on a payment plan. Collections charges 10%…of the original hospital bill…the p readjusted amount!
That is 10% annual interest.
The Medical Industrial Complex (coint by the doctor who wrote “Code Blue”) strikes again. Under Medicare Part B, the charge for ER probably carries a higher co payment and deductible compare to a hospital stay of less than 5 days.
BTW, I’ve heard several tell me that if you negotiate with the hospital they will reduce the bill.
My biggest peeve is that Health Departments do not administer vaccines, This is by design – collution with the MIC. We have to fight to change this. They’re supposed to do animal control and if you get bitten by an animal on the street it should be their responsibility to administer the shots.
My wife and I had to get rabies shots after an encounter with a bat. $22K EACH. We were both working, the insurance companies ended up arguing over the bill so we ended up paying $5K out of pocket. We have very good coverage, but if only one of us had been working, it would have all been all covered.
The current American health care system is designed to cost too much a month and encourage you to never use it. But when you do, it’s designed to suck all your money till you are dead. We need M4A NOW.
Scratches apparently can kill you but don’t make huge bills. When you get scratched by the cat it is a good idea to disinfect the scratch with hydrogen peroxide or alcohol immediately. That has been my practice.
In my novel my character is tortured by fear of the rabies shots in the stomach.
I ought have gone into the cost, but back years & decades things we’re different.
I want to thank all and especially Editor Webber, and author Caitlin Hillyard for a good read and warnings.
Maryland is to be emulated by other states.
Or betadyne (or equivalent – there are generics now), which doesn’t hurt and is more effective than peroxide. Peroxide is primarily a cleaner.
There are over the counter antibiotic ointments, too, strictly for external application. Might do that if the scratch is deep.
I wonder if it would make sense to disinfect Kitty’s claws once in a while?
You want so-called “Povidone Iodine” solution – not by way if a shopping recommendation but just by way of quick check, I see Amazon has 8-oz bottles for $4. It’s my stabdard got-o for cuts, scratches and scrapes, and has the nice property that once applied and left to dry, it an replace a band-aid for ares where it’s hard to get one to stick. You can apply it with a Q-tip, a latex-gloved figertip or even a washed-clean fingertip in a pinch, since the Iodine should kill any germs on same.
Regarding medical billing: A Time Magazine special a number of years ago described how standard billing costs for any given procedure are determined. I don’t recall the details except that the prices were basically set arbitrarily. (They may have used a dartboard. Kidding — I think.) These are the prices before negotiation with insurance companies, where they are ALWAYS drastically reduced. You can see this illustrated on any EOB from your insurance company. The “paid amount” relative to the “amount billed” is generally only a fraction, as opposed to some adjustment at the margins. The only people who have to pay the “billed amount” are — wait for it — those without insurance!
I had to get a rabies series ~50 years ago for an animal bite….old time vaccine…administered by the local health dept. Nothingburger. The “shots in your stomach” are subcutaneous, not IM, so are about as painful as an insulin shot; in other words, not. Paid a few dollars for the vaccine, nothing for administration. THIS is how it should be, since this is a public health problem, not an illness/trauma/whatever. It’s our insane healthcare system that has done this to us…
I met an Australian friend over the summer while on vacation in London, and he’d been in Myanmar just before. A few days before the trip, he wound up getting a pretty vicious rat bite. I think he paid nothing in Yangon and a total of $150-200 to the NHS for the full series of rabies shots. I couldn’t believe it.
I got the pre-exposure rabies vaccine in 1991. Since it was necessary for my job (geologist; caves, tunnels, sewers), I don’t think I paid anything. I got them at my regular clinic in the US, so I am not sure how that happened. They also had the stuff (it was tinted pink) in the clinic fridge.
That vaccine made me quite ill with flu like symptoms, but since the doctor warned me about that, we scheduled the first one on a Friday morning and took the day as sick time. Each shot after that made me less sick, But I still took the day as sick time. As nasty as the vaccine was, not having to worry about fatal, virus-loaded mammal bites while climbing around in caves and pipes was with the price.
If you’ve never seen a rabid animal, you really don’t want to. It’s not pretty.
Next time this is what you do. You fly to Mexico, Costa Rica, Honduras, etc. You get a hotel. You walk down the street to the pharmacy. You buy the vaccine. You enjoy the vacation.
This is a depressing story on so many levels. Sorry you had to go through it but thanks for sharing and yet another look at how the whole medical system combined with the insurance business just sadly doesn’t do what people really need for it to do.
When I lived in Germany with the military back in the 1990’s I had the contrasting experience of being with a friend had gotten a deep cut that needed stitches. It was late, we went to the military hospital (sort of like an urgent care place) but it was closed and someone told us we needed to go to the German hospital instead.
We took a cab. It was a completely different experience from what you just described. There was no waiting in the extremely modern German hospital emergency waiting room. After the doctor took care of my friend we wandered the halls looking for who we would need to pay. We were young, had never heard of socialized medicine and expected to have to pay a bill or at least fill out paperwork.
The bilingual medical professional we found explained that the stitches (and medicine) were paid for by tax dollars. There was no paperwork needed.
An entirely different experience from the one just described by your article. I’m certain that most people in the U.S. don’t even realize that any other way is possible. No need to re-invent the wheel here, plenty of other countries do healthcare much more effectively.
On a side note, I’m pretty sure that when a kitten is taken away from their mother too early (before natural weaning occurs) this turns them into a biter.
I received a bat bite about ten years ago and had to undergo the rabies vaccine treatment. Several injections of the rabies immunoglobulin into my right hand followed by the rabies vaccine itself which consisted of four injections over a period of about three weeks.
The County board of health didn’t give me a choice about receiving it. But since I live in Ontario, Canada it was fully covered by OHIP (Ontario Health Insurance Plan) so there was no charge to me. The vaccine, as I understand it, is almost 100% effective when given before symptoms appear. If the symptoms of rabies appear, the disease is almost 100% fatal.
When I read about a retired machinist in Bend, Oregon, who was bitten by his cat while trying to help free a stuck mouse or rat from its mouth, and contracted, wait for it…. Bubonic Plague!, I began looking at my rat-slaying cat differently. This man suffered two collapsed lungs and awoke from his coma to find they had amputated all his fingers and toes, save for a small part of his thumbs. Yikes!