I have argued before that health care has turned into a gold rush, where some medical providers price gouge without shame. The vast majority occurs in hospitals and especially in the emergency room. It has gotten worse in recent years. Kaiser Family Foundation (KFF) Health News reported in its news feature, Bill of the Month about a woman who had a close encounter with a bat while on vacation in Arizona.
While Erica Kahn was taking photos of the Arizona night sky a bat got tangled in her camera near her face. When she screamed it flew into her mouth briefly before exiting. Bats are more likely to carry rabies than other animals. Most of the people who die of rabies each year contracted it through a bat bite. Bats are susceptible to rabies because they can get it through contact with other animals, and the virus can remain dormant in bats for months. Ms. Kahn had no knowledge of being bitten but her father, a physician, thought the risk was too great not to be treated for rabies exposure. Once infected, rabies is always fatal.
Complicating matters was the fact that Kahn had been recently laid off from her biomedical engineering job. With her job loss, she also lost her health insurance. The following is from KFF Health News:
Kahn went the next day to a hospital in Flagstaff, Arizona, where she started rabies prevention treatment. Over the next two weeks, she received the rest of the rabies shots at clinics in Arizona and Massachusetts and at a hospital in Colorado.
Kahn received a total of four doses of the rabies vaccine. The doses are administered over the course of 14 days. Along with her first vaccination, she received three shots of immunoglobulin, which boosts antibodies against the virus.
Only about 10 people die annually from rabies. Post exposure rabies treatment is the reason. Patients thought to have been exposed to rabies are given the rabies vaccine and immunoglobulin within day of exposure. With the invention of the rabies vaccine in the 1950s doctors could treat post rabies exposure with a series of shots (14 to 21) as far back as 70 years ago. More modern post exposure rabies treatment dates back to the 1980s.
What do you think Ms. Kahn’s treatment cost? It was not cheap. Indeed, it appeared excessive. More from KFF Health News:
According to explanation-of-benefits statements, Kahn owed a total of $20,749 for her care at the four facilities. Most of the charges were from the hospital where she was first treated, Flagstaff Medical Center: $17,079, including $15,242 for the rabies and immunoglobulin shots.
Simple logic would suggest her four doses would cost similar amounts. That is not the case, however. Just over 82% of the charges ($17,079, including $15,242 for the rabies and immunoglobulin shots) were from Flagstaff Medical Center, which is part of a nonprofit health care system. Go figure. The other three locations where she received rabies vaccines and immunoglobulin shots charged a total of $3,670.
Treatment for post rabies exposure is relatively standard. It is hard to understand how the first place she went charged $15,242 for shots other providers charged around $1,200 for. It is hard to justify the tax breaks for a nonprofit institution that charges more than 10 times what others charged. Had Ms. Kahn had insurance, her health plan would have paid a fraction of that. A fraction of $20,749 is still far too high. Charging uninsured, unemployed patients several times more than health plans pay also seems unfair. One mistake she made was not going to an outpatient clinic and negotiating a cash fee for the service before receiving care. However, patients should not have to bargain for care like in a third world country. Neither should patients have to be on their guard to avoid getting ambushed by service providers.
It was not always this way. Around 60 years ago a family member was a four-year-old child exploring old buildings around my late grandparents’ farmstead when she was attacked by a rabid skunk. After daily shots in the abdomen for a couple of weeks she suffered no ill consequences. While growing up I heard versions of the story on many occasions. Not once did I hear any reference to price gouging or the cost being excessive.
Read the entire sordid story at KFF Health News: A Tourist Ended Up With a Wild Bat in Her Mouth — And Nearly $21,000 in Medical Bills
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