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.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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