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Monthly account: Treating rabies after a cat bite: Shots



Jeanne Parker, a animal-loving biologist, stopped to feed a homeless cat in a countryside outside the Everglades National Park in Florida. Instead of showing gratitude, the cat bit her.

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Janet Parker, a animal biologist, stopped to feed a homeless cat in a countryside outside the Everglades National Park in Florida. Instead of showing gratitude, the cat bit her.

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Compassion for the hungry cat led to a finger jerk – and also bite Jeanne Parker's purse.

In a rural area near the Everglades National Park in Florida, Parker noticed a cat wandering along the road. It looked thin, and when Parker, a biologist, offered food, the cat broke her finger.

"It broke my skin with my teeth," she recalls. the study began to worry about rabies, as the Miami-Dade County had a warning about the potentially deadly disease that was operating at that time.

She then went to his home in Florida Keys and called the Health Department, but she was closed.

So she went to the Emergency Department at Mariners Hospital, near her home. She spent about two hours in the emergency department, received two types of injections and an antibiotic and said she had never talked to a doctor.

"I went home happy as a molluscum," she said.

Then came the bills.

Patient: Jeanne Parker, 44-year-old biologist. Insured through the American Post Workers Union, because her husband works in the federal government in Everglades National Park.

Total account: $ 48512, out of $ 46,422 from this amount for one prophylactic drug

Service provider: The Mariners Hospital, part of the Baptist "South Florida", a nonprofit chain with eight hospitals and other institutions

Medical Service: Parker's skin was inspected and she received the first series of rabies shots, as well as another 12 mililiters of the immune globulin rabies, an antibody that triggers the immune system for Providing protection from the virus until the vaccine starts to work.

What gives: When you are potentially prone to fatal illness, you need treatment. At the moment, it's hard to get around or say no to high prices. Centers for Disease Control and Prevention estimate that prophylactic treatment after exposure to rabies, which includes immunoglobulin and four doses of the vaccine for two weeks, usually costs more than $ 3000 on average. According to the CDC, 40,000 to 50,000 people each year receive such treatments after exposure to potentially damaged animals. Each hospital can set its own treatment prices

In the case of Parker, most of the expenses were for a rabies immunoglobulin. Only for this new hospital, the hospital offered her and her insurer 46 462 dollars. This is much higher than what is considered typical.

"I have never heard anything so high for an immune globulin," said independent biomedical consultant Charles Rupprecht, a technical consultant at the World Health Organization for Rabies, who has been running a rabies program for CDC for over 20 years.

Parker thought that it seemed high after she requested and received a detailed bill from her insurer, and she agreed with him.

"I saw that an immunoglobulin was expensive, but it was not that is expensive," she said. "I was sitting there for a while because I was upset. Finally, I went to the hospital to confirm, and they said," Yes, that's right. "The immune globulin against rabies is a complex product made of blood plasma that The volunteers who were immunized against rabies donated three manufacturers of this product, and now there is no shortage, says the Food and Drug Administration. Currently, the average wholesale purchase price is the amount paid by the wholesalers, who then mark it when they are sell it to districts or hospitals – $ 361.26 per milliliter, according to Richard Evans, analyst of the industrial sector SSR Health, which is part of the investment boutiques firm SSR Ltd.

Using this average, the cost of the 12-milliliter dose received by Parker would be $ 4,335

Maybe the hospital miscalculated when billing, adding an extra zero?

No, – said the spokeswoman for Baptist Health Dore Roba Alvarez

. The $ 46422 charge reflects the hospital's price on September 22, 2018, when Parker was treated. Alvarez will not tell that speed, but simple mathematics shows that the hospital issued accounts of $ 7,737 per 2-milliliter dose, which is how immunoglobulin is often packed.

Alvarez also noticed that a month after Parker was treated, the Mariners changed their full list of prices, known as the "wizard." The hospital lowered the fee for the immune globulin rabies to $ 1,650 per 2 milliliters, which would make Parker's bill about $ 9,900 – still high but not high.

Hospitals periodically review their masters. It should be noted, however, that this 79% percentage came shortly before January, when the new rules required that all hospitals first publicly publish these previously hidden public meeting lists on websites, which is part of the interpretation of the Law on Affordable Medical Services. 19659008] "Claims for patients who received treatment before the change reflect the previous charge," Alvarez said.

She did not answer the following questions about the reasons for lower prices or above average prices before

Chargemaster prices, as a rule, is not that people with insurance payouts. One of the benefits of providing health insurance is that insurers agree to discounts for online services. Parker went to the hospital online.

But not every service has discounted bargains, said two billing experts in American health insurance plans, the trade lobby of the industry. And the discount from a very high charge remains a very large sum of money.

In the case of Parker, the health plan of her husband paid $ 34,618 for the total, including 33,423 single immunoglobulins.

Health Plan said that he had asked to check the bill to check it for accuracy. In a statement sent by e-mail, the plan said that there could not be much more. "With the exception of the discounts, the plan has little to do to challenge the hospital's charges. The charges are not raised to the level of fraud," the statement states.

Resolution: insurer payments, Parker had to pay $ 4191 per the final $ 344 of her franchise for the year plus her 10 percent share of the charges taken by her insurer.

"My funerals would be cheaper," she said.

Parker learned after he called his insurer that a cat's bite had to be considered as an accidental injury and thus has the right to 100% coverage under her insurance plan, net of residual value. She wants the hospital to re-submit the bill to the health plan to find out if she can take the rest of her share at 10% of the cost. The hospital did not offer to lower the price of the immunoglobulin to its current charge

Takeover: If you suspect that you were rabid, seek medical treatment. "It is advisable that she seek immediate and appropriate medical care," said Rupprecht.

Many health services can be obtained from local health departments. They range from vaccination to treatment after exposure to diseases such as rabies. If possible, contact your healthcare department to find out if treatment is offered.

But with a serious illness, like a tale, if these services are not immediately available, do not wait. Contact the hospital and make sure it is on the insurer's network if you have a choice. Moreover, now that hospital carers are publicly available on hospital websites, use them. They are long and complex. At least, they are not written in plain English. But many are in alphabetical order, and it is not difficult, for example, to find a record for "Rabies IG" (immunoglobulin versus rabies).

Check how the price you set matches with others in your area. (You can also check the average prices on sites such as HealthcareBluebook.com.) Share this information with your employer's human resources department or use it to discuss with your hospital and the insurer.

NPR has prepared and edited an interview with Kaiser Health News for broadcasting.

Kaiser Health News is a non-profit information service covering health issues. This editorially independent program of the Kaiser Foundation, which is not affiliated with Kaiser Permanente.


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