August 22, 2019

Why a cat's bite led to $26,229.35 in medical bills

Daily Briefing

    Caitlin Hillyard was petting a cat in her neighborhood when the cat bit her wrist. Writing for Kaiser Health News, Hillyard details her experiences and difficulties seeking treatment for the cat bite, and how she racked up more than $26,000 in health care bills.

    Infographic: What patients want in billing and collections

    Searching for treatment

    Hillyard writes that she was petting an orange tabby cat in her neighborhood when the seemingly friendly feline bit her wrist. Hillyard did not know to whom the cat belonged, and therefore could not be sure whether the cat was infected with rabies.

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    Given the uncertainty, Hillyard went to a nearby urgent care clinic to seek treatment. Once there, a nurse gave Hillyard a form to fill out that the city uses to track animal bites.

    Typically, when an animal bites someone, the animal is quarantined for 10 days to see if it develops rabies symptoms, Hillyard writes. However, since Hillyard did not know the cat, she was told she'd need treatment for rabies. According to Hillyard, post-exposure preventive rabies treatment includes a one-time injection of human rabies immune globulin and four injections of the rabies vaccine over the following two weeks.

    The urgent care clinic could not administer the rabies treatment, and Hillyard writes that she considered not seeking further treatment. "The odds the cat that bit me was rabid were, I'd guess, almost zero," she writes, adding, "He was probably someone's pet and didn't appear to have any symptoms." However, Hillyard notes, "[R]abies 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."

    So, three days after Hillyard was bitten by the cat, she went to a nearby ED. Hillyard writes that she tried to find the most cost-effective option for seeking treatment, and discovered the ED was the only place that could administer human rabies immune globulin.

    Hillyard writes that she had hoped to go somewhere other than the ED to receive her follow-up vaccines but, after calling her insurance agents, she discovered that there were no in-network providers who had the rabies vaccine in stock.

    The staff at the ED told Hillyard that specialized travelers' clinics could administer the vaccine, but it's generally not covered by health insurance. But after speaking with the public health department in Fairfax County, Virginia, Hillyard learned that none of its clinics administer the vaccine, nor could two hospital urgent care clinics.

    As a result, Hillyard received the required doses of RabAvert in the ED, over three visits.

    A costly cat bite

    Hillyard writes that the price of her ED visits for RabAvert varied each time, with the ED billing her insurer a total of $2,810.96 for one visit, $2,692.86 for the second, and $2,084.36 for the third. According to Hillyard, each dose of RabAvert would have cost $350 if she had purchased it a pharmacy.

    Hillyard also received a 10-day supply of the antibiotic amoxicillin to prevent any potential infections. While she didn't develop an infection, Hillyard writes that she had to see her primary care doctor after developing a rash, likely from the antibiotic, which racked up more costs. According to Hillyard, her primary care visit cost $206, which was paid by her insurer.

    In addition, Hillyard writes that the hospital bill for her initial ED visit and immune globulin treatment totaled $17,294.17, though her insurance provider negotiated the bill down to $898 and paid it.

    In the end, Hillyard writes that her ED visits, medication, and urgent and primary care visits racked up a total of $26,229.35 in health care costs—all from one cat bite.

    What Hillyard learned

    Though Hillyard's insurer was able to negotiate some of those bills down and picked up the tab, she notes that the experience highlights how the United States' confusing health care system makes it too easy for a person who should get medical care to postpone it or avoid it."

    "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."

    As for the cat that bit her? "[T]he police told me he was put under house arrest," Hillyard writes (Hillyard, Kaiser Health News, 8/20).

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