A Tourist Ended Up With A Wild Bat In Her Mouth — And Nearly $21,000 In Medical Bills

In retrospect, Erica Kahn realizes she made 2 large mistakes.

The first was choosing to temporarily forgo wellness security erstwhile she was laid disconnected from her job.

The 2nd was screaming erstwhile a chaotic bat later landed connected her face.

The bizarre brushwood happened past August, while nan Massachusetts resident was photographing nan nighttime entity during a picnic astatine nan Glen Canyon National Recreation Area successful Arizona. Kahn, now 33, noticed a fewer bats flying astir but didn't interest astir them — until 1 flew up to her and sewage tangled betwixt her camera and her face.

She screamed, and portion of nan bat went successful her mouth. She doesn't cognize which portion aliases for really long, though she estimates it was only a fewer seconds. "It seemed longer," she said.

The bat flew away, leaving Kahn shaken.

She didn't deliberation nan animal had bitten her. Regardless, her father, who is simply a expert and was walking pinch her, said she should spell to a infirmary wrong a time aliases truthful and statesman vaccinations against rabies.

Figuring she would beryllium covered arsenic agelong arsenic she obtained security earlier going to nan hospital, Kahn said, she recovered a argumentation online nan time aft nan bat incident. She said she called nan institution earlier she bought its argumentation and was told services related to an mishap aliases "life-threatening" emergency would beryllium covered.

Kahn went nan adjacent time to a infirmary successful Flagstaff, Arizona, wherever she started rabies prevention treatment. Over nan adjacent 2 weeks, she received nan remainder of nan rabies shots astatine clinics successful Arizona and Massachusetts and astatine a infirmary successful Colorado.

Then nan bills came.

The aesculapian procedure

Kahn received a full of 4 doses of nan rabies vaccine. The doses are administered complete nan people of 14 days. Along pinch her first vaccination, she received 3 shots of immunoglobulin, which boosts antibodies against nan virus.

Rabies is typically transmitted done bites aliases scratches from an infected animal. Experts urge precautionary measures erstwhile a personification has been perchance exposed to rabies, because erstwhile nan neurological illness causes symptoms, it is fatal. The Centers for Disease Control and Prevention says postexposure rabies curen has reduced nan number of quality fatalities to less than 10 a twelvemonth successful nan U.S.

The last bill

According to explanation-of-benefits statements, Kahn owed a full of $20,749 for her attraction astatine nan 4 facilities. Most of nan charges were from nan infirmary wherever she was first treated, Flagstaff Medical Center: $17,079, including $15,242 for nan rabies and immunoglobulin shots.

The billing problem: Most security doesn't commencement immediately

Kahn's argumentation did not salary for immoderate of nan services. "The required waiting play for this work has not been met," said an explanation-of-benefits missive she received successful December.

Kahn was stunned. "I thought it must person been a mistake," she said. "I conjecture I was naive."

When Kahn was laid disconnected from her occupation arsenic a biomedical technologist past summer, she had nan action to temporarily enactment connected her erstwhile employer's security nether a COBRA plan, astatine a costs of astir $650 a month. But arsenic a young, patient person, she gambled that she could get by without security until she recovered different job. She figured that if she needed aesculapian care, she could quickly bargain a backstage policy.

According to nan Centers for Medicare & Medicaid Services, those who suffice for COBRA must beryllium fixed astatine slightest 60 days to motion up — and if they do, nan sum applies retroactively. Kahn, who was still wrong that play astatine nan clip of nan incident, said precocious that she did not recognize she had that option.

The argumentation she purchased aft nan bat episode, which costs astir $311 a month, was from a Florida institution called Innovative Partners LP. Documents Kahn provided to KFF Health News opportunity nan argumentation has a 30-day waiting period, which "does not use to benefits regarding an mishap aliases nonaccomplishment of life."

Kahn said that aft receiving announcement that her claims were denied, she called nan institution to inquire really she could entreaty and was told a expert would person to record paperwork. She said she wrote a missive that was signed by a expert astatine Flagstaff Medical Center and submitted it successful March but was incapable to scope doctors astatine nan different facilities.

Kahn said she was fixed conflicting answers astir wherever to nonstop nan paperwork. She said a typical pinch nan institution precocious told her it had not received immoderate appeals from her.

Benefits statements Kahn received successful early July show Innovative Partners had not paid nan claims. The institution did not respond to requests for remark for this article.

Sabrina Corlette, co-director of nan Center connected Health Insurance Reforms astatine Georgetown University, said astir wellness sum plans return effect connected nan first time of nan period aft a customer enrolls.

"The security companies — for bully logic — don't want group to hold to motion up for sum until they are sick," she said, noting nan premiums patient group salary thief equilibrium nan costs of paying for wellness care.

The Affordable Care Act requires insurers to screen preexisting conditions, specified arsenic glucosuria aliases bosom issues. But that doesn't mean they person to salary for curen of an wounded sustained soon earlier a personification enrolls successful coverage, she said.

Corlette, who reviewed a little benefits overview provided by Kahn, said nan argumentation appears to person been a limited, "fixed indemnity" plan, which would salary only group amounts toward treatments per time aliases different play sloppy of full expenses incurred. Such plans person been astir for decades and aren't required to meet ACA standards, she said.

But she said moreover if Kahn had bought broad wellness insurance, it astir apt wouldn't person covered curen received truthful soon aft she purchased it.

David Shlim, a recreation medicine master successful Wyoming who studies rabies, said Kahn made nan correct prime by promptly seeking treatment, moreover though she didn't consciousness nan bat wound her. The illness is deadly, and nan truth that nan bat went into her rima meant she could person been infected from its saliva, he said: "You could hardly person a much nonstop vulnerability than that."

Shlim, who precocious co-wrote a national advisory astir rabies prevention, added that patient bats don't usually alert into people, arsenic nan 1 successful this lawsuit did. The animal's entanglement pinch Kahn suggests it could person been sick, perchance pinch rabies, he said.

Rabies prevention curen is overmuch much costly successful nan United States than successful astir different countries, Shlim said. The priciest portion is immunoglobulin, which is made from nan humor plasma of group who person been vaccinated against rabies.

The curen is often administered successful infirmary emergency rooms, which adhd their ain steep charges, Shlim noted.

The resolution

Kahn said she is employed again and has bully wellness security but is still facing astir of nan bills from her misadventure astatine Glen Canyon. She said she paid a expert measure from Flagstaff Medical Center aft negotiating it down from $706 to $420. She said she's besides arranged a $10-a-month scheme to salary disconnected nan $530 she owes for 1 of her rabies shots astatine different facility.

She said she plans to proceed appealing nan denials of costs for nan remainder of nan bills, which full much than $19,000.

In a connection connected behalf of nan Flagstaff infirmary — wherever Kahn incurred nan highest charges — Lauren Silverstein, a spokesperson astatine Northern Arizona Healthcare, said nan wellness strategy does what it tin to limit costs. "We person little expertise to power nan prices of captious supplies that we usage to dainty patients, including pharmaceuticals, biologics, diagnostics and aesculapian devices made by different companies," she said.

Silverstein said nan infirmary needs to support immunoglobulin connected manus to forestall rabies, moreover though specified cases are comparatively uncommon and nan supplier is expensive.

The takeaway

COBRA security policies, named for nan Consolidated Omnibus Budget Reconciliation Act of 1985, alteration galore group who suffer job-based sum to salary to enactment connected those plans temporarily. There is simply a 60-day model to take COBRA coverage, and erstwhile a beneficiary pays for it, nan sum applies retroactively — meaning that aesculapian attraction is covered moreover if it occurred erstwhile nan personification was uninsured.

Corlette said Kahn's predicament illustrates why group request to make judge they person wellness insurance.

She said group who suffer employer-based sum should see enrolling successful individual security plans sold connected national aliases authorities marketplaces. Many group who bargain specified policies suffice for important ACA subsidies to thief salary premiums and different costs.

"If you are losing your job, COBRA is not your only option," Corlette said.

Kahn wishes she had signed up for security sum erstwhile she was laid off, moreover though she felt assured she would find different occupation wrong a fewer months. "That's a very large instruction I learned nan difficult way," she said.

Her wildlife brushwood did not destruct her emotion of nan outdoors. She moreover sees joke successful it.

"I cognize what bats sensation for illustration now. It's an earthy, saccharine benignant of flavor," she joked. "It's really a beautiful funny communicative — if it weren't for nan horrible aesculapian measure that came pinch it."

Bill of nan Month is simply a crowdsourced investigation by KFF Health News and The Washington Post's Well+Being that dissects and explains aesculapian bills. Since 2018, this bid has helped galore patients and readers get their aesculapian bills reduced, and it has been cited successful statehouses, astatine nan U.S. Capitol, and astatine nan White House. Do you person a confusing aliases outrageous aesculapian measure you want to share? Tell america astir it!