What should a patient do if their insurance requires a copay for rabies vaccination and immunoglobulins after a dog bite?

Rabies Post-Exposure Prophylaxis Should Never Be Delayed Due to Insurance Copay Issues

A patient requiring rabies vaccination and immunoglobulins after a dog bite should proceed with treatment immediately regardless of insurance copay concerns, as rabies is nearly 100% fatal once symptoms develop but almost 100% preventable with proper post-exposure prophylaxis. 1

Urgency of Rabies Post-Exposure Prophylaxis

Rabies post-exposure prophylaxis (PEP) is a medical urgency that should not be delayed for any reason, including financial considerations:

• Administration of rabies PEP is considered a medical urgency, not a medical emergency, but should be initiated as soon as possible after exposure 2
• PEP should ideally begin within 24 hours of exposure, though there is no absolute time limit 1
• Even with significant delays after exposure, PEP should still be administered as it may prevent disease 1

Standard Post-Exposure Protocol

For previously unvaccinated individuals, the complete PEP regimen includes:

1. Immediate wound cleansing: Thorough washing with soap and water for at least 15 minutes 1
2. Human Rabies Immune Globulin (HRIG): 20 IU/kg body weight, infiltrated around and into the wound(s) 2
3. Vaccination: 4-dose regimen of rabies vaccine administered on days 0,3,7, and 14 1

Options for Addressing Insurance Copay Issues

1. Proceed with Treatment and Address Financial Concerns Later

• Given the fatal nature of rabies, treatment should never be delayed
• The CDC and FDA guidelines make no provisions for delaying treatment due to financial concerns 2, 3

2. Contact Public Health Authorities

• Local or state public health departments should be consulted for assistance 2, 3
• Many health departments can:
  • Provide rabies vaccine and immunoglobulin directly
  • Offer financial assistance programs
  • Help negotiate with insurance companies

3. Hospital Financial Assistance

• Most hospitals have financial assistance programs for life-saving treatments
• Patient should request to speak with a hospital financial counselor immediately

4. Insurance Appeals Process

• While receiving treatment, the patient can:
  • File an expedited appeal with their insurance company
  • Request a peer-to-peer review between their physician and the insurance medical director
  • Emphasize the life-saving nature of the treatment

Important Considerations

• Never delay treatment: Rabies is almost invariably fatal once clinical symptoms appear 1
• Correctly administered PEP is nearly 100% effective in preventing rabies 1
• Common errors in PEP administration that reduce effectiveness include delayed initiation and incomplete vaccination 1

Special Circumstances

If the biting animal is available for observation or testing:

• For domestic dogs and cats that can be observed for 10 days, PEP may be discontinued if the animal remains healthy 3
• If laboratory testing confirms the animal is not rabid, PEP can be discontinued 3

Conclusion

The risk of developing rabies, which is almost universally fatal, far outweighs any financial considerations. The patient should proceed with the complete PEP regimen immediately while simultaneously pursuing options for financial assistance. Public health authorities should be contacted immediately for guidance on both medical and financial aspects of rabies PEP.