Bat scare minimal compared to bill
No family members had direct, known contact with the bat, but rabies vaccinations for three people caused a mountain of stress when the family's insurance carrier initially refused to pay.
"We thought we had decent insurance," said Evelyn Galindo-Doucette, a Spanish teacher in the Janesville School District. "Somehow, prices have gotten so inflated that if you happen to get charged for something because of a loophole in your insurance, you could be done. You're one step from bankruptcy."
She said her experience shows how health care doesn't seem like a crisis until you face it—even when you have good insurance.
Galindo-Doucette wants to make people aware of the vaccine's cost and how to possibly avoid the bill. In retrospect, the family would have captured the bat and had it tested for rabies, possibly eliminating the need for the vaccinations, she said.
Data collected by the Wisconsin Hospital Association Information Center shows nearly 600 records of rabies vaccination cases among the about 150 hospital emergency rooms in the state in the last four quarters.
The average charge for initial rabies care, including emergency-room visit and first dose of vaccine, was about $2,400, said Joe Kachelsi, vice president of the WHA Information Center.
Dr. Keith Konkol, infectious disease physician at Mercy Hospital, said several factors go into the cost of the vaccine, though it is relatively expensive compared to other vaccines.
"No matter where you go, it's going to be expensive," he said.
The vaccine likely has a higher cost to develop and recent worldwide shortages also have probably made it more expensive, he said. In addition to the vaccine costs, hospital bills include the medical professionals' charges, emergency room/clinic charges and other costs, he said.
Konkol estimates three to five patients are seen per year at Mercy needing the post-exposure rabies vaccine.
How it happened
Evelyn and her husband, Chuck, were watching TV on the couch when she saw a bat swooping in from the dining room toward her.
"Get it outta here!" the couple exclaimed as the situation turned slightly chaotic in just a few seconds.
The bat took a short flight around the upstairs, where the couple's kids, Ernesto, 4, and Lilli, 2, were sleeping behind closed doors. Chuck got the bat outside through an open door.
Then they wondered how the bat got in and how long it had been around. The previous day they had read in the newspaper that two bats from Rock County have tested positive for rabies.
The next morning, the family headed to Mercy Hospital's emergency room, where a doctor determined that no one had bat-related marks but recommended the family be vaccinated.
Once symptoms develop, it's too late to treat rabies, and it likely will be deadly, she said.
Chuck decided he'd take the risk, but Evelyn and the kids started the five-dose series of the vaccine, plus the initial rabies immune globulin, she said.
Then came the bill: $9,000 for the initial emergency room visit and a total of $18,000 including the four additional clinic visits for the remainder of the vaccines. But their insurance doesn't cover rabies vaccinations, she said.
Insurance eventually agreed to pay after the vaccine was considered treatment because the case started in the ER, said Evelyn, who is on sabbatical while she earns her master's degree.
"I don't even know how we would manage it," she said. "One random thing, a bat decides to fly into your house, and $18,000 later … "
The irony is that Evelyn originally is from El Salvador, a third-world country and one of the poorest in Central America. Yet family members there told her the equivalent vaccines would be available for just hundreds of dollars.
The experience has sparked more interest for her in the national debate on health care reform, she said.
Socialized health care in El Salvador allows even the poorest people to receive treatment, even though they might wait, she said.
She's happy she didn't know the cost of the vaccine at the time because she would resent having to make a potentially life or death decision for her kids, she said.
"It's kind of an awful decision to make—once you develop it, you're dead."
When is a rabies vaccine needed?
The rabies vaccine is offered in two ways: pre-exposure and post-exposure.
The pre-exposure vaccine is given in three doses for people traveling to certain countries or to people in a high-risk occupation, officials at the Rock County Health Department said. High-risk occupational settings include a humane society, veterinary clinic, animal rehabilitation center or Department of Natural Resources, officials said.
The three-dose, pre-exposure series is available at the health department for $165.
The post-exposure vaccine is given in five doses, along with the rabies immune globulin. A person who has been bitten or exposed to a possible rabid animal needs the vaccine.
The health department refers those people to medical providers and does not offer the vaccine to them.
If you haven't been exposed, and you're not in a high-risk setting, you don't get the vaccine, officials said.
The cost shouldn't dissuade someone from getting the vaccine because rabies is fatal, said Adam Elmer, a sanitarian at the health department.
"If someone shows signs of rabies, it's too late to get the vaccine," he said.
But you may not know for sure if you've had a rabies exposure, said Dr. Keith Konkol, infectious disease physician at Mercy Hospital, who points to the Center for Disease Control recommendations. It doesn't mean there has to be a documented bite or scratch, especially with bats, he said.
"If you wake up in the morning with a bat flying around the house, there's no way to know if you were exposed," he said.
Bats have small, sharp teeth and one could bite a young child and we might not even be aware of it, he said.
The main animals in Wisconsin to be concerned about are bats, raccoons and foxes, Konkol said.
If a possible rabies exposure occurs with such an animal and you have access to it, kill it—just don't crush the skull/brain—and contact the health department, he said. The animal can be sent to a state lab to determine if it is rabid. If it's not rabid, you don't need the vaccine.
Other animals such as dogs and cats should be immunized, and the health department reminds pet owners to keep pet vaccinations updated.