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Rich&Sylvia

Medicare and the unknown medical expenses

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What part of Medicare or which supplemental plan would cover the cost of anti-venom for a snake bite?

Rabies exposure?  Brown recluse bite?

I can't seem to find any information specific to these things that rarely happen but can be financially catastrophic. 
Anyone have first or second hand knowledge on the subject?

 

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Basically, the Medicare part A covers "in patient" care such as hospitals and skilled nursing facilities. Medicare part B covers things like a doctor visit or emergency clinic care where you are an "outpatient." Your coverage is not defined by what the care is for or by what your medical diagnosis is, but by who supplies it. In the example you give, if you were hospitalized that hospital bill would be under part A but if at an emergency clinic it would be part B. 

We never really give any thought to which part is covering the care given, only to what we pay "out of pocket." Since Medicare normally pays 80% of things and because there are a few things not covered, we do buy a supplemental policy, commonly known as Medigap coverage. That comes in different levels as well and at different premiums but the purpose is to cover what Medicare does not. 

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All three items listed would presumably get you to the a hospital ER, especially the first two.   I had a Brown Recluse bite and, while the wound area did ulcerate, never had to have extensive treatments - others have more severe reactions and wold be in a Hospital ER.  We are like Kirk - never worry about which part covers, just what we are going to have to pay out-of-pocket.  Plus we are careful around strange animals, don't reach underthings in the desert, etc.

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6 hours ago, Rich&Sylvia said:

Rabies exposure? 

If the animal is recovered, it may take time for the testing to confirm that the animal had rabies. There is a window of up to several days to start treatment. Post exposure treatment involves multiple injections, usually at a doctor's office. If you are concerned about and feel you are at risk of exposure to rabies, talk to your doctor. You may be able to get pre-exposure treatments that will reduce the number of post exposure treatments required. During my working years, I had both pre-exposure and post exposure rabies treatments and never went to an ER to get them.  

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9 hours ago, Rich&Sylvia said:

What part of Medicare or which supplemental plan would cover the cost of anti-venom for a snake bite?

Rabies exposure?  Brown recluse bite?  .....

 

Under Medicare it doesn't matter why you need treatment (except specific exclusions below), if you need a doctor or hospital, its covered, at the 80% they cover. Coverage of the remaining 20% and the Medicare annual deductible and any over charges could be covered by your Suppl Policy depending on which type you chose. Its all the same whether its due to a snake bite, a car crash, an ATV crash, a disease, or simply getting sick.

There are a few things Medicare does not cover, read that specific list here ...

https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b

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Just had treatment. My medicare with supplement; In the hospital outpatient treatment, everything covered by medicare B, including drugs used. Supplement picks up the deductible and co-pay. After sent home with prescription, Plan D covered the Pharmacy. That part hurts my wallet. You do have to be careful that the provider accepts medicare consignment. Some don't. Some can charge a % premium over what medicare covers. So there are some black holes.

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7 hours ago, Sehc said:

.... You do have to be careful that the provider accepts medicare consignment. Some don't. Some can charge a % premium over what medicare covers. So there are some black holes.

For doctors who accept Medicare patients, but have not signed on to accept Medicare Assignment (agreeing to accept whatever the Medicare rate is as payment in full), they are allowed to bill up to 15% higher than the approved Medicare rate. These are called Part B Excess Charges, which your Supplement Plan covers if you have a type G or F supplement, otherwise its an out of pocket cost to you.

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I believe the snake bite anti-venom would be covered under your Part D coverage, just as the rabies treatment medications were covered for me. The administration of the medications would be under your normal ER, outpatient, or hospitalization Part A or B coverage.  You would have to check your Part D formulary to see which tier it's in to see what your plan would cover. The standard snake bite anti-venom "CroFab" is not cheap though, so expect it be in a high tier if covered at all, and several doses are typically needed.

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On ‎11‎/‎25‎/‎2018 at 7:01 AM, Rich&Sylvia said:

What part of Medicare or which supplemental plan would cover the cost of anti-venom for a snake bite?

Rabies exposure?  Brown recluse bite?

I can't seem to find any information specific to these things that rarely happen but can be financially catastrophic. 
Anyone have first or second hand knowledge on the subject?

 

Are you planning to get bit?  The chances are slim. :)  If you're on Medicare and have a supplement your medical treatment will be paid.   If you're hospitalized then the anti-venom will be paid.

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Not planning on getting bit.  But (pre-medicare) we have had rabies exposure and the required shots - which are not as historically painful as in the past.  (We were not bitten but were technically exposed.)
However, getting the rabies vaccines into the hands of our doctor was the trick.  Insurance at the time would only cover the shots (about $3,000) if the product was in stock at our  healthcare facility.

Typically, those types of vaccines are not kept "on the shelf" and have to be special ordered and fall into a coverage loophole.  We had some insider advocate help and transported the vaccines ourselves to the doctors office - and were able to work around the cost.

Rattlesnake anti-venom treatment can run upwards to $200,000. in billing.  (Snopes article)
Co-pay becomes very important.  Once bit, twice shy.


 

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There is a difference, before the fact, and after the fact. After getting bitten, it is medicare a or b. Before the fact, it is vaccination. That could be out of your pocket.  I had to get my rabies vaccination when working animal control. It wasn't anything like $3000. 

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43 minutes ago, Rich&Sylvia said:

Not planning on getting bit.  But (pre-medicare) we have had rabies exposure and the required shots - which are not as historically painful as in the past.  (We were not bitten but were technically exposed.)
However, getting the rabies vaccines into the hands of our doctor was the trick.  Insurance at the time would only cover the shots (about $3,000) if the product was in stock at our  healthcare facility.

Typically, those types of vaccines are not kept "on the shelf" and have to be special ordered and fall into a coverage loophole.  We had some insider advocate help and transported the vaccines ourselves to the doctors office - and were able to work around the cost.

Rattlesnake anti-venom treatment can run upwards to $200,000. in billing.  (Snopes article)
Co-pay becomes very important.  Once bit, twice shy.


 

It looks like your situation only called for the preventive rabies vaccine treatment, not the full post-bite protocol. Post-bite, as soon as possible you're given shots of rabies immune globulin, with half the shots administered directly into the wound site. I can tell you from personal experience that those shots can be very painful! The other half in the butt not so much. Following that, you're given the standard multi-week 4 shot vaccine protocol that's about the same as getting a flu shot every week or so. On the good side, you only get the globulin injections once and never need them again, even if bitten again, since the vaccine has taken effect by then. You only need vaccine booster shoots for repeat exposures. The current protocol is much less painful than the former belly shots though, or so I'm told...

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The latest US news about snake bite care is more than a year old (found one less from AU) so good information is difficult to find but you seem to have found a really flagrant case. Wikipedia says that there are about 7000 venomous snake bites in the US each year. Since the story you found is now more than 3 years old, I suspect that it isn't especially typical or accurate for today. I do know someone who received rattlesnake antivenom about 30 years ago and I know that his healthcare plan did cover it. I also know that his coverage was a typical employer supplied plan and that no special information was asked for. Most recently, I was a park volunteer in Joshua Tree Natl. Park and part of the communication for the rescue of a rock climber who was bitten by a rattler in early 2007. He was treated in a local hospital and no mention was made of outrageous costs.

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1 hour ago, Kirk W said:

The latest US news about snake bite care is more than a year old (found one less from AU) so good information is difficult to find but you seem to have found a really flagrant case. 

I subscribe to a local facebook group here in AZ - a couple of people reported the costs of treatment for rattlesnake bites - with billing over $100K in both instances.  As I recall, one of them reported paying only about $3,000. out of pocket after insurance kicked in.

 

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2 hours ago, Rich&Sylvia said:

.... - a couple of people reported the costs of treatment for rattlesnake bites - with billing over $100K in both instances. ....

 

$100,000 is on the low side for a serious bite in recent years. The only rattlesnake antivenom approved for use in the US, CroFab, has gone from $2000 to almost $20,000 per vial over the last 10 yrs. It takes 2 to 6 vials to treat a serious bite where venom was injected. So, Yes making sure your Part D Rx plan covers antivenom could be important if you frequent a high risk area.

The cost of that exact same CroFab antivenom in all the rest of the world is $20 per vial. Like most drugs the cost in the US is extremely higher than the rest of the world. Part of that increase is justified by the high cost of performing required Gov testing to get approved, Gov fees, liability insurance, etc. But a big portion of it is just pure greed, especially when the company has a monopoly like the makers of CroFab had for many years. After years of significant price increases, its cost is finally coming down since a competitor is about to have their new antivenom approved by FDA. There is nothing complicated or expensive about producing antivenom. Its made the same way its been made for 100 yrs. Snake venom is injected into goats, the goats body produces the antivenom , its collected from the goat & purified..

Edited by JRP

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