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In a rural area near the Everglades National Park in Florida, Parker spotted the wandering kitten along the road. He looked skinny and sick, and when Parker, a wildlife biologist, offered the tuna that she had in her car, the cat bit her finger.
"It broke my skin with her teeth," she recalls.
After cleaning the wound, she did some research and began to worry about rabies, Miami-Dade County having warned at the time about this potentially life-threatening disease.
She then returned home to the Florida Keys and called the health department, but the office was closed.
She went to the emergency room at Mariners Hospital, not far from her home. She said she spent about two hours in an emergency, receiving two types of injections and an antibiotic, without ever consulting a doctor.
"I came home happy like a clam," she said.
Then the bills arrived.
Patient: Jeannette Parker, a 44-year-old biologist specializing in fish and wildlife. Insured with the Union of American Postal Workers (APWU) because her husband works for the federal government at Everglades National Park.
Total invoice: $ 48,512, including $ 46,422 for preventive medication.
Service provider: Mariners Hospital, part of Baptist Health South Florida, a non-profit denominational chain of eight hospitals and various other institutions.
Medical service: Parker's wound was examined and she received the first of a series of rabies vaccines, as well as an injection of 12 milliliters of rabies immune globulin, an antibody that stimulates the immune system so the protect from the virus until the vaccine is triggered.
Which give: When you are potentially exposed to a deadly disease, you need treatment. For now, it is difficult to shop around or refuse high prices. The patients are blocked. The Centers for Disease Control and Prevention estimate that a post-exposure rabies preventive treatment, which includes immunoglobulin and four doses of vaccine administered over a two-week period, typically costs more than $ 3,000. According to the CDC, approximately 40,000 to 50,000 people benefit from such treatments each year after being exposed to potentially rabid animals. Each hospital can set its own prices for treatment.
In the case of Parker, most of the cost was for rabies immune globulin. For this one injection, the hospital charged him $ 46,422, as well as to his insurer. This is well above what is considered typical.
"I've never heard anything so high for immunoglobulin," said Charles Rupprecht, independent biomedical consultant, technical advisor for rabies at the World Health Organization, which directed the CDC's rabies control program for 20 years. "How is it possible?
Parker thought it sounded high after asking and receiving a detailed invoice from her insurer, so she found it on Google.
"I saw that immunoglobulin was expensive, but it was not so expensive," she said. "I sat on it for a while because I was upset. Finally, I passed near the hospital to confirm and they said "Yes, it's true".
Rabies immunoglobulin is a complex product made from blood plasma from rabies immune volunteers. Three manufacturers manufacture the product and, according to the Food and Drug Administration, there is no shortage currently. Currently, the average wholesale purchase price – the amount paid by wholesalers who then rate it when they sell it to distributors or hospitals – is $ 361.26 per milliliter, according to Richard Evans. , drug industry analyst at SSR Health, part of the boutique investment. SSR LLC company.
Using this average, the cost of the 12 milliliter dose received by Parker would have been $ 4,334.
Maybe the hospital made a mistake in billing by adding an extra zero?
No, said Baptist Health spokeswoman Dori Robau Alvarez in a statement.
The fees of $ 46,422 reflected list prices that the hospital had put in place on September 22, 2018, when Parker had been treated. Alvarez would not disclose this rate, but a simple calculation shows that the hospital billed $ 7,737 per 2-milliliter dose, which often explains the conditioning of the immunoglobulin.
Alvarez also noted that the month after Parker's treatment, the sailors had reorganized his full price list, known as "charge master". high, but not exorbitant.
Hospitals periodically visit their "care masters". However, it should be noted that this 79% reduction took place shortly before January, when new rules required all hospitals to publicly publish these previously hidden expense lists on websites, in accordance with the Trump Administration's interpretation of the Affordable Care Act.
"Statements from patients who received treatment before the change would reflect the previous charge," said Alvarez.
She did not answer the following questions about why prices dropped or the price was above average before the change.
The prices of Chargemaster are generally not those paid by the insured. One of the benefits of health coverage is that insurers are negotiating discounts for networked care. Parker went to a network hospital.
But not all services receive a negotiated rebate, said two billing experts to the US health insurance plans, the industry lobby group. And a discount on a very high charge is a very large sum of money. In Parker's case, her husband's health care plan paid $ 34,618 to her total emergency bill, including $ 33,423 for immunoglobulin alone.
APWU said that she had asked for an audit of the bill to verify its accuracy. The health plan, in a statement sent by email, indicated that it could not be done much else. "Aside from the negotiated rebates, the plan can not do anything to challenge the hospital's costs. The charges do not reach the level of fraud, "the statement said.
Resolution: After taking into account the insurer's payments, Parker had to pay $ 4,191 for the remaining $ 344 of his deductible for the year, plus his 10% share of the fees accepted by his insurer.
"My funeral would have been cheaper," she said.
After calling his insurer, Parker learned that the cat's bite should have been considered an accidental injury and therefore eligible for 100% coverage under his insurance plan, net of the remaining deductible. She wants the hospital to resubmit the bill to her health plan to determine if she will pay the rest of her 10% share of the costs. The hospital has not proposed to lower the price of immunoglobulin to its current load.
The takeaway sale: If you think you have been exposed to rabies, get treatment. "It is prudent that she seek immediate and appropriate medical care," said Rupprecht.
Many public health services can be obtained inexpensively or cheaply from local health services. These range from vaccinations to post-exposure treatments to diseases such as rabies. If possible, check with your health department to see if it offers treatment. But in the case of a serious illness like rabies, if these services are not immediately available, do not wait. Head to a hospital and make sure it is part of your insurer's network, if you have a choice.
If you receive an invoice for an amount that seems surprising to you, get the detailed bill from the hospital, not just the recap. In addition, now that hospital leaders are publicly available on hospital websites, use them.
They are long and complicated. For the moment, at least, they are not written in fluent English. But many are alphabetic and it is not difficult, for example, to find an entry for "Rabies IG" (anti-rabies immunoglobulin).
Check the price charged compared to prices in your area. (You can also check average prices on sites such as HealthcareBluebook.com or FairHealthConsumer.org.) Share this information with your employer's Human Resources department or use it to negotiate with your hospital or insurer.
NPR produced and edited the interview with Elisabeth Rosenthal of Kaiser Health News for broadcast. Nancy Klingener, a Florida Keys reporter for the WLRN member station, provided an audio report.
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