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Bay Area couple shocked by $200K hospital bill for rabies shots
- notch898b 3y agoI encountered a bat many years ago acting erratically inside the house. It had evidently entered in my sleep. I looked up the cost, and found out the household would be bankrupted by the shots and we would end up homeless. I calculated the danger from homelessness outweighed the risk of rabies. I guess the bet paid off, as we're now well past the 99th percentile of incubation period.
- mongol 3y agoCan you get rabies still, theoretically, from this event?
- AdamJacobMuller 3y agoTheoretically, yes. The infection can lie dormant for an exceptionally long period of time in an exceptionally small percent of cases and can be triggered by unrelated external factors.
- i386 3y agoI believe it’s only transmissible through saliva. Unless you are bitten by the infected animal you will be fine. https://www.cdc.gov/rabies/transmission/index.html https://www.cdc.gov/rabies/transmission/index.html
- dr_dshiv 3y ago25 years! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424805/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424805/
- klipklop 3y agoSeems pretty remote chance to get rabies without being bit, but did you read the last paragraph? "The Aguilars wound up paying $3,546.64 out of pocket. The insurance company told us Wednesday that they "are reaching out to NorthBay Healthcare... to address these excessive charges."" The shot normally costs ~$600 USD. There is no way the insurance in the end will pay the $54k the hospital tried to get away with.
- notch898b 3y agoIf I recall correctly we had no insurance at the time. I was able to afford to re-vaccinate my animal, as it's only $60 at the vet, I figured at least my pet would survive.
- AdamJacobMuller 3y agoIt would almost definitely have been cheaper for you, without insurance, than it was for this couple.
- AdamJacobMuller 3y ago> United Healthcare still paid more than $58,000 for the couple's rabies treatment They did.
- klipklop 3y agoSays in the article they are contesting it. I am guessing in the end they will be made whole. The only more vicious actor in this situation is the insurance company.
- thaumaturgy 3y ago> Seems pretty remote chance to get rabies without being bit Just FYI, it's possible to get bit by a bat while sleeping and not realize it. Most bats are small and a bite mark may not be painful or immediately noticeable. There was a case in 2021 in Illinois of a man being bitten by a bat in his sleep; in his case, he realized he'd been bitten, but declined treatment (cost, probably...) and died of rabies a month later. Not a fun way to go. I've heard the advice before to get a prophylactic rabies shot if you find a bat trapped in your house while you were sleeping. ...in civilized countries, anyway. edit: https://www.npr.org/sections/health-shots/2016/06/02/480414566/bats-in-the-bedroom-can-spread-rabies-without-an-obvious-bite https://www.npr.org/sections/health-shots/2016/06/02/4804145...
- switchbak 3y agoDang. I don't have a lot of financial reasons to prefer living in Canada, but that's definitely one (for now at least). That's rough though, lucky you didn't get sick. It's not a choice I'd like to make.
- p1esk 3y agoWhat happens if you refuse to pay?
- timy2shoes 3y agoThey give your rabies back.
- olliej 3y agoDebt collectors, A lien on their house, etc
- AdamJacobMuller 3y agoDispute the debt. They can't put a lien on property without a court case and I want to see someone stand in front of a judge and justify an un-itemized 100k bill when their own public charge sheet shows that the service should cost <1000.
- 1letterunixname 3y agoThat doesn't work in the real world. Their army of lawyers can and will outspend you at every turn. They will force you into bankruptcy when you should've declared bankruptcy to begin with.
- p1esk 3y agoBut do they want to outspend you? Especially if the case is not a sure win for them.
- falcolas 3y agoIf they’re paying the lawyers regardless (as in paying them a salary), might as well give them some work.
- teeray 3y agoSo the real disruption would be to DoS their lawyers by patients disputing absolutely everything questionable. Create an app to upload all the EOBs and make it dead simple to create grief for the hospital.
- clueless 3y agoso a whole story about a billing mistake, which they could have figured out without involving the news org?
- darth_avocado 3y ago“Billing mistakes” happen way too often in this country and the hospitals don’t fix them that easily.
- 1letterunixname 3y agoGood luck with them ever admitting to any mistake. They have collectors who don't care who will suck every penny. Just don't get sick in America.
- schemescape 3y agoWhere does it say it's a billing mistake?
- jlmorton 3y agoThe article does not say it's a billing mistake, but it notes that NorthBay Healthcare lists a price online of $547.65 for a rabies vaccine. Surely human rabies immunoglobulin would be another $1,000, maybe more, but there is no chance on Earth that it is $100,000 each. NorthBay Healthcare is a non-profit hospital. This is a very, very obvious billing mistake. And while I have zero evidence for what I am about to say, I would be willing to bet that ABC7News did not even share the case they were preparing to discuss with the hospital. They just wanted to run the story, and so they asked the hospital for generic comment about a patient's large bill. I've looked for follow-up to this two-month old story, and I can't find any. But I am sure it's a billing mistake.
- schemescape 3y agoThanks for pointing out that this article is not brand new. I’m curious to see if there is an eventual follow-up. If not, then that would be extremely disappointing.
- dmarchuk 3y ago> Tens of thousands of people each year receive a series of shots to prevent rabies after a possible exposure. It normally costs between $1,200 and $6,800. Not in this case. Even that "normal" cost is absolutely crazy.
- 1letterunixname 3y agoMost Americans don't realize how bad they have it. They've grown accustomed to being punched and slapped around and so won't rebel. They'll keep giving all of what little and shrinking of what they have to legitimized criminals.
- xiphias2 3y agoHow? They don't have internet? Even in Zurich, Switzerland, one of the most expensive places and healthcares in the world, it's 85 CHF / shot: https://reisemedizin.uzh.ch/en/pre-travel_advice/rabies https://reisemedizin.uzh.ch/en/pre-travel_advice/rabies Emergency room is 50 CHF extra in non-emergency cases: https://www.thelocal.ch/20210617/emergency-room-visits-to-now-cost-50-francs-in-switzerland#:~:text=People%20who%20visit%20the%20emergency,approval%20for%20a%20rule%20change https://www.thelocal.ch/20210617/emergency-room-visits-to-no....
- jfengel 3y agoWe do have Internet, but we've gotten used to being told that the Internet lies to us. We've been repeatedly told that people wait months for treatment in the UK, and that Canadians are streaming over the border to get health care in America. We read horror stories like this one, but say "Whew, glad that won't happen to me." We imagine that because of capitalism, if our insurance company screws us over, we'll change to the next one -- freedom we wouldn't have if we had a national health care. It never seems to occur to us that all of the private insurers have a capitalism-driven goal of maximizing profits, and national insurers don't.
- darth_avocado 3y agoThe insurance company paid $58000 for the treatment? How the hell did they not get the hospital to get things fixed? My insurance made me submit proof, rejected it, submit proof again, partially approve, call them and then finally reimburse my $18 covid take home tests. But somehow they don’t do the same to hospitals?
- AdamJacobMuller 3y agoWhat's their incentive to reduce the cost? They make money as a % of care paid out (max profit is capped). More costs == more profits and the costs are just passed onto the people paying for insurance (both employees and employers)
- 1letterunixname 3y agoThere is no incentive except to commit highway robbery. Pay, or pay and die. It's the weakness and disorganization of the consumers who emboldens them.
- HPsquared 3y agoIn a normal competitive market a series of new entrants would come in and undercut the incumbents by charging 10% less than the competition, one after the other until a sensible price is reached. Why doesn't this happen? Also where does all that money even go? It's so insane.
- nostrademons 3y agoMedical licensing. Can't practice medicine without a license. And if you're a doctor and you strike out and practice medicine on your own, a.) where are your hospital affiliations? your equipment? your support team of nurses & orderlies and b.) who's gonna pay your own health insurance? Money goes mostly to the salaries of healthcare administrators and dividends for shareholders, with enough going to doctors and nurses to keep them from striking out on their own.
- AdamJacobMuller 3y ago
- olliej 3y agoThis is another of those cases which seem to be very clearly price gouging, which is illegal, unless you're a hospital. The hospital should be subpoena'd to get the actual cost of treatment - both the vaccination, the amount paid to the ER staff during the time the patients were there, etc. Also this BS where they can just say "out of respect for patient privacy we don't discuss billing matters", when the patient has provide explicit documentation and consent saying the hospital can discuss billing can also get shafted.
- nradov 3y agoI won't attempt to defend the hospital but even outside of healthcare, price gouging is almost always legal. There are only a few limited circumstances where it is banned in a subset of US states.
- mindslight 3y ago"Price gouging" is only legal when a contract is formed. A contract requires well defined consideration, as well as a meeting of the minds - neither is present when a person is not told an up front price (especially after asking), and is under medical duress.
- porkbeer 3y agoDid you know your little printed recipt is a contract?
- mindslight 3y agoIt's better described as evidence of a contract. But I guess a signed piece of paper is merely evidence of a contract as well, despite being commonly referred to as "a contract". But this isn't really relevant when discussing healthcare, because the problem is precisely with providers not dealing in specifics that would be necessary to create a printed receipt. It would be a terrible system if hospitals demanded full payment ahead of treatment and price gouged patients on the spot, but it would be significantly more legitimate than what we currently have!
- 1letterunixname 3y agoThat's a shitty bill. It's also insane that US doctors and hospitals aren't required to post prices, keep prices reasonably within an allowed range, and are allowed to price gouge customers for however much they want without limit. In Redding CA, I ran across a woman with a nasal infusion pump tube taped to her face in a coffee shop. She was hurriedly collecting paperwork for a hearing across the street. It turns out she was preparing to go through bankruptcy proceedings while she was dying from incurable Stage IV cancer. That the doctors and hospitals were vultures picking her life apart for money while she was dying but still alive and making her end-of-life as miserable as possible was adding insult to injury. Some hippocratic oath. More like hypocritical chisels out to monetize misery. So when someone is out of money and dying in America, they are treated like criminals with court proceedings. At their hearing, they get a chance to justify their existence requires clothes, transportation, and housing while everything else goes to creditors.
- nradov 3y agoHospitals have been required to post price lists for several years. https://www.cms.gov/hospital-price-transparency https://www.cms.gov/hospital-price-transparency
- 1letterunixname 3y agoDoesn't matter. Nothing has changed.
- m0llusk 3y agoFrom this recent HN thread it looks like we still have a ways to go there: New health insurance "transparency data" looks suspiciously wrong https://news.ycombinator.com/item?id=35347647 https://news.ycombinator.com/item?id=35347647
- dheera 3y agoIt's meaningless unless you can get a price before you get services. The trouble is even if the price list says $500 for something, they'll charge you $8000 for "general classification" and $2000 for a Tylenol. I have a remote heart monitor at my bedside that, upon pressing a button, wirelessly retrieves data about arrythmia incidents from my implanted defibrillator and sends any incidents to the hospital. Every time I hit the button, even if there are ZERO incidents for them to review, I get hit with a $300 bill for some "general classification". So I hit the button less often than I'm supposed to.
- paulpauper 3y agoThese sort of stories like these go viral. The amount paid is nowhere close to that, sometimes nothing is paid. The final price is always negotiated vastly lower. The patient often pays a tiny fraction of this. It's bad that this happens in the first place though. There is something wrong when people getting these outrageous bills in the first place. Hospitals send out these bills in the hope a tiny fraction of people pay in full.
- schemescape 3y agoLooks like there was already an outrageous payment: > Even with plan discounts, United Healthcare still paid more than $58,000 for the couple's rabies treatment.
- pengaru 3y ago> The amount paid is nowhere close to that, sometimes nothing is paid. The final price is always negotiated vastly lower. Wow, look at the Stockholm Syndrome on this guy! As if that's an acceptable normal process for anyone to be subjected to...
- s_m_t 3y agoHow is that legal? What is stopping the hospital from charging 200 million dollars for the rabies shots? If I hired someone to fix my plumbing and they wouldn't give me an estimate and then decided to charge me $20k/hr I don't think a court would honor that contract.
- akomtu 3y agoI'm not sure about that. Hospitals use the fact that patients have no choice. Amoral business is the most profitable. A pipe in your house has burst, you called a plumber and he arrived in 1 hour (other plumbers were even further). He looks at your situation and says "sign here, my rate is 5k/hr plus unexpected expenses up to 50k" and when you try to negotiate, he calmly looks at water flooding the second floor in your 2mln house and answers nothing. You both know that very soon the repairs will cost you 100 thousands of dollars. I doubt any judge would agree that the plumber owes you work at a rate convenient for you.
- 1letterunixname 3y agoIt's the gambit of brinkmanship + Vito Corleone.
- s_m_t 3y agoSure the plumber is free to only offer outrageous rates but I'm not sure they would be able to markup a roll of teflon tape they used in the repairs as 50k and say that is covered by "plus unexpected expenses up to 50k". To me it just seems like fraud. Forget about patient choice because in this situation the patients conceivably could have shopped around for rabies shots, AFAIK you aren't going to die because you got your rabies shot a few hours later the you needed to. The problem seems to be that even if they were able to shop around and find the lowest price apparently the hospital can just charge whatever they want regardless of the expected or quoted cost. Going back to the example of the plumber; Imagine if my house is flooding and I get into contact with two plumbers, one tries to price gouge me and quotes me $5k/hr and one is seemingly honest and quotes me $80/hr. I go with the plumber that quotes me less but then he ends up charging me $50k for the teflon tape he used anyways. We can see this isn't a breakdown in being able to shop the market and the normal competitive dynamics that arise from that, the breakdown occurs because of the fraud.
- rediguanayum 3y agoAgreed while this is excessive, many hospitals do this to cover the uninsured who don't pay their bills. Hospitals have to care for such patients due to EMTALA. Consequently many non-academic hospitals are under huge financial stress (https://www.kqed.org/science/1981588/half-of-california-hospitals-are-in-the-red-pandemic-troubles-pile-up-for-ers https://www.kqed.org/science/1981588/half-of-california-hosp...) and go after anyone that can pay to the point of bankrupting them. The US medical system is simply dysfunctional.
- JohnFen 3y ago> The US medical system is simply dysfunctional. That's an epic understatement. I'm of the opinion that the root cause is the insurance companies.
- 1letterunixname 3y agoThat's an overly simplistic hot take. You have to look at the interests involved. Sure, in some other countries, for-profit health insurance is illegal. There are many more for-profit hospitals in the US than there were 40 years ago. Many not-for-profits sold out to for-profit companies. I believe John Oliver or VICE did a piece on this years ago. Then there are the doctors. Only in the US is being a doctor insanely lucrative. Not all US doctors are out to financially abuse patients, but there are enough who are complicit in the hospital and outpatient practice system who enable mass exploitation. Single-payer wouldn't end this. Medicare for all wouldn't even be close to fixing the problem. Most of Medicare is administered by for-profit health insurance companies. Medicare pays, but doesn't cover 100%. It still requires paying for one of a laundry list of letters Medicare supplemental and prescription plans. Also, the US doesn't have a functional mental healthcare system. And that's not covered either. Dental and vision also aren't covered.
- JohnFen 3y ago> Only in the US is being a doctor insanely lucrative. And only for some doctors. Most aren't making crazy money at all. > Single-payer wouldn't end this. I never said it would. But this is a thing that most other modern nations have figured out (imperfectly, sure, but orders of magnitude better than we have in the US). It's insane that the US can't seem to resolve this situation, especially considering that it kills people. But then, we here in the US don't seem to prioritize actually helping people. The US is the wealthiest, most powerful nation in the history of the planet. That we allow anyone to go without a roof over their head, food in their belly, and adequate medical care is criminal.
- itake 3y agoDoes anyone have advice on how to protect yourself from bills like this? My insurance is fighting me on a $450 test (that I could have gotten done with an Amazon kit for $80).
- pengaru 3y agoTIL Vacaville is considered Bay Area... that's a pretty far drive from SF.
- 1letterunixname 3y agoCow city. It's a shithole halfway to Sacramento. A woman crashed her car into my vehicle there. She didn't stop. A cop was right there and did nothing. I called 911. The county or city didn't have E911 properly configured with Verizon and couldn't get my location. This is how America works. Broken, lawless, and dysfunctional.
- pengaru 3y ago[dead]
- psychphysic 3y agoSo healthcare costs like 500-1k per month for the good stuff. And you still might have to pay through the nose for a £75 vaccine? Or is this a case of bad insurance? That the US can spy on the entire world but can't get its own people basic healthcare is shocking.
- 1letterunixname 3y agoNo, it depends on your age, health, and coverage. For limited disastrous healthcare coverage, that might get you $1m in lifetime coverage with a $8k deductible if you were 28 and in perfect health.
- psychphysic 3y agoYou didn't say how much that would cost.
- lastofthemojito 3y agoAbsolutely insane that they would have been better off heading to SFO, walking up to the Air Canada or Aeroméxico counters, and leaving the country for care.
- xiphias2 3y agoOr just get a private flight...it's much cheaper than $200k
- testemailfordg2 3y agoProbably a DFT^P03 message caused an issue somewhere... Or this was to be... "CDPH does not have a role in setting charge limits or ranges for services."
- ifdefdebug 3y agoI am so happy that I don't have to put up with crazy shit like $200k for a few shots which is NOT just a billing failure, just by not living on the other side of the Atlantic... Because here where I live, if you walk into an emergency room and walk out a few hours later with two shots and a $200k bill, ... well it's unthinkable, but if it happened anyway and the hospital tried to defend it, the judge would just laugh their lawyers out of the door.
- virgulino 3y agoBrazil here. A few years ago, my wife was bitten by a dog. We simply went to the neighborhood free healthcare clinic, the standard entry point to our free universal healthcare system. After a very short wait they cleaned the wound and administered the first rabies vaccine. We went back there for the next doses. All free of charge, and the only "paperwork" she needed to do was to present her national ID card. https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BAde https://en.wikipedia.org/wiki/Sistema_%C3%9Anico_de_Sa%C3%BA...
- defrost 3y agoThis is pretty much how things go in Australia for the poorest to the richest citizen. The USofA has an unbelievably shitty healthcare system.
- notch898b 3y agoWikipedia says it's free for foreigners and nationals, so I'm curious why they require the ID.
- virgulino 3y agoI am pretty sure that ID is not required, but they ask for it, so that they can access and update your medical records.
- majikaja 3y agoThis thread isn't about developed countries
- 1letterunixname 3y agoMichael Moore made a movie on this topic. Barely anything changed except what's left of Obamacare. https://www.imdb.com/title/tt0386032/ https://www.imdb.com/title/tt0386032/
- masfuerte 3y agoI needed rabies shots before I went to South America. The NHS doesn't cover the vaccine but they will stick it in your arm for free. So I spent £50 at a pharmacist for the three phials and the nurse at my doctor's surgery administered the first two. The last dose was due the day before I left but the nurse was off sick. So I rang another local surgery and the nurse there was happy to do the job. The American system baffles me.
- 1letterunixname 3y agoI once dropped in to a hospital near Vacaville, maybe the same one. There was a security guard at the front with a grey keypad. The would not speak to you unless you entered your Social Security Number. I made the mistake of entering it but thought nothing would happen because I didn't see any live human. Guess what? $800 bill for the pleasure of seeing exactly no service provider. This is how they work.
- mindslight 3y agoDid you pay it? If so, why? So many anecdotes end with "they sent me a bill", without saying what happened next. Just because someone sends you a bill does not mean you have to pay, especially when that bill seemingly isn't based on a contract or other form of legal liability. Did you tell them to go screw, they took you to court, and they actually managed to substantiate the debt? Or if you were worried and strapped for time and just gave in to the extortion, please let us know that.
- merek 3y agoI'm not in the US, is medical tourism common amongst US citizens? For non-urgent cases, why not travel to a country that offers cheap, quality health care? Financially seems justifiable, given that in the US, simple treatments and medical procedures can cost many 000s without any transparency ahead of time.
- theGnuMe 3y agoPeople go to Mexico all the time for medical and dental procedures.
- 1letterunixname 3y agoLouis Pasteur is rolling in his grave. The 3 shot rabies PEP vaccine costs $108 while in the US it costs $1000. Same shit, American patients just receive the privilege of paying more. https://www.who.int/news-room/fact-sheets/detail/rabies https://www.who.int/news-room/fact-sheets/detail/rabies
- wizofaus 3y agoSadly, my first reaction to the headline was "why shocked, I thought that sort of thing was standard in the US..."
- peter-m80 3y agoThe funny part is that US people are paying more (2x) for public health (not private) than the average european and receiving nothing in return... And they say public healthcare is communism. That shot in my country would cost 0. Like a cancer treatment or giving birth. Just 0. That's why we pay taxes. I'm glad I don't live in the US. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20consumption%20expenditures%20per%20capita,%20U.S.%20dollars,%20PPP%20adjusted,%202021%20or%20nearest%20year https://www.healthsystemtracker.org/chart-collection/health-...