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She was encouraged to take a rabies shot after an encounter with a bat. Now a Charlottesville woman faces a $30K bill.

After a concerning encounter with a bat in her house last summer, a Charlottesville woman is trying to get answers about why the rabies shots recommended for her cost more than $30,000.

Jocelyn Diaz says she’s been getting increasingly stern letters from Martha Jefferson Hospital’s parent company, Sentara Health, telling her to pay her portion.

“I got this invoice and called Sentara and said, ‘I’m sure you made a mistake,’” Diaz told The Daily Progress. “There’s no way this could be this extraordinary amount.”

It’s not the first time Sentara has been accused of overcharging patients. Five years ago, Charlottesville residents learned the company had been charging them the highest health insurance rates in the country. Since then, the Department of Justice has been poring over the company’s financial records, reporting late last year that a Sentara subsidiary known as Optima Health may have unfairly pocketed $665 million by exploiting the monopoly it held in Virginia for two years.

Sentara, Diaz says, told her there was no mistake with her bills, and a Sentara representative directed The Daily Progress to an online price list that appears to confirm the prices which Diaz was charged.

As the North Downtown resident tells the story, she was watching a movie with friends one evening last July when she suddenly saw a bat flying around her living room. She was able to shoo the winged mammal from the dwelling without touching it, but the next day her qualms caused her to seek guidance.

“The department of health said, ‘The odds are that you didn’t get bitten while you slept, but if you did get bitten while you slept, the bite marks are really, really small and you wouldn’t have seen them,’” she said. “‘But if you did get bitten while you slept and it’s rabid, it’s fatal; so you need to go get a vaccine.’”

While only two Virginians have contracted the fatal disease since 2009, according to the Blue Ridge Health Department, Diaz took the advice to get the shots. She would need five in all, and while the health department could handle the last three, the first two must be administered in an emergency room, so she drove to Martha Jefferson Hospital.

“One shot in one leg and one in the other,” she said. “I was in and out within 30 minutes.”

As it turned out, this initial emergency room visit was the most expensive part of her treatment. One of those two shots was a special type of human blood plasma called rabies immunoglobulin which provides a super dose of antibodies for protection after possible rabies exposure. The cost for that single item was $23,000.

“Immunoglobulin is expensive,” Costi Sifri, an infectious disease specialist at the University of Virginia, told The Daily Progress. “It is astronomical.”

Sifri said that harvesting the plasma requires human subjects.

“You have to find individuals who have a robust immune response to the rabies vaccine — a high amount of antibodies in their blood — and package it up, so it’s a costly medical product,” he said.

Then there’s the rabies vaccine itself. Although it’s essentially the same thing that dogs routinely receive for about $35, the providers of vaccines for humans routinely charge more.

A Charlottesville-area Walgreens said that pharmacy charges can run an uninsured person about $1,500 for a nonemergency — i.e., no immunoglobulin — rabies regimen. Martha Jefferson charges more.

In addition to the immunoglobulin charge, Martha Jefferson sent Diaz bills totaling more than $4,900 for two shots of the vaccine. Emergency room service fees for her two visits moved the total up another $1,600.

“When you set foot into an emergency room, you have no idea what you’ll end up owing,” Sue Null, a professional patient advocate, told The Daily Progress.

“What matters,” said Null, who runs New York-based medical billing advocacy firm Systemedic, “is what the contracted rate is with the insurance company. And you don’t know that when you walk in.”

Diaz’s invoices show her insurer, Anthem, was able to secure more than $7,000 in price reductions and then made nearly $16,000 in payments to Sentara on her behalf. That still left over $7,000 that Diaz owed.

Her portion is more than the total treatment cost estimated by the Centers for Disease Control and Prevention. In 2019, when it last updated its guidance, the CDC estimated that the vaccination series Diaz received should range from $1,200 to $6,500, with an average of $3,800.

By contrast, the cost of Diaz’s regimen was $30,321, eight times higher.

“How could it be this much?” asked Diaz. “It just feels extraordinarily expensive.”

Diaz remembers going over her bills with a representative from Anthem.

“He found massive discrepancies between what is typically charged and what was charged by Sentara,” said Diaz.

And yet a reporter’s inquiry with Charlottesville’s other major hospital, the University of Virginia Medical Center, found similar pricing — although it’s impossible to precisely compare totals without learning the exact dosage of immunoglobulin administered.

Diaz said her Anthem representative let her stay on the telephone line while he called the Sentara billing office to make sure there were no mistakes. Everything checked out.

“He said, ‘We’ve already paid our portion,’” said Diaz.

That leaves Diaz looking at an out-of-pocket bill of more than $7,400, according to invoices she showed to The Daily Progress.

One bright note for her is that the local health department administered two of her shots and charged just $368 each, with no facility or other fees, and that cost was fully covered by Anthem.

“I’m feeling like this is really worrisome,” said Diaz. “I kept thinking this bankrupts a family.”


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