One evening in mid-November, Sarba Aguda asked her 10-year-old daughter to accompany her to walk Percy, the family dog, around the block in their quiet neighborhood in Glen Ridge, New Jersey. She was hoping they could have a heart-to-heart about appropriate social media usage, but the walk took a disturbing turn when Aguda felt something rub up against the back of her leg.
“At first I thought it was a stray cat, but then I realized the animal was snarling and making noises and Percy reacted and started jerking at the leash, trying to get away,” Aguda said.
She realized it wasn’t a cat but a red fox. And instead of running away when she shouted at it, the fox just stared her down. Her daughter ran home for help while Aguda tried to get away.
When Aguda turned around to run from the animal, it nipped at the backs of her calves. As she reached her front door, her husband came out and was able to chase the animal off. But not before it left a mark on her leg.
Aguda called the police, who told her she should get treated right away for potential exposure to rabies, a virus that is almost always deadly. At first she held off because the wound on her leg seemed minor. But by the next day, the fox had attacked four other people in her area, prompting her daughter’s school to keep the children inside rather than releasing them for a planned early dismissal. Finally, the animal was captured and killed by the police. At that point, Aguda heeded their advice.
She first called her doctor’s office and a local urgent care center to see if they could provide the rabies shots she needed. When they said they couldn’t, she went to the emergency room at Mountainside Medical Center in Montclair.
After getting started on her course of treatment for rabies exposure, Aguda’s peace of mind was restored--that is, until she got the bill. Aguda’s husband, Chris, was still in shock over the nearly $24,000 price tag when he called in to the Brian Lehrer Show last month during a segment on #PriceCheckNYC, the health cost transparency project Gothamist is working on in collaboration with WNYC and ClearHealthCosts.
Mountainside billed Aetna, Aguda’s insurance provider, a total of $23,886.97. Most of that bill—$18,449.14—was for an injection of rabies immune globulin, a substance that’s critical to protecting someone in the immediate aftermath of exposure until their body starts to respond to the rabies vaccine. A course of treatment typically includes the immune globulin and four shots of the rabies vaccine, administered over a couple of weeks.
Under the contract that Aetna has negotiated with Mountainside, the initial $24,000 bill was reduced to $11,524.92. Of that, Aguda was charged $1,929.41--the remaining amount on her family’s deductible—and Aetna paid the rest.
It’s unclear how the hospital arrived at its original $18,000 price tag for the rabies immune globulin injection. The substance, which contains the blood of people who have been vaccinated against rabies, can be expensive to produce. But the average cost of the immune globulin, along with a full course of rabies vaccine shots, is around $3,800, according to the Centers for Disease Control and Prevention, which notes that some 55,000 Americans get this treatment every year.
A spokesperson for Mountainside Medical Center, which is owned by the hospital network Hackensack Meridian Health, declined to respond to an inquiry from Gothamist about why it charges so much for the potentially lifesaving shots. “In consideration of patient confidentiality we do not publicly discuss an individual’s care,” the spokesperson said, ignoring the fact that Aguda had given Gothamist written permission to reach out to the hospital for comment on the bill.
The spokesperson also declined to respond when asked if she could comment generally on what factors went into the charges.
“We are committed to assisting patients with financial, billing or insurance questions,” the spokesperson said. “Our practice is to have an advisor work directly with the patient to review services and charges as well as payment options or financial support.”
The CDC says the cost range for a course of rabies treatment is typically between $1,200 and $6,500. But Aguda isn’t the only one who has received a bill that’s much higher than that. The fact that emergency rooms, which typically charge extra fees, are often the only ones that can provide urgent rabies treatment only adds to these costs. In Aguda’s case, the hospital billed $2,993.55 just for emergency room care.
If Aguda lived in New York—with the exception of New York City—she likely would not have had to pay at all. New Yorkers outside of the city who might have been exposed to rabies are supposed to contact local authorities to get authorized for treatment. “With this prior authorization, it is likely that you will not have to pay for the cost of treatment,” the state Health Department website says. “Without prior authorization, you may be responsible for treatment expenses.”
Although New York City is exempt from paying for such treatment, it is not entirely rabies-free. The city reports that 24 animals in the five boroughs tested positive for rabies in 2019 (accounting for about 6.4 percent of the total number of animals statewide that tested positive for rabies that year).
Rabies incidents in NYC, 2019
New York is one of the few states where the government will cover the cost of post-exposure rabies treatment. Some states that previously provided such coverage have dropped it in recent years, in part because the cost of treatment is going up.
In New Jersey, “essentially it would be the individual’s responsibility,” said a spokesperson for the local Bloomfield, NJ, Health Department, which serves Glen Ridge.
Aguda’s husband has sought to contest the charges with Mountainside Medical Center but hasn’t been able to get them reduced.
“We’re fortunate that we can ultimately pay this, but $2,000 is really prohibitive for a lot of people,” Aguda said. “It’s not right. Rabies is basically a terminal illness. You don’t want to play around with that."
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Support for this work was provided by the New York State Health Foundation (NYSHealth). The mission of NYSHealth is to expand health insurance coverage, increase access to high-quality health care services, and improve public and community health. The views presented here are those of the authors and not necessarily those of the New York State Health Foundation or its directors, officers, and staff.
