美国国家公共电台 NPR Cat Bites The Hand That Feeds; Hospital Bills $48,512（在线收听）

DAVID GREENE, HOST:

Here's one reality in our health care system - prices that can be unpredictable and really, really high. Now, patients are told to be consumers, to shop around and find the best prices. But in some situations, you really can't do that. You are stuck at a hospital, which can charge you really whatever they want to. This is at the heart of our latest Bill of the Month segment Dr. Elisabeth Rosenthal from our partner Kaiser Health News is here to help us try and understand and dissect a huge bill that was sent to us from a listener in the Florida Keys. Dr. Rosenthal, welcome back.

ELISABETH ROSENTHAL: Thanks for having me again.

GREENE: Well, who are we talking about today?

ROSENTHAL: We're talking about a bill from Jeannette Parker. She's 44, a biologist. And she was exposed to rabies or was afraid she might've been. So, as you can imagine, she was rather alarmed.

GREENE: Yeah. I mean, that can be fatal if you don't take care of it, right?

ROSENTHAL: Absolutely. Luckily, there are really effective treatments. But it involves getting some immune globulins and then, basically, a rabies vaccine, which is exactly what Jeannette did.

GREENE: OK. Well, let's hear her story. And then I want to come back to you and ask you some questions. But her story comes to us from reporter Nancy Klingener from our member station WLRN in South Florida. She went to visit Jeannette.

NANCY KLINGENER, BYLINE: Jeannette Parker is an animal lover. That's obvious from the menagerie at her home in the Florida Keys.

JEANNETTE PARKER: Two dogs, three cats, sulcata tortoise - he's 80 pounds - poultry, fish tanks, bearded dragon (laughter).

KLINGENER: That last one's a lizard. Her cats are normally pretty shy around company, but one of them comes out to greet us while another streaks under the couch.

(SOUNDBITE OF CAT MEOWING)

PARKER: That is Breakneck Sally because she'll walk between your feet and trip you. So...

KLINGENER: Parker's love for animals has become part of her career. She's a wildlife biologist for the state of Florida, so she monitors the populations of endangered species like the Key deer and the lower Keys marsh rabbit. But her love for animals got her in trouble last September. She was on the mainland near Everglades National Park, and she saw a kitten by the side of the road.

PARKER: It's pretty common for people to dump animals in that area right outside the park.

KLINGENER: The kitten was skinny and looked like it was sick. Parker had a packet of tuna in the car and pulled over to give it some food.

PARKER: And in the process, he just grabbed onto my finger while he was eating. So he broke the skin on my finger.

KLINGENER: Parker says the kitten wasn't trying to bite her.

PARKER: And it was just a tiny, little scratch. And I was embarrassed to go to the emergency room over my tiny scratch. But he did break the skin, and I was bleeding. And there had been a rabies alert in the county that month. A couple of cats and quite a few raccoons tested positive and one otter also.

KLINGENER: So Parker went to the emergency room at Mariners Hospital just up the Overseas Highway from her house. She got the immunoglobulin injection that protects against rabies until the rabies vaccination takes effect.

PARKER: Yeah, I went home - just no big deal. I was in and out of there really fast.

KLINGENER: And then the bill came. The total cost was $48,000.

PARKER: And I thought it was a joke. I just couldn't believe it. It had to be a mistake. That was what I was thinking. I sort of laughed, and I was upset at the same time. Yeah, I couldn't believe it. For a shot, it was $48,000.

KLINGENER: Parker says she eventually stopped by the hospital to get an itemized bill, but they didn't drop the price. She had to pay $344 to cover her deductible, then 10 percent of the bill. Parker says no one at the ER said anything about cost when she was there. If she had realized how much it would be, she would've waited until Monday and gone to the county health department. The experience has given her a new perspective on money.

PARKER: I like to gauge everything now by how much my rabies shot cost. So my boss got a new roof on his house, and it cost $20,000. And I was joking that you couldn't even get half a rabies vaccination for that.

KLINGENER: One thing has not changed because of this experience. She's still an animal lover.

Would you hesitate now before pulling over if you saw a sick animal on the side of the road?

PARKER: (Laughter) Probably not.

KLINGENER: And now with the protection of her rabies vaccine, she says she might be even more inclined to stop the next time.

GREENE: That story comes to us from Nancy Klingener from member station WLRN. She was reporting from Plantation Key in Florida. I'm still with Dr. Elisabeth Rosenthal from Kaiser Health News. Dr. Rosenthal, $48,000 for a shot. And I'm just trying to do the math here. Jeannette had to pay 10 percent. I mean, she was responsible for more than $4,000.

ROSENTHAL: That's right. And, you know, rabies immunoglobulin is expensive, but many hospitals would charge about $3,000 for that. So the pricing here is pretty out of line.

GREENE: Well, why is the hospital able to charge, I mean, like, more than 10 times what it should be or what other hospitals charge?

ROSENTHAL: Well, you know, hospital prices are pretty arbitrary. There's little rhyme or reason for how they set their prices. And, hey, look, this is a medical service you can't refuse. You might've been exposed to rabies. So you're kind of a sitting duck, and they can basically charge whatever they want. The funny thing is when we looked into this, we discovered that the price of the rabies medicine Jeannette got dropped from about $7,000 a unit to about $1,650 a unit just a month or two later. So that shows you how crazy it is.

GREENE: Oh, so this hospital started charging dramatically less for this shot shortly after Jeanette was treated.

ROSENTHAL: Yes. And when we asked the hospital, they said, oh, well, we periodically adjust our prices. But I'd like to note that on January 1 this year, hospitals had to suddenly reveal their prices according to a new federal regulation. So they knew that that maybe-too-high $7,000 price would be out in the public as of January 1. So maybe they were trying to make adjustments before a new year came.

GREENE: Oh, wow. So the hospitals were trying not to look outrageous when they were actually required...

(LAUGHTER)

GREENE: ...To start telling people what they were charging.

ROSENTHAL: Well, that's one theory. You know, so the price dropped about 60 percent. And can you imagine if, like, you went to buy a Prius one month and it was $30,000, and the next month, on the first of the month, it was suddenly $10,000? I mean, that would be outrageous. But that's what happens in medical care all the time.

GREENE: I certainly couldn't imagine if I paid the $30,000 (laughter), and then saw it drop, like, the next day. What can you do, I mean, if you're bitten by an animal, and you go to the hospital, and you're desperate, and you don't know that they're charging this much?

ROSENTHAL: Since, for the moment, there's no kind of price-drop guarantee in health care, I think what you need to do, first of all, is protect your health. So you do need to go to the hospital. You need a rabies immunoglobulin. You should know that many public health departments will hand it out. So if it's during the week, you can check there first. And then, you know, try and go to an in-network hospital so at least you have better negotiating power.

GREENE: Is anything going to change for Jeanette? Can she get some money back?

ROSENTHAL: The problem with - in health care is that once you've spent, it's very hard to get money back. But her insurer is negotiating this. And I do hope that, you know, they look at this price drop and say, hey, what gives; we - she shouldn't be responsible for that big of a bill.

GREENE: Well, we'll hope for the best for her. Dr. Elisabeth Rosenthal, thanks as always.

ROSENTHAL: Thank you.

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