On reflection, Erica Kahn realizes she made two huge errors.
The primary was selecting to quickly forgo medical 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 night time sky throughout a trip on the Glen Canyon Nationwide Recreation Space 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 received tangled between her digital camera and her face.
She screamed, and a part of the bat went in her mouth. She doesn’t know which half or for a way lengthy, although she estimates it was just a few seconds. “It appeared longer,” she mentioned.
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 along with her, mentioned she ought to go to a hospital inside a day or so and start vaccinations in opposition to rabies.
Figuring she can be lined so long as she obtained insurance coverage earlier than going to the hospital, Kahn mentioned, she discovered a coverage on-line the day after the bat incident. She mentioned she referred to as the corporate earlier than she purchased its coverage and was informed providers associated to an accident or “life-threatening” emergency can be lined.
Kahn went the subsequent day to a hospital in Flagstaff, Arizona, the place she began rabies prevention therapy. Over the subsequent two weeks, she obtained the remainder of the rabies photographs at clinics in Arizona and Massachusetts and at a hospital in Colorado.
Then the payments got here.
The Medical Process
Kahn obtained a complete of 4 doses of the rabies vaccine. The doses are administered over the course of 14 days. Alongside along with her first vaccination, she obtained three photographs of immunoglobulin, which boosts antibodies in opposition to the virus.
Rabies is often transmitted by means of bites or scratches from an contaminated animal. Consultants advocate precautionary measures when an individual has been doubtlessly uncovered to rabies, as a result of as soon as the neurological illness causes signs, it’s deadly. The Facilities for Illness Management and Prevention says postexposure rabies therapy has lowered the variety of human fatalities to fewer than 10 a 12 months within the U.S.
The Last Invoice
In keeping with explanation-of-benefits statements, Kahn owed a complete of $20,749 for her care on the 4 amenities. A lot of the prices have been from the hospital the place she was first handled, Flagstaff Medical Heart: $17,079, together with $15,242 for the rabies and immunoglobulin photographs.
The Billing Downside: Most Insurance coverage Doesn’t Begin Instantly
Kahn’s coverage didn’t pay for any of the providers. “The required ready interval for this service has not been met,” mentioned an explanation-of-benefits letter she obtained in December.
Kahn was surprised. “I assumed it will need to have been a mistake,” she mentioned. “I assume I used to be naive.”
When Kahn was laid off from her job as a biomedical engineer final summer time, she had the choice to quickly keep on her former employer’s insurance coverage beneath a COBRA plan, at a value of about $650 a month. However as a younger, wholesome particular person, she gambled that she might get by with out insurance coverage till she discovered one other job. She figured that if she wanted medical care, she might rapidly purchase a non-public coverage.
In keeping with the Facilities for Medicare & Medicaid Companies, those that qualify for COBRA should be given not less than 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, mentioned just 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 referred to as Progressive Companions LP. Paperwork Kahn offered to KFF Well being Information say the coverage has a 30-day ready interval, which “doesn’t apply to advantages relating to an accident or lack of life.”
Kahn mentioned that after receiving discover that her claims have been denied, she referred to as the corporate to ask how she might attraction and was informed a health care provider must file paperwork. She mentioned she wrote a letter that was signed by a health care provider at Flagstaff Medical Heart and submitted it in March however was unable to achieve medical doctors on the different amenities.
Kahn mentioned she was given conflicting solutions about the place to ship the paperwork. She mentioned a consultant with the corporate just lately informed her it had not obtained any appeals from her.
Advantages statements Kahn obtained in early July present Progressive Companions had not paid the claims. The corporate didn’t reply to requests for remark for this text.
Sabrina Corlette, co-director of the Heart on Well being Insurance coverage Reforms at Georgetown College, mentioned most well being protection plans take impact on the primary day of the month after a buyer enrolls.
“The insurance coverage firms — for good cause — don’t need folks to attend to join protection till they’re sick,” she mentioned, noting the premiums wholesome folks pay assist steadiness the prices of paying for well being care.
The Inexpensive Care Act requires insurers to cowl preexisting situations, reminiscent of diabetes or coronary heart points. However that doesn’t imply they need to pay for therapy of an damage sustained shortly earlier than an individual enrolls in protection, she mentioned.
Corlette, who reviewed a quick advantages overview offered by Kahn, mentioned the coverage seems to have been a restricted, “mounted indemnity” plan, which might pay solely set quantities towards therapies per day or different interval no matter complete bills incurred. Such plans have been round for many years and aren’t required to satisfy ACA requirements, she mentioned.
However she mentioned even when Kahn had purchased complete medical insurance, it most likely wouldn’t have lined therapy obtained so quickly after she bought it.
David Shlim, a journey medication specialist in Wyoming who research rabies, mentioned Kahn made the correct alternative by promptly in search of therapy, although she didn’t really feel the bat chew her. The illness is lethal, and the truth that the bat went into her mouth meant she might have been contaminated from its saliva, he mentioned: “You could possibly hardly have a extra direct publicity than that.”
Shlim, who just 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 might have been sick, probably with rabies, he mentioned.
Rabies prevention therapy is far more costly in the US than in most different international locations, Shlim mentioned. The priciest half is immunoglobulin, which is created from the blood plasma of people that have been vaccinated in opposition to rabies.
The therapy is usually administered in hospital emergency rooms, which add their very own steep prices, Shlim famous.
The Decision
Kahn mentioned she is employed once more and has good medical insurance however remains to be dealing with a lot of the payments from her misadventure at Glen Canyon. She mentioned she paid a health care provider invoice from Flagstaff Medical Heart after negotiating it down from $706 to $420. She mentioned she’s additionally organized a $10-a-month plan to repay the $530 she owes for one among her rabies photographs at one other facility.
She mentioned she plans to proceed interesting the denials of cost 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 best prices — Lauren Silverstein, a spokesperson at Northern Arizona Healthcare, mentioned the well being system does what it will probably to restrict prices. “We now have much less means to regulate the costs of essential provides that we use to deal with sufferers, together with prescribed drugs, biologics, diagnostics and medical units made by different firms,” she mentioned.
Silverstein mentioned 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 Finances Reconciliation Act of 1985, allow many individuals who lose job-based protection to pay to remain on these plans quickly. There’s 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 particular person was uninsured.
Corlette mentioned Kahn’s predicament illustrates why folks want to ensure they’ve medical insurance.
She mentioned individuals who lose employer-based protection ought to contemplate enrolling in particular person insurance policy bought on federal or state marketplaces. Many individuals who purchase such insurance policies qualify for substantial ACA subsidies to assist pay premiums and different prices.
“In case you are shedding your job, COBRA shouldn’t be your solely possibility,” Corlette mentioned.
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 really huge lesson I discovered the exhausting method,” she mentioned.
Her wildlife encounter didn’t destroy her love of the outside. She even sees humor in it.
“I do know what bats style like now. It’s an earthy, candy form of taste,” she joked. “It’s really a reasonably shaggy dog story — if it weren’t for the horrible medical invoice that got here with it.”
Invoice of the Month is a crowdsourced investigation by KFF Well being Information and The Washington Put up’s Effectively+Being that dissects and explains medical payments. Since 2018, this collection has helped many sufferers and readers get their medical payments lowered, and it has been cited in statehouses, on the U.S. Capitol, and on the White Home. Do you might have a complicated or outrageous medical invoice you wish to share? Inform us about it!
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.
USE OUR CONTENT
This story may be republished without cost (particulars).