Better Solutions for Healthcare

NPR: Cat Bites The Hand That Feeds; Hospital Bills $48,512

Cat Bites The Hand That Feeds; Hospital Bills $48,512


Compassion for a hungry stray kitten led to a nip on the finger — and also took a bite out of Jeannette Parker’s wallet.

In a rural area just outside Florida’s Everglades National Park, Parker spotted the cat wandering along the road. It looked skinny and sick, and when Parker, a wildlife biologist, offered up some tuna she had in her car, the cat bit her finger.

“It broke my skin with his teeth,” she recalls.

After cleaning off the wound, she did some research and began worrying about rabies since Miami-Dade County had warnings about that potentially fatal disease in effect at the time.

She then drove back to her home in the Florida Keys and called the health department, but it was closed.

So she headed to the emergency room at Mariners Hospital, not far from her house. She spent about two hours in the emergency room, got two types of injections and an antibiotic and says she never talked with a doctor.

“I went home happy as a clam,” she said.

Then the bills came.

Patient: Jeannette Parker, a 44-year-old state fish-and-wildlife biologist. Insured through the American Postal Workers Union because her husband works for the federal government at Everglades National Park.

Total bill: $48,512, with $46,422 of that total for one preventive medication

Service provider: Mariners Hospital, part of Baptist Health South Florida, a faith-based nonprofit chain with eight hospitals and a variety of other facilities

Medical service: Parker’s wound was examined, and she received the first in a series of rabies shots, as well as an injection of 12 milliliters of rabies immune globulin, an antibody that kick-starts the immune system to provide protection from the virus until the vaccine kicks in.

What gives: When you are potentially exposed to a fatal disease, you need treatment. In the moment, it’s hard to shop around or say no to high prices.

The Centers for Disease Control and Prevention estimates that post-exposure preventive treatment for rabies, which includes the immune globulin and four doses of vaccine given over a two-week period, usually costs more than $3,000 on average. An estimated 40,000 to 50,000 people annually get such treatments following exposure to potentially rabid animals, the CDC says. Each hospital can set its own prices for treatment.

In Parker’s case, the majority of the cost was for the rabies immune globulin. For that injection alone, the hospital billed her and her insurer $46,422. That’s well above what’s considered typical.

“I have never heard anything that high for immune globulin,” said independent biomedical consultant Charles Rupprecht, a World Health Organization technical adviser on rabies who ran the rabies program at the CDC for 20 years. “How is that possible?”

Parker thought that seemed high after she requested and received an itemized bill from her insurer, so she Googled it.

“I saw that immune globulin was expensive, but it wasn’t that expensive,” she said. “I sat on it for a while because I was upset. Finally, I went by the hospital to confirm, and they said, ‘Yes, that is right.’ ”

The rabies immune globulin is a complex product, made from blood plasma donated by volunteers who have been immunized against rabies. Three manufacturers make the product, and there are no shortages right now, the Food and Drug Administration says. Currently, the average wholesale acquisition price — the amount paid by wholesalers that then mark it up when they sell it to distributors or hospitals — is $361.26 per milliliter, according to Richard Evans, a drug industry analyst at SSR Health, part of the boutique investment firm SSR LLC.

Using that average, the cost for the 12-milliliter dose Parker received would have been $4,335.

Perhaps the hospital erred when billing, adding an extra zero?

No, said Baptist Health spokeswoman Dori Robau Alvarez in an emailed statement.

The $46,422 charge reflected list prices the hospital had in place on Sept. 22, 2018, when Parker was treated. Alvarez wouldn’t disclose that rate, but simple math shows the hospital was billing $7,737 per 2-milliliter dose, which is how the immune globulin is often packaged.

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