Tony Leys
In retrospect, Erica Kahn realizes she made two massive errors.
The first was selecting to briefly forgo medical health insurance when she was laid off from her job.
The second was screaming when a wild bat later landed on her face.
The weird encounter occurred final August, whereas the Massachusetts resident was photographing the evening sky throughout a trip on the Glen Canyon National Recreation Area in Arizona. Kahn, now 33, seen a number of bats flying round however didn’t fear about them — till one flew as much as her and obtained tangled between her digicam and her face.
She screamed, and a part of the bat went in her mouth. She doesn’t know which half or for the way lengthy, although she estimates it was only some seconds. “It seemed longer,” she stated.
The bat flew away, leaving Kahn shaken.
She didn’t suppose the animal had bitten her. Regardless, her father, who’s a doctor and was touring together with her, stated she ought to go to a hospital inside a day or so and start vaccinations towards rabies.
Figuring she could be coated so long as she obtained insurance coverage earlier than going to the hospital, Kahn stated, she discovered a coverage on-line the day after the bat incident. She stated she known as the corporate earlier than she purchased its coverage and was informed providers associated to an accident or “life-threatening” emergency could be coated.
Kahn went the following day to a hospital in Flagstaff, Arizona, the place she began rabies prevention therapy. Over the following two weeks, she obtained the remainder of the rabies pictures at clinics in Arizona and Massachusetts and at a hospital in Colorado.
Then the payments got here.
The Medical Procedure
Kahn obtained a complete of 4 doses of the rabies vaccine. The doses are administered over the course of 14 days. Along together with her first vaccination, she obtained three pictures of immunoglobulin, which boosts antibodies towards the virus.
Rabies is often transmitted via bites or scratches from an contaminated animal. Experts recommend precautionary measures when an individual has been doubtlessly uncovered to rabies, as a result of as soon as the neurological illness causes signs, it is fatal. The Centers for Disease Control and Prevention says postexposure rabies therapy has diminished the variety of human fatalities to fewer than 10 a 12 months within the U.S.
The Final Bill
According to explanation-of-benefits statements, Kahn owed a complete of $20,749 for her care on the 4 amenities. Most of the costs have been from the hospital the place she was first handled, Flagstaff Medical Center: $17,079, together with $15,242 for the rabies and immunoglobulin pictures.
The Billing Problem: Most Insurance Doesn’t Start Immediately
Kahn’s coverage didn’t pay for any of the providers. “The required waiting period for this service has not been met,” stated an explanation-of-benefits letter she obtained in December.
Kahn was shocked. “I thought it must have been a mistake,” she stated. “I guess I was naive.”
When Kahn was laid off from her job as a biomedical engineer final summer season, she had the choice to briefly keep on her former employer’s insurance coverage below a COBRA plan, at a price of about $650 a month. But as a younger, wholesome individual, she gambled that she may get by with out insurance coverage till she discovered one other job. She figured that if she wanted medical care, she may rapidly purchase a non-public coverage.
According to the Centers for Medicare & Medicaid Services, those that qualify for COBRA have to be given at least 60 days to enroll — and in the event that they do, the protection applies retroactively. Kahn, who was nonetheless inside that interval on the time of the incident, stated lately that she didn’t understand she had that possibility.
The coverage she bought after the bat episode, which value about $311 a month, was from a Florida firm known as Innovative Partners LP. Documents Kahn supplied to KFF Health News say the coverage has a 30-day ready interval, which “does not apply to benefits regarding an accident or loss of life.”
Kahn stated that after receiving discover that her claims have been denied, she known as the corporate to ask how she may enchantment and was informed a physician must file paperwork. She stated she wrote a letter that was signed by a physician at Flagstaff Medical Center and submitted it in March however was unable to achieve medical doctors on the different amenities.
Kahn stated she was given conflicting solutions about the place to ship the paperwork. She stated a consultant with the corporate lately informed her it had not obtained any appeals from her.
Benefits statements Kahn obtained in early July present Innovative Partners had not paid the claims. The firm didn’t reply to requests for remark for this text.
Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, stated most well being protection plans take impact on the primary day of the month after a buyer enrolls.
“The insurance companies — for good reason — don’t want people to wait to sign up for coverage until they are sick,” she stated, noting the premiums wholesome folks pay assist stability the prices of paying for well being care.
The Affordable Care Act requires insurers to cowl preexisting conditions, equivalent to diabetes or coronary heart points. But that doesn’t imply they need to pay for therapy of an damage sustained shortly earlier than an individual enrolls in protection, she stated.
Corlette, who reviewed a short advantages overview supplied by Kahn, stated the coverage seems to have been a restricted, “fixed indemnity” plan, which might pay solely set quantities towards remedies per day or different interval no matter complete bills incurred. Such plans have been round for many years and aren’t required to meet ACA requirements, she stated.
But she stated even when Kahn had purchased complete medical health insurance, it in all probability wouldn’t have coated therapy obtained so quickly after she bought it.
David Shlim, a journey drugs specialist in Wyoming who research rabies, stated Kahn made the suitable alternative by promptly in search of therapy, although she didn’t really feel the bat chunk her. The illness is lethal, and the truth that the bat went into her mouth meant she may have been contaminated from its saliva, he stated: “You could hardly have a more direct exposure than that.”
Shlim, who lately co-wrote a federal advisory about rabies prevention, added that wholesome bats don’t usually fly into folks, because the one on this case did. The animal’s entanglement with Kahn suggests it may have been sick, presumably with rabies, he stated.
Rabies prevention therapy is rather more costly within the United States than in most different international locations, Shlim stated. The priciest half is immunoglobulin, which is constituted of the blood plasma of people that have been vaccinated towards rabies.
The therapy is usually administered in hospital emergency rooms, which add their very own steep expenses, Shlim famous.
The Resolution
Kahn stated she is employed once more and has good medical health insurance however continues to be going through many of the payments from her misadventure at Glen Canyon. She stated she paid a physician invoice from Flagstaff Medical Center after negotiating it down from $706 to $420. She stated she’s additionally organized a $10-a-month plan to repay the $530 she owes for one among her rabies pictures at one other facility.
She stated she plans to proceed interesting the denials of fee for the remainder of the payments, which complete greater than $19,000.
In an announcement on behalf of the Flagstaff hospital — the place Kahn incurred the very best expenses — Lauren Silverstein, a spokesperson at Northern Arizona Healthcare, stated the well being system does what it might probably to restrict prices. “We have less ability to control the prices of critical supplies that we use to treat patients, including pharmaceuticals, biologics, diagnostics and medical devices made by other companies,” she stated.
Silverstein stated the hospital must hold immunoglobulin readily available to stop rabies, although such instances are comparatively uncommon and the drug is dear.
The Takeaway
COBRA insurance coverage insurance policies, named for the Consolidated Omnibus Budget Reconciliation Act of 1985, allow many individuals who lose job-based protection to pay to remain on these plans briefly. There is a 60-day window to decide on COBRA protection, and as soon as a beneficiary pays for it, the protection applies retroactively — that means that medical care is roofed even when it occurred when the individual was uninsured.
Corlette stated Kahn’s predicament illustrates why folks want to ensure they’ve medical health insurance.
She stated individuals who lose employer-based protection ought to think about enrolling in particular person insurance policy offered on federal or state marketplaces. Many individuals who purchase such insurance policies qualify for substantial ACA subsidies to assist pay premiums and different prices.
“If you are losing your job, COBRA is not your only option,” Corlette stated.
Kahn needs she had signed up for insurance coverage protection when she was laid off, although she felt assured she would discover one other job inside a number of months. “That’s a very big lesson I learned the hard way,” she stated.
Her wildlife encounter didn’t destroy her love of the outside. She even sees humor in it.
“I know what bats taste like now. It’s an earthy, sweet kind of flavor,” she joked. “It’s actually a pretty funny story — if it weren’t for the horrible medical bill that came with it.”
Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical payments. Since 2018, this collection has helped many sufferers and readers get their medical payments diminished, and it has been cited in statehouses, on the U.S. Capitol, and on the White House. Do you have got a complicated or outrageous medical invoice you wish to share? Tell us about it!
