r/HealthInsurance • u/MI-1040ES • Feb 17 '25
Claims/Providers Hospital refusing to send me an itemized bill after charging me $17,200 for a rabies vaccine
I've requested the itemized bill multiple times and each time, I just get redirected to a voicemail box
Any advice?
Edit: I keep getting comments asking why I'm getting multiple rabies shots. My first exposure was in 2018 when I was living in a house whose backyard was a bat sanctuary. My current house has bats living within the floors/ceilings/ walls
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u/HawaiianCalabrese Feb 17 '25
Go to the hospital and ask for it. But what is the purpose of this bill? Did they already bill your insurance?
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u/MI-1040ES Feb 17 '25
The purpose of the bill is to find out why I was charged more than $17,200 for one single shot.
I've gotten rabies vaccines in the past and they didn't cost anywhere near this much money.
They haven't billed my insurance yet, and it's been about a month so I'm not entirely sure what the hold up is
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Feb 17 '25
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u/jhakens Feb 17 '25
If OP was previously vaccinated for rabies (in the last 40 years or so), they would not need immunoglobulin though. That's in Florida, is it different in your area?
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u/Disastrous_Teach_370 Feb 18 '25
What you said is per CDC guidelines and correct. Any rabies exposure to vaccinated individuals needs only one booster shot and no immunoglobin. In fact, it is dangerous to get the immunoglobin shot if you were vaxed and exposed to rabies because immunoglobin messes up the vax response. I found out the hard way because my local ER knew nothing of rabies with previously vaxed folks like myself. Thankfully, the bat I was exposed to came back negative and my insuranced covered the ER bill (around $60k). Going forward, I will keep the CDC guidelines with me for any Rabies ER visit and recommend others do the same.
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Feb 18 '25
You are absolutely correct, & I’m sorry you had to experience that( very anxiety inducing!) Vaccinated individuals get a booster- nothing else.
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Feb 17 '25
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u/jhakens Feb 17 '25
Wow, that's a terrible assessment by the PA that saw you, especially since history would obviously steer treatment. Hopefully, OP gets it sorted out and their ER did a thorough history.
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u/AdvertisingOld8332 Feb 18 '25 edited Feb 18 '25
Not every PA or NP is good. As an RN, I dont see mid levels . It's just so cumbersome to have to go back and fix errors. I never really get sick but I had a cold last spring. Lost 8 pounds in one week so I went in. I gave the NP and RN a list of my meds. When I read my chart the NP had pulled my meds from 10 years ago after a work accident and signed off that she verified them with me. This is fraud.
The fact that they double vaxed you is a medical error and they can be held accountable.
They should have asked for your history
The nurse should have asked about your medical hsitory too and documented. it.
Did you divulge it to the ER nurse? I would call the hospital administer and issue a complaint and tell them that you were double vaxed.
I am sure it will go to risk management (hospital attorneys_
If you talk about litigating the issue , they willl likely right off the bill/
I would definately go to my PCP and have them runt tests if needed about being double vaxed. I would get it documente.d
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u/vwscienceandart Feb 18 '25
You are absolutely correct, and also, the hospital staff can still either fuck up by not reading patient history, OR, upon not having hard documentation of history, may refuse to take a chance on a patient lying or being incorrect.
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Feb 17 '25
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Feb 18 '25
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u/Intelligent-Owl-5236 Feb 18 '25
At that point, you get the regular vaccine and stay covered. You don't go to the ER going "oh shit, I might have rabies!"
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u/ChewieBearStare Feb 17 '25
Rabies shots are expensive. It’s rare for people to need them, so most facilities don’t keep it on hand, and it costs a lot to produce them.
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u/DogsOnMyCouches Feb 17 '25
Tons of people need rabies vaccines. It’s rare to need the after exposure treatment. Which did OP need? Which was given?
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u/SnooChickens9974 Feb 17 '25
The after exposure treatment IS the vaccine.
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u/DogsOnMyCouches Feb 18 '25
No. Pre exposure, like for vets, is the vaccine and boosters. Post exposure is immunoglobulin, the vaccine, and even more boosters. Neither is just one. And if a vet gets exposed, they often need more boosters, too, but probably not the immunoglobulin.
Just rye one shot isn’t the protocol for anything, that I can find.
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Feb 18 '25
pre-exposure rabies vaccines for humans exist, they just aren't usually recommended to people who aren't employed in jobs that involve being frequently bitten by wild animals. most people only get vaccinated after exposure, but that's a different vaccine.
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Feb 17 '25
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u/CaptBlackfoot Feb 17 '25
Well this article explains how they can cost $10,000.
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Feb 17 '25 edited Feb 17 '25
[deleted]
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u/eileen404 Feb 17 '25
So it's cheaper to take a month vacation in the UK and pay out of pocket?
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u/flossiedaisy424 Feb 17 '25
I mean, if you’ve just been exposed to rabies, it’s probably not a great idea to get on a transatlantic flight.
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u/Better_Weekend5318 Feb 17 '25
You need treatment within a certain number of hours of exposure. I forget how long, but getting on a transatlantic flight is probably a bad idea.
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u/Comfortable_Two6272 Feb 18 '25
Its actually days vs hours but I still would not fly to UK and hope to get it.
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u/anonymowses Feb 17 '25
In the US, pharmacies say, "What is a life worth?" for a lifesaving medication and price it accordingly.
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u/StevenBrenn Feb 17 '25
i got my rabies shot for free in Brazil. I’m pretty sure it’s cheap hell to make. It’s not even uncommon at all, anyone bitten by a strange dog needs to get one
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u/Accurate_Weather_211 Feb 17 '25
Rare. Don’t keep it on hand, expensive to produce.
$400 -$1200 for a rabies shot.
It depends on where you live. I live in Florida, according to the Florida Department of Health, the initial rabies shot for humans that contains the immunoglobin is guaranteed to be delivered to the hospital in need within 24 hours of ordering it. If it's kept on hand, why would they need a 24-hour turnaround time. Also from their site: "In the United States, postexposure prophylaxis consists of a regimen of one dose of immune globulin and five doses of rabies vaccine over a 28-day period. Rabies immune globulin and the first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure. Additional doses or rabies vaccine should be given on days 3, 7, 14, and 28 after the first vaccination."
https://www.floridahealth.gov/diseases-and-conditions/rabies/_documents/rabiesguide2014-web.pdf
https://www.miamicountyhealth.net/pdf/rabies-monitoring/1268b5_285c2ae7ebc6496db805bf908cae9ffd.pdf
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u/Intelligent-Owl-5236 Feb 18 '25
We kept it on hand, but I wasn't expecting the day I had to vaccinate 8 people for the same exposure. Had to courier in extra doses. Same with anti-venom, we have it in the ER, but it's so expensive and such a pain that we only have enough for a couple of people at a time.
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u/saucisse Feb 17 '25
That's about how much it costs. There is no economy of scale for rabies vaccine manufacturing, and it doesn't last a long time in storage so they make very small amounts and can only keep it for so long before they have to chuck it. I've had to get one once and the retail cost was $10K, for the immunoglobulin and all doses and this was a decade ago before the entire global supply line was interrupted in 2020.
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u/the1whoshrooms Feb 17 '25
Wah wah wah “economies of scale”. It’s a curable disease with a near 100% untreated fatality rate. Dont shill for the billionaires
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u/EdenSilver113 Feb 17 '25
Unclear and you’re getting downvoted when recommending folks stop defending oligarchs. They’re the reason insulin is $1000/month. They got the recipe for insulin FREE.
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u/Actual-Government96 Feb 17 '25
I don't see anyone defending oligarchs. The commenters are merely stating that the price OP is being charged is within the realm of "normal" for a fast-acting rabies vaccine in the US. I don't think you will find many people who think US drug pricing is fair.
The downvotes are in response to people that lash out and insult those just trying to provide some clarity.
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u/VelvetElvis Feb 18 '25
You can get the OG insulin for dirt cheap. It doesn't work well for most diabetics. Synthetic insulins are vastly superior and cost a fortune. They aren't interchangeable.
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u/dooooom-scrollerz Feb 17 '25
The fact your getting downvoted shows the billionaires corporate bots / shills are in full force on reddit.
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u/The_Derpy_Walrus Feb 17 '25
Trump is the guy who signed the No Surprises Act into law, you know, the only protections people have at the ER.
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u/EdenSilver113 Feb 18 '25
Trump is a billionaire who doesn’t care about us.
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u/The_Derpy_Walrus Feb 18 '25
He is one of the few who does care about Americans. The other side detests the people and is in the pocket of insurance and medical companies.
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u/EdenSilver113 Feb 18 '25
If you think Trump cares about us you’re in for a rude awakening. He literally does not even know you exist.
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u/Aicethegamer Feb 17 '25
Literally lmao. And now the new administration is now making it harder for healthcare lmao
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u/ClaireHux Feb 17 '25
It can also take a while for your claim to process and an EOB generated.
What is your line of work/activity where you readily need rabies vaccines and/or exposure to rabies-infected animals?
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u/kilgore_cod Feb 17 '25
Why do you need so many rabies vaccinations? Just curious because it seems pretty rare to need them at all. Do you work with bats or other wild mammals that are frequent carriers?
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u/MI-1040ES Feb 17 '25
My backyard in 2018 was a designated bat sanctuary, and a bat ended up flying into the house one night
My current house just has a shit ton of bats around for some reason lol a family has also started living within the ceiling and floors of the building. I hear them flapping about and chittering in the middle of the night once every couple of nights
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u/Adventurous-Act926 Feb 18 '25 edited Feb 18 '25
2018, you probably needed a complete post-exposure prophylaxis. But unless you found one in your room while or after sleeping in it, you shouldn't have needed one this time. If they are in the walls or floors/ceilings only, then you've not been "exposed." There is no chance of being bitten. But definitely, yes, if you were sleeping and found a bat (or handling bats), 100% need the booster vaccination. Not that it matter since its a little late now, but for next time. You seem to be attacted to bats 😉😂
Edit: I nevermind, I read farther haha. I'll leave this here for anyone else trying to decide if they should have bats in their house.
Also, it's way cheaper to save the bat (put it in something while live, but don't directly touch it) and send it in for rabies testing. If you contact your health department, they may cover the cost of rabies testing for you. Although a vet can also send it in for around a couple hundred bucks if it doesn't get covered, which is still cheaper than post-exposure prophylaxis if you don't need it.
If it's dead already, do NOT freeze it. Put the whole bat in the fridge and get it in to do testing the next day, or asap. Freezing will destroy the sample.
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u/kilgore_cod Feb 17 '25
That’s really cool! Not so neat about the bats in your house (abjectly terrifying) but bat sanctuary yard is awesome!
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u/MI-1040ES Feb 17 '25
Yeah! I got lucky in that the house was part of a housing coop, so I was able to get the coop to pay for the rabies treatment back in 2018.
I'm friends with the executive director so I asked her if she remembered how much the treatment cost, and she said that she didn't remember but that it was nowhere near 17k
I'd be surprised if it was more than a couple thousand dollars tbh
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u/AndroidColonel Feb 17 '25
I've gotten rabies vaccines in the past
What are you doing that has required multiple rabies shots over your lifetime?
I do stupid shit daily on a semi-professional basis, and I've only thought I was about to need one twice.
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u/MI-1040ES Feb 17 '25
I answered this in another comment, but the first time was because my backyard was a bat sanctuary and a bat ended up flying into the house one night
The most recent time was a bat who lives within the walls / ceiling/ floors of my current house found its way into my bedroom while I was asleep
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u/GreenStrong Feb 17 '25
Did you get the rabies vaccine, or the vaccine plus the immunoglobulin? Standard procedure in the United States is both, for the first treatment. The vaccine causes your body to make antibodies, but that takes time, and the virus is spreading, so they start with antibodies extracted from vaccinated horses. This is incredibly expensive and raises the odds of saving the patient’s life from well over 90% to nearly certain.
Keeping horses free from unnecessary exposure to possibly dangerous viruses is expensive, but the serum is used too rarely to warrant development of a biotech source of antibody. It is a weird artisanal process with few other applications beyond antivenin for snakebite, which is also incredibly expensive. But snakebite is common enough that a biotech antivenin is under development for snakes found in the tropics.
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u/DependentMoment4444 Feb 17 '25
Your insurance has been sent the bill. You need to go to the Finance office of the hospital and have them explain to you how the bill is itemized for a rabies treatment. They are to be transparent by directive by the President Donald J Trump in his first term. Good luck and stick to your guns. They have to explain the bill.
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u/DatabaseSolid Feb 17 '25
A rabies vaccine is different from the rabies shot you get after contact with the rabies virus. Did you get the expensive shot after being bitten by a rabid animal?
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u/CutDear5970 Feb 17 '25
How many times have you had to get the vaccine? I e dealt with it twice, once with my husband and once with my daughter. It is NOT just one shot. It is a series and you would have also been given an antibiotic and a tetanus if you were not up to date.
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u/rationalomega Feb 18 '25
My first rabies vaccine which is actually 2 was $11K in 2013 in seattle. With inflation, $17K isn’t crazy.
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u/nanoatzin Feb 18 '25
It isn’t just one shot
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u/MI-1040ES Feb 18 '25
This one shot I got was 17k.
I didn't count the other shots here.
My guy it's not that hard to follow lmao
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u/OrangeDimatap Feb 18 '25
That is, unfortunately, within normal ranges for a rabies vaccine series.
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u/OverallComplexities Feb 18 '25
The basic shot is cheap-ish... like $1800 I think.
If you got immunoglobulin... that's costly
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u/AdvertisingOld8332 Feb 18 '25
As an eR nurse this sounds outrageous. There is definately a reason why the wont send it. They are prob overbilling. There can also be human error in a hospital bill. There is no reason to refuse to give you the hospital itemized bill. Tell them you are not paying, disputing the bill and if necessary will involbe an attorney. Sh
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u/Solid-Feature-7678 Feb 17 '25
Hospital bills often have errors that can add up to thousands of dollars.
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u/Low_Mud_3691 Feb 17 '25
Are they charging your insurance $17,200 or is that the stated patient financial responsibility on your EOB?
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u/MI-1040ES Feb 17 '25
My insurance hasn't gotten the bill, but I would reckon it's the former since the latter would mean that my insurance isn't covering any of it
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u/Alternative-Sweet-25 Feb 17 '25
If they haven’t billed your insurance yet how do you have a bill charging you for anything?
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u/epiphanette Feb 17 '25
The hospital group we get our care through loves sending out bills immediately, before submitting to insurance. I know enough to throw them out and wait until Blue Cross has finished with them but I'm sure some percentage of people don't understand and just pay the bill up front and are getting ripped off.
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u/Low_Mud_3691 Feb 17 '25
The amount they charge your insurance is irrelevant to the price you pay negotiated by your insurance company. If your insurance company hasn't received the bill, they might not even be able to give you an itemized bill due to a variety of reasons. The itemized list of CPT/ICD 10 codes are just going to be the vaccine CPT code and the administration code. Rabies is expensive.
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u/Art_Music306 Feb 17 '25
The amount you pay your insurance is very likely based on a percentage of the overall total AKA a "co-pay". It is very much related to how much you pay. Anyone claiming otherwise is being misleading.
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u/lrkt88 Feb 18 '25
You don’t understand the billing process. It’s not misleading at all.
Firstly, if your copay is $50, you’re going to pay $50 for the service regardless of how much is charged or what insurance pays.
You’re thinking of coinsurance. This is when you’ll have 10% or 20% responsibility of the allowable charges. But the keyword in that is allowable charges, not total charges. A healthcare provider can charge whatever their heart desires for a service. Insurance will look up the codes and tell them what they’re allowed to charge based on their contractual agreement. The coinsurance is based on the allowable.
The only situation where total charges matter to someone with insurance is if a) the hospital is out of network and not bound by insurance contracted rates or b) the existing insurance agreement is based on percent of charges, which is basically non existent because providers would just charge crazy rates to get their percentage. It’s hardly misleading to not consider these two scenarios in the vast majority of cases.
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u/Art_Music306 Feb 18 '25
I'm sure you're right. People need degrees in "medical billing". I can't think of any other industry with such specialization in billing alone.
Ten years ago my BCBS had a $50 copay for ER visits, then a year later it was $75. Three or so years after that, my part of the 17k ER bill was $1700. If it were this year it would be $3400. I'm not sure understanding helps very much.
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u/BagOnuts Feb 18 '25
That’s not what a co-pay is.
Why are so many people adamant to give advice on here without knowing what they are talking about?
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u/MI-1040ES Feb 17 '25
I'll contact my insurance company again
I've also looked it up and the rabies shot I got costs between $3k-$10k depending on the patient's weight. I'm not entirely sure how my 143 lbs ass would justify an additional $7,200 over that $10,000 upper range
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u/Johnnyg150 Feb 17 '25
You're overthinking this. Your insurance company has a prenegotiated price for rabies shots, and your cost-sharing will be calculated based on that. The hospital can claim it's $500,000 for all they care.
Ask the hospital if they received the response from your insurance company about your liability. If they haven't, don't pay a dime.
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u/Low_Mud_3691 Feb 17 '25
Again, what they bill the insurance company doesn't matter. They could bill a million dollars but you'd only be responsible for a predetermined rate by your insurance company. But as you saw, these vaccines are expensive. What's your deductible and out of pocket?
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u/ElleGee5152 Feb 17 '25
There is both a facility and a physician charge when you go to the ER. That $17K is probably not just for the vaccine. The facility charges are billed by the hospital and the physician charge usually comes from a separate ER physician group who works with that hospital.
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u/Ranra100374 Feb 17 '25 edited Feb 17 '25
You're getting downvoted because as stated the hospital could charge a million dollars but it doesn't matter, it matters what their negotiated rate with insurance is.
Like dialysis charges something like $30,000 per month but insurance pays more like $3000/month.
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u/VelvetElvis Feb 18 '25 edited Feb 18 '25
Based on my experience, here's how this is going to go:
After you get medical care, the hospital bills your insurance for an arbitrary amount. Insurance says "we have previously negotiated that we only owe you x for this." The hospital says, "cool, pay us x." Insurance then says, "naw, we'll give you $2.50."
You are then sent a letter that they hope will scare you into paying out of pocket. You say "lol, no." The hospital and insurance will then spend the next year and a half haggling. Finally, insurance pays the hospital a random amount. The hospital writes off some of what they couldn't get get from insurance and sends you a bill for the rest. You'll pay something like $147.62. A month later, you'll get a check in the mail for $2 you were overcharged.
It's completely absurd. Just roll with it and let the process play itself out.
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u/OriginalOmbre Feb 17 '25
We spent 39,000 on ours before insurance.
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u/Low_Mud_3691 Feb 17 '25
Why would you pay anything before insurance covers it?
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u/OriginalOmbre Feb 17 '25
It’s literally in response to OP. If you read their comments, their price is before insurance. I was just saying how much ours was. After insurance, is what we paid.
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u/Low_Mud_3691 Feb 17 '25
So you literally didn't literally pay $39,000. They charged your health insurance company $39,000 which doesn't matter because they could bill your insurance company a million dollars and it wouldn't change what you literally owe.
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u/OriginalOmbre Feb 17 '25
Did you even read OP comments. Theirs hasn’t been sent to insurance yet either. It’s literally the exact same thing.
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u/Worth_Criticism_7594 Feb 17 '25
If you have ER sponsored health coverage see if they have an advocate to help you. Take it to HR. They can direct you.
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u/Spirited_Meringue_80 Feb 17 '25
When did you get the shot and did you go through the Emergency Department?
If it’s recent and you don’t have an EOB from your insurance company then your bill doesn’t really mean anything at all. It could say a million and it wouldn’t really matter. Your insurance company has preset rates they agreed upon with the hospital for every single possible thing from administering a Tylenol to open heart surgery and ultimately that agreement dictates the rates your insurance company will pay based on. You’ll only know your responsibility once your insurance has processed your claim, which will still be based off the price the insurance company and hospital agreed to.
If you went in the ER the bill also wont just be for the vaccine itself. That’ll will be one of the charges (and arguably an expensive one) but you’ll also have essentially a facility fee, exam fee and a bunch of other things that you’re being charged for. I’m assuming this was post exposure? Post exposure shots are far more expensive than the rabies vaccine as well and you typically need a few of them if you’re getting treatment post exposure.
Ultimately you’ll need to wait until you have the EOB in hand before you’ll know much.
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u/StevenBrenn Feb 17 '25 edited Feb 17 '25
Don’t pay until you get it.
I got my rabies shot in a country with universal healthcare. Just went to the Health station and waited 15 minutes in line. No payment required.
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u/CrankyCrabbyCrunchy Feb 17 '25
$17K isn't your cost, it's what the hospital/provider chose to bill your insurance. This is a very common practice. Wait until they bill your insurance to see what your actual price is.
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u/katie_cat22 Feb 18 '25
When I worked insurance follow up at a facility in New York, the rabies immunoglobulin injection given through the ER was about what you were describing. Between 15 and 28K. Almost every insurance carrier would deny it for medical necessity we would send records they would come back and pay it at a pre-negotiated rate. I don’t know why they wouldn’t give you an itemized bill, but I’m going to tell you that it will show the shot and the amount charged and that’s it. It’s not going to offer some amazing insight. Let the appeals process play out. They should be initiating it for you or if you have a group sponsored health plan through your employer you probably have patient appeal options as well.
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u/MayhemAbounds Feb 18 '25
I wouldn’t go looking for these before they submit to insurance. Twice I’ve had large bills thrown completely out because the hospital didn’t send to insurance within the allowed timeframe. Plus what they send you won’t be you actual costs until they go through insurance for the allowed and negotiated rates which are vastly different from what you would see before that happens.
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u/paintitblack37 Feb 17 '25
So I don’t know if this is true but I saw on a post a while back someone had commented to reach out to your area’s public health and they might help with some of those costs. I don’t know if it’s true but it’s worth a shot.
Edit: the post was specifically talking about rabies vaccines
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u/ok_final_attempt_two Feb 18 '25
“…worth a shot” 🤭 I meeeean raise your hand if you think it would be cool for this to equate to exactly one shot 🙋♂️
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u/MI-1040ES Feb 17 '25
I'll reach out to the county and see if I can be partially reimbursed, thanks !
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u/carolineecouture Feb 17 '25
The hospital should have a patient advocate office that might be able to help. If that is where you are being directed to and no one responds to your voice mail start going up the chain to hospital administration.
Good luck.
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u/apap52287 Feb 17 '25
17k likely includes the vaccine as well as the work up, any tests performed etc. Regardless, I’m not surprised it cost that much.
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u/101chipmunks Feb 18 '25
Excuse me, what? 17 thousand dollars for a rabies vaccine doesn't surprise you? You really have gotten used to the system screwing you.
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u/Comfortable_Two6272 Feb 18 '25
Welcome to the US. My ER rabies immunogloben plus 1st rabies vaccine dose was $48k 6 years ago. Thankfully my insurance paid all but $100. People without insurance get really screwed - lots of us news articles on rabies costs.
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u/3Secondchances Feb 18 '25
I got a rabies vaccine in the UK & it was free. If these costs don’t surprise you, you’re always going to be stuck with a healthcare system that will gouge you every opportunity they get.
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u/jeffreyan12 Feb 17 '25
well at least is was not what they charged here. https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-couple-northbay-healthcare-vacavalley/12788545/ over 200k for them. what is wrong with this timeline.
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u/CutDear5970 Feb 17 '25
Having had to deal with the rabies vaccine twice, you definitely need an itemized bill. It will show an antibiotic and several,other precautionary things as well as wound care and all the nurses and doctors who treated you. The vaccine is not cheap. You also need to have several more shots over the course of 2 months
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u/Fluffydoggie Feb 17 '25
Are you paying this yourself or covered by your insurance? I see claims daily and most of the rabies claims are submitted to either county or state dept of health to be paid. You can ask in your area if one of those dept of health will cover your bills for the treatment.
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u/MI-1040ES Feb 17 '25
I've called the county's health department and haven't had any luck there. Will try the state next, ty
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u/spookyscaryscouticus Feb 18 '25
Whatever you do, after you finish, you should probably also apologize to whatever you passed off that resulted in it cursing you with a multi-year bat plague
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u/notPabst404 Feb 18 '25
The US: where they have such a disdain for your that rabbies is preferable to medical treatment...
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u/KismaiAesthetics Feb 17 '25
The how is simple.
Most hospitals mark up pharmaceuticals and biologics 3-4x over their cost.
Fortunately, the majority of drugs administered in hospitals are generics. Granted, many are sterile injectables, so they’re $$-$$$/dose instead of pennies for oral forms, but 4x $$ is still usually low $$$.
Where the suck starts is branded chemo drugs. But generally you hit your out of pocket max in the process of finding out you need a branded chemo drug, one CT scan and lab test and consult at a time.
But speciality vaccines and biologics are like getting hit by a train.
I got stung by a bark scorpion, and it was insanely painful - worse than a car crash, fractured ribs or lung cancer surgery. Mind-clearing searing pain. There has been an antivenin for almost a hundred years. Made the same way all along. The intersection of a state budget controlled by an ignorant governor and how unapproved biologics can be sold meant that the US supply of scorpion antivenin dried up overnight.
A foreign biologics company had learned the process from the innovator state agency and has made it for years. It’s not cheap exactly - for someone my size it’s about USD$300 per dose. Typically one dose does the job but some envenomations merit up to four. But they have a social health system that buys most of it so nobody goes broke.
A pharmaceutical company in the US saw the need, but since the serum was a legacy drug that hadn’t had formal approvals, they needed a clinical trial. So they bought product from the foreign manufacturer and put it through a relatively small trial in the US. The trial didn’t uncover any new safety signals (most common issue is allergic reaction to the horse proteins in the serum, managed with Benadryl and Tagamet and steroids). They got FDA approval.
And now they sell it to the hospitals for $12000 for my dose. And the hospitals apply their linear markup. So we’re at $36,000. Also, it now requires that you be in the ICU for monitoring so there’s another $24,000. And that assumes one dose cuts the mustard.
So I suspect that rabies IG is $5500ish wholesale. And that’s how you get to $17000 in a single vial.
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u/MI-1040ES Feb 17 '25
I actually looked up the wholesale manufacturing cost of the rabies vaccine in Texas (only Texas and California have them as public information for some reason) and it costs between $650 to $2,300ish per vial 😖
Sorry to hear about your scorpion sting 😳 that sounds horrible
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u/KismaiAesthetics Feb 17 '25
I should have added: if they have frequent problems with the rare biologics expiring before administration, they’ll often mark them up even more to cover that.
I’d be curious which one of the IGs they used. The price data for the three licensed ones is all over the place and it takes a lot of product. One vial contains between 300 and 1500 IU, and dosing is 20IU/kg. A clever hospital system could easily have a per-IU price that accounts for vial expiration and wastage and make a buck by setting their prices using the more expensive agents in smaller vials and actually selling one of the cheaper agents from larger vials. Peds cases break even and adult cases would be a windfall.
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u/skydreamer303 Feb 17 '25
Dude all these people trying to normalize a 17k shot are fucking insane. I hope you get it worked out op
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u/JessterJo Feb 17 '25
Pharmaceutical and manufacturers can charge anything they want, and the hospital has to pay it because they can't just not have necessary supplies. They can't look for a better price either because they're locked into contracts that restrict who they can buy from. It IS fucking insane.
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Feb 17 '25
[removed] — view removed comment
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u/skydreamer303 Feb 17 '25
If you need this shot, youre a vet, vet tech, or animal control officer who likely got bit by an animal. But i do low key love you blaming it on the person. its not as if people are out in droves hunting for rabid bats to be bit by. Like get your head out of your ass.
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u/magicienne451 Feb 17 '25
Lots of idiots try to handle wild/feral animals and get bit. Of course, sometimes it’s people just doing their job. Accidents happen.
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u/Illustrious-Way4125 Feb 17 '25
If your insurance is not covering it, you should at least ask for a self-pay discount. Typically they offer 30-60% off.
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u/Justachattinaway Feb 17 '25
Request in person. Request in writing. Find out the right person to send it to at the hospital.
Send by certified mail. Multiple times. Keep copies of certified mail receipts/delivery confirmations.
Sue if necessary.
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u/Entire_Dog_5874 Feb 17 '25
You have every right to an itemized bill and they have no right to refuse you. If they continue to do so, contact whichever entity oversees hospitals in your state and file a complaint and submit a copy to the hospital.
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u/Ordinary-Concern3248 Feb 17 '25
I’m just curious why you have had to get multiple rabies vaccines. Whatcha doing?
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u/Fin-Tech Feb 17 '25 edited Apr 06 '25
plucky reminiscent nine history scale seemly crush shocking straight imminent
This post was mass deleted and anonymized with Redact
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u/Yummylicorice Feb 18 '25
My run in with a sick bat cost my insurance 29.7k. That was immunoglobulin and vaccines
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u/donttakemymedadvice Feb 18 '25
I work at a hospital but I don't work at your hospital. Post your location to get better advice. You will be transferred customer service/billing number if you call. You need to go to the hospital where you received treatment. The ER will not help you because they are too busy for billing questions. You need to go to patient registration or front desk staff, they will be able to produce a statement for you. I think you could even go to Medical Records and request your discharge paperwork from your ER visit that will contain everything that happened to you. Your hospital should also have patient advocates and financial advisors, ask to be put in contact with them.
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u/faseguernon Feb 18 '25
They may be waiting to send you the statement until they hear from your insurance company what they are going to pay. You could as for a copy of your medical records and specifically request a copy of the itemized billing statement.
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u/Comfortable_Two6272 Feb 18 '25
Fwiw my hospital charges nearly $48k for the rabies immunoglobeen and vaccine. Its crazy!
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u/q_thulu Feb 18 '25
Your lucky they only charged you 17k. Ive seen some on the news charged more than 100k.
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u/Art_Music306 Feb 17 '25
I have a family member who has spent decades as an attorney focusing on medical and insurance issues. Their advice is to keep asking questions.
You can't really be denied an itemized bill- and you may need to ask for it in writing. I had a similar 17k bill for an in and out ER visit, and I eventually discovered a duplicate 5k charge that I had to ask to be removed. Since many of us pay a percentage of the total bill as copay, this was a $500 savings for me personally.
Was it intentional or a $5,000 mistake? Hard to say, but you can definitely get an itemized bill, and ask for it to be accounted for. It just takes more time in phone calls and emails than might be worthwhile, which is not an accident.
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u/MrPBH Feb 17 '25
Any one reading this, this is a good example of why it pays to get the vaccine at your local health department. It is vastly cheaper than the hospital.
In most cases, you have time to arrange vaccination at the health department. Most health departments have a streamlined process to get you your rabies vaccination.
I had an exposure on a Tuesday afternoon and got my initial vaccine plus immunoglobin shots on a Thursday. It was well within the 72 hour window. There was no copay or deductible as it was billed as preventative treatment through my insurance.
If you ever have a bite and you aren't sure what you need, call your county department of health. They will advise you over the phone on the next steps to take. If you think you need additional treatment beyond a rabies vaccine, go to the ED. Even in that case, it's good to contact the DOH as it can save you thousands.
The Department of Health does this day in and day out. They are responsive and will help you!
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u/nagem12 Feb 17 '25
Health department worker here—this advice is excellent for pre-exposure vaccinations. Most health departments do not carry rabies immunoglobulin, which is recommended for post exposure (unless you’ve had pre-exposure series completed prior to exposure). Immunoglobulin can only be obtained at hospital ED’s in most areas. My health department is only allotted 5 rabies vaccines (not even immunoglobulin—we don’t carry that) a month which doesn’t cover the amount of exposures we see. We often refer to the hospital for all rabies vaccines and save the few we have for high risk exposures in under- or noninsured victims.
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u/Comfortable_Two6272 Feb 18 '25
My state does not offer at health dpt. Only ERs have immungloben and select private (not public health dpt) have vaccines. It took me over 12 hours of phone calls to find the vaccine for the multi doses after getting IG and 1st vax at ER.
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u/Guy_Incognito1970 Feb 17 '25
They overcharge and then write off those “loses” against extortionate profits
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u/911MDACk Feb 17 '25
Research the indications for rabies vax. There is a good chance you didn’t even need it.
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u/Orome2 Feb 17 '25
If you have an exposure, you need it. If you wait for rabies symptoms to manifest you are already dead.
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u/911MDACk Feb 18 '25
Yes but I’ve seen many examples of when it’s given inappropriately because either it was a low risk exposure or the animal was available for observation.
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