As John Downie hovered on the edge of sleep in the predawn darkness one morning last summer, he heard the faint flapping of wings. And then he felt something soft and furry on his forehead.
“It was a bat," he said. “When I opened my eyes, it was making loops over the bed.”
For the next couple of days, Downie, his wife, Julie Scaramella, and their 21-year-old son Ian would catch frightening glimpses of the flying mammal as it darted around their Newton home, usually around dusk or dawn.
Finally, with one well-placed swing of a tennis racket near an open door, they managed to get their creepy guest outside.
Then came a battle of a different sort: How to get their health insurance plan to fully cover the cost of preventative treatment for rabies — one of the world’s most deadly viruses, which can be carried by bats.
Downie and Scaramella are particularly attuned to health care costs because they’re self-employed and have a high-deductible plan with Tufts Health Plan that costs them almost $20,000 a year in premiums. But coverage doesn’t kick in until they have spent $6,600 out of pocket.
But there is one big exception: preventative care.
Downie and Scaramella say they made multiple calls to Tufts Health Plan about the bat and whether preventative treatment for rabies would be covered. They told me they were led to believe Tufts Health Plan classified the rabies vaccine as preventative.
Downie and his son went to Newton-Wellesley Hospital’s urgent care facility. While neither had obvious bite marks, Downie had certainly come in contact with the bat and Scaramella and Ian feared they may have been touched by it, too, while they slept.
The doctor pronounced it “highly unlikely” anyone was infected since only a small percentage of bats carry the virus. But he also said if they were infected and didn’t get the vaccine that day, they almost certainly would succumb to a slow and painful death. About 45,000 people get treated for exposure to rabies annually, but only one or two get the virus.
The doctor also mentioned that bats drool and lick, and their saliva can cause infection via an open mouth, nose, or skin laceration or condition. (View this video on the Mayo Clinic website, if you dare.)
Downie quickly opted for a two-step process: injections of immunoglobulin, which gives the immune system an immediate boost to fight infection, as well as the rabies vaccine. It’s the protocol recommended by the Centers for Disease Control.
Then, in October, Downie received a bill for $6,240. Stunned, he called the hospital, which attributed it to a mistake in how the treatment was coded. (Five-digit CPT codes, which stands for current procedural terminology, are the language medical providers and insurers use to communicate; consumers should get familiar with them, too).
But new bills kept coming. Finally, Tufts Health Plan said that the rabies vaccine was considered preventative — and not subject to the deductible — but the immunoglobulin was not.
“Why didn’t someone tell us that at the time?” Downie asked. He and Scaramella said they aren’t sure what they would have done if they had known the full cost.
I don’t think the vaccine/immunoglobulin distinction was made clear to Downie and Scaramella by their insurer or their providers. It’s a testament to the complexity of health care.
In his first call to Tufts Health Plan about the bat, Downie had asked about costs, according to a recording of the call provided by Tufts Health Plan. Downie was told that his only out-of-pocket costs would be for an office visit, without any discussion of the vaccine or immunoglobulin.
Downie, already freaked out by the bat, may have been too eager to believe his insurer. In retrospect, he should have asked exactly what the treatment would entail, confirmed that all of it was considered preventative, and gotten it in writing. But that sounds unrealistic to me. Was he supposed to have checked the CDC protocol before making his call?
Because the family had not yet met its $6,600 deductible, they were billed for the full cost of the immunoglobulin treatment.
Another thing that created confusion is that Scaramella was billed less than $100 for the same vaccine plus immunoglobulin treatment by Atrius Health, a physician-led health care organization that she went to because her primary care physician is there while her husband and son went to Newton-Wellesley Hospital.
But it turns out Atrius simply made a mistake by failing to bill Scaramella for the immunoglobulin. A representative said this week that the decision was made to waive the bill because too much time has lapsed.
I think Tufts Health Plan should waive Downie’s $6,240 bill for immunoglobulin. If it treats the vaccine as preventative, it should do the same for the other half of the CDC protocol.
Consumers of health care need to be on their toes. That means becoming familiar with the basic outlines of their plans and knowing how to drill down for the details when needed.
As one health care professional put it, “You gotta know what plan you have and how it works.”
To her surprise, Judy Murphy recently spotted an $800 credit on her Citibank credit card statement.
Last fall, Murphy got scammed into purchasing two Google Play gift cards after receiving e-mails from what she thought was a friend asking her to buy them for her, but what turned out to be from her friend’s hacked account. And I wrote a column about it.
I thought Murphy brave for offering her story as a cautionary tale, knowing she would be dismissed by some as a naive victim of scammers.
So I’m delighted that Citibank stepped up and did the right thing.