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View Full Version : Guess what first rabies shots in the ER cost?


Napier
05-06-2012, 07:26 PM
So, guess what it cost last week for somebody to get the first set of shots in the Emergency Room after we figured out the cat that did the scratching was rabid?

$5,082. For 8 shots (one vaccine and seven separate syringes of the same immunoglobulin injected into seven different sites). This includes a doctor and some fiddling around, but no treatment of the wound, no tests, just the consult and the injections in the ER.

Wow.

Digital is the new Analog
05-06-2012, 07:44 PM
Note to self - avoid rabid cats.

Secondary note to self - make sure to proof read in case self types "rabbit" instead of "rabid."

Hope the bill is the only painful part left, Napier!

-D/a

samclem
05-06-2012, 07:52 PM
Your health insurance coverage is, of course, what determines you ultimate costs.

Let us know what happens.

SeaDragonTattoo
05-06-2012, 07:54 PM
I'm not all that surprised at the cost. ER treatments are expensive, and even non-ER rabies vaccinations for vets and techs are not cheap! Why can't they develop a human vaccine that's a one-time with a booster in a year and done? And, you know, a few dollars like they are for pets.

I'm even more interested in a rabid cat. I know some areas have more prevalence than others. I've been working with feral cats for 10 years and have yet to run across a case of rabies. I haven't been bitten myself (knock wood), but several co-workers have, and we've sent in plenty of heads, but no rabies in cats around here.

Was there saliva involved with the scratch? How? I have to say we wouldn't take scratches terribly seriously unless the cat was drooling and whipping saliva all over - maybe that's a mistake? Bites are the biggest concern, or licking/drooling into an existing wound or mucous membranes.

I'm so very curious.

USCDiver
05-06-2012, 08:22 PM
I'm not all that surprised at the cost. ER treatments are expensive, and even non-ER rabies vaccinations for vets and techs are not cheap! Why can't they develop a human vaccine that's a one-time with a booster in a year and done? And, you know, a few dollars like they are for pets.

Vaccination is not the same as post exposure prophylaxis.

NonrandomPerson
05-06-2012, 08:27 PM
Vaccination is not the same as post exposure prophylaxis.

Except that following the CDC treatment for rabies post exposure includes the vaccine as well as human rabies immunoglobulin.

http://cdc.gov/rabies/medical_care/index.html

Otherwise generally correct.

Siam Sam
05-06-2012, 08:40 PM
Rabies is one vaccine I always keep up with now, especially over here. You need a booster every 10 years. I'd let mine lapse and was bitten almost 10 years ago by The Mangiest Dog in Bangkok (just outside the city actually), and that's saying a lot. I'd inadvertently wandered close to her litter of pups. I didn't go to the ER, but I did go to a private, Western-style hospital for the first shot, then finished the series at the Red Cross. That first shot was still cheaper than in the West, less than US$100, maybe about $50, but it also cost more than the entire rest of the series at the Red Cross. If I'd kept up on my vaccine, I would've only needed a single booster shot.

That reminds me, it's coming up time to get my 10-year booster.

percypercy
05-06-2012, 08:46 PM
I took a class in Mammalogy (ask me about the deer station!). My professor and several of his grad students had the pre-exposure rabies vaccines since they were exploring caves, looking for bats. I never heard how much the shots cost, but they would have relieved me.

http://immunizationinfo.org/vaccines/rabies

From what I've read and my experience, the pre-exposure human vaccine isn't perfect by a long shot, but it's better than nothing.

lavenderviolet
05-06-2012, 08:49 PM
Look at it this way: Considering that rabies is almost invariably fatal (not quite 100% mortality anymore thanks to the Milwaukee Protocol, but still pretty bad odds) once symptoms start showing up, that's really not THAT high of a price to pay to protect yourself against a mostly fatal disease. :)

KarlGrenze
05-06-2012, 08:55 PM
You can get your titers checked, Siam. I got my series 8 years ago (Yikes! It's been that long!), and due to my work, have to have the titers rechecked every other year. So far, I'm above the threshold (whatever that is), and no boosters are needed.

Siam Sam
05-06-2012, 09:01 PM
You can get your titers checked, Siam. I got my series 8 years ago (Yikes! It's been that long!), and due to my work, have to have the titers rechecked every other year. So far, I'm above the threshold (whatever that is), and no boosters are needed.

Thanks. I wonder if that would actually cost more than just getting the booster, considering how cheap it is at the Red Cross.

SnakesCatLady
05-06-2012, 09:01 PM
I think my rabies vaccination cost between $400-$500 for the series. I was just disappointed I didn't get a vaccination tag.

Siam Sam
05-06-2012, 09:06 PM
I'm wondering if the Red Cross gives these vaccinations in the US the same as it does over here. If so, that would save some money.

Koxinga
05-06-2012, 09:11 PM
Look at it this way: Considering that rabies is almost invariably fatal (not quite 100% mortality anymore thanks to the Milwaukee Protocol, but still pretty bad odds) once symptoms start showing up, that's really not THAT high of a price to pay to protect yourself against a mostly fatal disease. :)

From what I've always heard, once symptoms show up you're already dead meat.

Vinyl Turnip
05-06-2012, 09:31 PM
Good lord. To paraphrase the old joke:

"It's extremely important to begin the injections immediately. The first eight will cost $5,082."
"I see. Thank you."

"What'd they say?"
"They said you're going to die."

SeaDragonTattoo
05-06-2012, 09:34 PM
Vaccination is not the same as post exposure prophylaxis.

True, of course. My point that wasn't at all clear was that many more people in the animal control/rescue field would get vaccinated if it weren't so cost-prohibitive in the first place. Vets and techs have to for school - but the vast majority of people who work with ferals and higher risk animals aren't formally schooled and are not vaccinated - but perhaps would be if it wasn't so expensive. I would think the post-exposure prophylaxis would fall in line, or possibly not be needed if there was a less expensive, more effective vaccine that more people got in the first place.

Clearly, the money is in vaccinating pets (a 1-year dog/cat rabies vaccine can be had for under $2) in the millions, rather than the few thousand additional animal care workers who would pony up for it if it weren't for school requirements.

As it is, the vast majority (who I know in Illnois) just keep hoping odds stay in their favor and they won't need ER treatment as in the OP's acquaintance. The last reported case of a cat with rabies in Illinois was in 1996, and dog was in 1994.

KarlGrenze
05-06-2012, 09:45 PM
The total cost for my series was around $300, eight years ago (yikes, I am getting old). Insurance didn't cover it.

A couple of years ago there was a shortage in the human vaccine line, with problems in one of the factories that make the FDA-approved vaccines, and the other factory unable to meet the demand. Some pre-exposure people (students just entering veterinary medicine) had to wait until supply increased before getting their series, and some places were considering looking at their post-exposure protocols and determining who really was exposed (ie, what did they consider as exposure and hence, deserving the vaccine).

As far as I know, that has been solved in the US.

Siam, as far as I know, the Red Cross here doesn't give vaccines, perhaps it is something that varies by country, as you're in an area that has a higher incidence of disease than the US.

Siam Sam
05-06-2012, 10:20 PM
Siam, as far as I know, the Red Cross here doesn't give vaccines, perhaps it is something that varies by country, as you're in an area that has a higher incidence of disease than the US.

Yes, the local Red Cross seems more active locally than its stateside counterparts. It's also home to the Queen Saovabha Memorial Institute (http://en.wikipedia.org/wiki/Queen_Saovabha_Memorial_Institute), which supplies snake antivenom nationwide and is a tourist attraction.

araminty
05-06-2012, 11:24 PM
If you do work with animals and want the pre-exposure series, it's worth checking with your health insurance company. I'm with Kaiser Permanente here in California, and when I started at the zoo, they had no problem in administering the vaccine at no up-front cost to me, not even a co-pay. The other big insurer around here, Anthem Blue Cross, didn't offer this cover, and would have charged me something like $500 per shot (it's a series of 3).

I'm occasionally bitten by mammals in my job (zoo educator), but the main reason I'm glad I got the vaccine isn't really health related - I wouldn't get to work with our skunks or bats if I hadn't been vaccinated! They're really cool, and great to work with. Out fruit bats are very smart - we're training the three straw-coloured fruit bats to walk along a rope, and into a crate, so we can take them into classes.

flatlined
05-07-2012, 12:34 AM
I'm also wondering about needing rabies shots due to being clawed. I'm a rescue person as well, and the main reason I love my pre-exposure shots is because on the rare times that I get bitten, I can quarentine the biter instead of having it tested. I've never considered getting treated because I was scratched up.

This thread is a good reminder, because I often forget to get my blood drawn.

SnakesCatLady I think my rabies vaccination cost between $400-$500 for the series. I was just disappointed I didn't get a vaccination tag.

My insurance co-pay was $20. I was also disappointed that I didn't get the tag. I would have bought a collar and worn it proudly.

KarlGrenze
05-07-2012, 05:05 AM
Flatlined, unless they have substantially changed the wording of it in the last year, your vaccination status is not what determines what happens to the animal, it is the animal's vaccionation status (and species) that counts for quarantine purposes.

And the usual recommendation is a 10 day quarantine, regardless of the bitten person's vaccination status. If they're biting and they have symptoms, it is usually terminal. Note that there are people who will euthanize the animal if it has bitten someone, even without the quarantine, and even if the animal had valid vaccination status.

What having the pre-exposure vaccine allows, though, is that they are usually the people selected to deal with suspected rabies/unknown rabid status. For example, during the Katrina follow-up, I worked at the animal shelter formed for pet refugees. Since I had the pre-exposure vaccine, guess who got to medicate all the not so nice, stressed out kitties that had bitten the other volunteers? :) Oh, joy!

Also, in my work line, they are wary about letting people without pre-exposure vaccine to be on the necropsy floor. And if it is a rabies suspect, only residents, pathologists, or techs are allowed to handle the brain and nervous tissue, not the veterinary students. So I get to remove brains from potential rabid cases.

Desert Nomad
05-07-2012, 06:30 AM
$5000 seems like a deal. In Nevada I was told it would be $12,000 (I can't get insurance due to pre-existing).

Imasquare
05-07-2012, 07:22 AM
$5000 seems like a deal. In Nevada I was told it would be $12,000 (I can't get insurance due to pre-existing).

What happens if you've been bitten but can't pay? Will they treat you anyway or do you just have to take your chances?

Lightnin'
05-07-2012, 07:32 AM
In 1990, my shots cost about $1500. I didn't have insurance, so I had to go on a payment plan with the hospital. After three payments, they sold the account to a collections agency... who apparently lost money on me, as they never even tried to get into contact with me to let me know where to send the check.

Damn, but our system is inefficient. I honestly don't understand how anyone, other than an insurance exec, can defend it.

CairoCarol
05-07-2012, 07:39 AM
after we figured out the cat that did the scratching was rabid?


I thought you had to get the shots right away - not to wait until a clear determination was made whether the animal was actually rabid or not?

Everyone in my family has had the pre-exposure series (it was a precondition of moving to Egypt with my husband's employer several years ago). But when my son was bitten a few months by a feral cat, they just gave him the next shot; they said that waiting until the cat was tested would take too long.

KarlGrenze
05-07-2012, 08:13 AM
I thought you had to get the shots right away - not to wait until a clear determination was made whether the animal was actually rabid or not?

Everyone in my family has had the pre-exposure series (it was a precondition of moving to Egypt with my husband's employer several years ago). But when my son was bitten a few months by a feral cat, they just gave him the next shot; they said that waiting until the cat was tested would take too long.

Nope, especially after what I mentioned above with the recent backlog in vaccine production. Usually they wait until confirmation if the animal was rabid or not before starting the series. OTOH, if the bite was straight to the face, I can see where they would treat first, ask later. But not for most cases.

I guess it depends on where you are, but in the states, you can get confirmation that the animal is rabid the same day the head is sent to the diagnostic lab. Now, our diagnostic lab is not the state-sanctioned confirmatory lab, but many labs run a prelim test, then send the rest of the sample (if warranted) to the state lab for confirmation. Still, the test itself takes no more than 2 hours to run (including set up and reading results).

Earl Snake-Hips Tucker
05-07-2012, 09:17 AM
I've read that anti-venin for snakebites is pretty high. From what few things I've seen in various documentaries, possibly a couple grand per vial.:eek:

Broomstick
05-07-2012, 09:43 AM
Look at it this way: Considering that rabies is almost invariably fatal (not quite 100% mortality anymore thanks to the Milwaukee Protocol, but still pretty bad odds) once symptoms start showing up, that's really not THAT high of a price to pay to protect yourself against a mostly fatal disease. :)
Unless, of course, you simply don't have the money.

What happens to people who just don't have the money and don't have insurance?

Vinyl Turnip
05-07-2012, 09:51 AM
Unless, of course, you simply don't have the money.

What happens to people who just don't have the money and don't have insurance?

See post #24. You get billed, you don't pay, it goes to collections, you don't pay, then (maybe) you get sued. Not sure what happens at that point, but they can't get blood from a tur... er, stone.

Minnie Luna
05-07-2012, 11:11 AM
I paid around $300 for my pre-exposure series in the early 2000s. Insurance did not cover it, I didn't even bother to submit it. I was doing it for work in a wildlife clinic and needed the shots to work with the raccoons, skunks, fox, bats, etc.

There was a large group of us getting vaccinated all at one time, so the cost of the vaccine was lower. I have my titers checked every couple of years and have not needed the booster yet.

IIRC, the high cost of the post-exposure protocol is the cost of the Imunnoglobulin, not the vaccine. A vial of the vaccine is expensive, but the Ig is more expensive.

The CDC also has a link to assistance programs (http://cdc.gov/rabies/medical_care/programs.html) to help people who are uninsured or under-insured pay for post-exposure treatment.

mnemosyne
05-07-2012, 01:35 PM
You can get your titers checked, Siam. I got my series 8 years ago (Yikes! It's been that long!), and due to my work, have to have the titers rechecked every other year. So far, I'm above the threshold (whatever that is), and no boosters are needed.

My sister has had two sets of vaccinations in the past 5 years; one as a requirement for vet school and a second set after a cat she was treating (she graduated last year) went apeshit and bit and scratched her arm all to hell. The ER checked her titers and she was at zero, as if she'd never had the vaccine to begin with! They will check her again next year, but it seems that she's one of those people for whom it just doesn't work.

She has a separate auto-immune disease, so it's possible (well, it's a WAG) that either the disease itself or it's treatment somehow negates the vaccine. It's rather weird.

Sailboat
05-07-2012, 07:14 PM
I had post-potential-exposure shots a few years back, required to be from the emergency room because of some protocol about conserving the limited supply. My insurance happily gouged me for $100 per emergency room visit -- it would have been far less at my GP's clinic -- but no other costs. The series was stopped after 4-5 shots because the cat was still alive and the stuff was, after all, in short supply.

Napier
05-07-2012, 08:16 PM
To those who mentioned the point, scratching is reason to give the shots if rabies is found in the animal. We did not know this and when Mrs Napier got scratched we did not pursue shots. Then our vet told us, a week later, a rabid cat had been caught where she was scratched, and it matched the description (orange tabby male with injured front feet). This was 6 days later. So she got the first set of shots, and the wound, which had already healed nicely, swelled and got red and hot and bumpy and itchy. We take this as an indication but not proof that she did have rabies virus or virus fragments in the wound. Scary.

flatlined
05-07-2012, 08:51 PM
Flatlined, unless they have substantially changed the wording of it in the last year, your vaccination status is not what determines what happens to the animal, it is the animal's vaccionation status (and species) that counts for quarantine purposes.

Lots of snips happened...but you are probably right. It might be where I live, and that I don't report bites when I mishandle ferals. The bites are my fault, not because the critter is rabid.

Now, if I get bit by a rat, I'm going to report it and get treated. I always assume that a raccoon I see during the day is rabid. I'm quite sure that the coyote that attacked me was rabid, but we didn't have physical contact.

I've not had a cat or dog tested. The ones I handle bite from fear, and I've gotten smarter. The last time I was bit was 3 years ago. A fat ankle biter who was running around in the highway.

Daylate
05-07-2012, 08:54 PM
Way back in the antedeluvian times of 1948, there were 13 members of our family that attended a Mother's Day get-to-gether. What made it interesting was that another attendee of this festivity was a dog, who got sick during the weekend and turned out to have rabies.

So all 13 of us got to daily traipse down to Doc Roberson's office and get our shots. Those of us who were at the party but had no contact with the dog got 14 shots, and those who actually touched the animal got the full series of 21. IIRC, there were 10 in the first group, and 3 in the second, for a total of 203 shots given.

The Great State of Illinois provided the vaccine free, which I thought was pretty good of them. But Doc Roverson's bill for giving all those shots was $172.00. Dad, who was pretty P.O.'d about the whole thing (he had never liked that rotten dog anyway), put his foot down and sent the $172 bill to the owners of the dog, and it was eventually paid by them. So that was what it cost back in the olden times.

Ever since I've always heard about what a horrible experience that gettin rabies shots was. I can state with certainty that a flue shot is just as bad (or even worse). We got each shot in the upper arm, alternating arms each day, with a really small syringe and needle. It was really a piece of cake, except I had to leave high school classes once a day for a trip to the Doctor's office. Bummer!

ralph124c
05-07-2012, 08:55 PM
Pretty reasonable-considering the alternative is.. death.:D

flatlined
05-07-2012, 09:25 PM
To those who mentioned the point, scratching is reason to give the shots if rabies is found in the animal. We did not know this and when Mrs Napier got scratched we did not pursue shots. Then our vet told us, a week later, a rabid cat had been caught where she was scratched, and it matched the description (orange tabby male with injured front feet). This was 6 days later. So she got the first set of shots, and the wound, which had already healed nicely, swelled and got red and hot and bumpy and itchy. We take this as an indication but not proof that she did have rabies virus or virus fragments in the wound. Scary.

I'm glad that Mrs Napier is doing well. I agree that its better to be safe where rabies is involved. One of the many reasons I give my ferals shots is for the herd immunity thing. (and yes, I do trap them every year and stick needles in them. this is not as hard as it sounds)

I hope that the Mrs won't stop trying to help hurt cats in the future. I'm pretty sure that this was a one time thing, and that the poor kitty had hurt feet from fighting his way from a coyote or something. Poor Mrs and poor kitty.

manila
05-08-2012, 08:22 AM
Rabies is one vaccine I always keep up with now, especially over here. You need a booster every 10 years. ..snip!.

Wait, what? I need get my boosters every 2 years. That is after the initial 3 shot program. And apparently if am unlucky enough to get infected apparently they still give anti rabies shots post exposure.

Yellow Fever and Tetanus boosters are every ten years.

KarlGrenze
05-08-2012, 08:32 AM
Wait, what? I need get my boosters every 2 years. That is after the initial 3 shot program. And apparently if am unlucky enough to get infected apparently they still give anti rabies shots post exposure.

Yellow Fever and Tetanus boosters are every ten years.

Manila, where are you and what do you do that you need rabies boosters so often? People with anti-immune disease (like mnemosyne's sister) probably need them more often, but I've had them for 8 years (after the initial 3 shots), and my titers are still what they consider "strong".

And IIRC, what changes in the post exposure versus the pre-exposure is that, if you have the vaccine, the amount of shots (immunoglobulin and/or vaccine) is reduced. If you do not have the vaccine, you get it along with the immunoglobulin shots.

manila
05-08-2012, 08:47 AM
Am currently in Gabon, I travel into the jungle but not specifically dealing with animals. Its just Company rules stating that my vaccinations should not be more than 2 years old. I'll check my vaccination 'passport' for details of the renewal date. The will not consider titer results if you are outwith 12 months since initial vaccination. This was also the case with another employer when I worked in Azerbaijan

Am certain that this company would not spend money on its employees' health if not absolutely essential. So I think I will need a little more research to find out which organisation mandates this regimen

KarlGrenze
05-08-2012, 01:26 PM
Ok. It may be because of the rabies incidence in the area you work. Again, I work in an increased risk environment, but in the US, which has a lower incidence than other countries. Still, my titers, which I do have to do every other year, show strong response.

Granted, there is not a good cutoff on what a good "titer" is, and I'd still get treated for rabies if exposure is shown. Again, the difference in my case will be both the urgency of the treatment and the total amount of shots needed, compared with someone who has not been vaccinated.

In that note, I want to clarify the difference in the rabies shots. There are the vaccine series (which for pre-exposure, at least, total 3 over month), and then there are the immunoglobulin shot. The immunoglobulin shot (RIG) is already formed antibodies against rabies. They will not help you with your own immunity, but will neutralize the virus while your own body defences gear up. The vaccines are the ones that prompt your body into "antibody production mode".

I refer to these charts (http://cdc.gov/rabies/medical_care/index.html) from the CDC about post-exposure protocols. Again, the difference between the previously vaccinated and unvaccinated are in the use of the immunoglobulin and the total amount of boosters needed.

Tom Tildrum
05-08-2012, 01:56 PM
Is the $5000 figure cited in the OP the charge that was presented to the OP's insurance (if any), or the cost that was actually paid (by the OP or the insurer)?

TreacherousCretin
05-08-2012, 02:42 PM
I took a class in Mammalogy (ask me about the deer station!).

Please tell us about the deer station.

Way back in the antedeluvian times of 1948....
Ever since I've always heard about what a horrible experience that gettin rabies shots was.

That was the lore when I was a kid in the 50's: Twenty-plus shots, in the abdomen, excruciatingly painful.
.

Siam Sam
05-08-2012, 10:21 PM
Wait, what? I need get my boosters every 2 years. That is after the initial 3 shot program. And apparently if am unlucky enough to get infected apparently they still give anti rabies shots post exposure.

Yellow Fever and Tetanus boosters are every ten years.

I was told every 10 years, and rabies is definitely endemic here. (Plus one shot post-exposure if any.) Looking around on the Internet, I'm seeing all sorts of numbers including 2-3 years. One site says the three-shot series + a booster after one year is good for 10 years.

It's clear I'm due for one anyway, be it two years or 10. When I get it, I'll ask.

Napier
05-10-2012, 04:38 PM
Is the $5000 figure cited in the OP the charge that was presented to the OP's insurance (if any), or the cost that was actually paid (by the OP or the insurer)?

The charge presented. Why? Is what the insurance pays usually less, even if no charge passes on to us?

Is this one of those innocent questions that make people think, "Oh that poor sap, he doesn't even know!"

Tom Tildrum
05-10-2012, 09:36 PM
The charge presented. Why? Is what the insurance pays usually less, even if no charge passes on to us?

Is this one of those innocent questions that make people think, "Oh that poor sap, he doesn't even know!"

Typically, the insurance companies will have contracts in place whereby they pay much less. For instance, I got a notice today of a recent doctor's appointment being charged at $160, and the insurance company's contract disallowed all but $63.

If these shots were covered by insurance, you would typically get an "Explanation of Benefits" in the mail, showing the charge, the amount paid by the insurer and the amount (if any) that the patient owes.

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