In preparation for my trip to Nepal this past month, I received quite the course of vaccinations, which I mostly arranged at my local Walgreens. Highest on the list was hepatitis A, which is a concern in Nepal but not something people are typically vaccinated against here in the mothership, as well as typhoid, Tdap (very important), and even a “booster” of polio, because although the 4-shot course we receive as children (if our parents love us) is usually enough, polio is alive and well in Nepal and, yeah, get shrekked, you basically need everything.
But there were a few others, too, namely rabies. The reason why this is a concern in Nepal is that dogs are not typically vaccinated against it, as people don’t own dogs the way we do and are not therefore responsible for them. My guide told me about the religious significance of dogs, and although I don’t have the full background on that, you find doggos sleeping everywhere in Nepal, perfectly chill. They don’t typically bother people, but when they attack each other at night, you’d think the whole town could hear it. I knew that I would be in some extremely remote regions, so I decided to get vaccinated against rabies. If you get bit by something, it still ends your trip as you have to receive treatment at a hospital, but having received the vaccination beforehand, time is on your side for getting to a hospital that can treat the potential for rabies infection, and you need far less treatment. I decided it was worth the cost to me. And that cost was about $1,200 total for 3 shots.
Is that a lot of money? Hell yeah, that’s a lot of money. But insurance wasn’t going to cover it. It’s not like traveling to Nepal is medically necessary, either. But while hepatitis A can fuck your liver up and polio is usually cleared by your body, rabies will kill you, hands-down. The risk of contracting rabies is very low, but when you do get it and it isn’t treated in time, you die. I don’t know about you, but when I plan to go hiking in extremely remote regions with a known population of unvaccinated canines, I personally like the idea of paying some cash to hedge my bets. So I did.
But this isn’t even the main story, today. No. I also received a vaccination for a mysterious disease known as Japanese encephalitis, caused by excessive anime consumption. Just kidding. It travels by mosquito and like the other diseases, can seriously fuck you up. The risk in Nepal is apparently highest during and immediately proceeding the monsoon season, and I was going to be traveling in Nepal during the early monsoon season. But mosquitos aren’t a great concern in the midlands and the mountainous regions, so I had not scheduled the shots through Walgreens. But when I finally relented to a travel consultation at a large hospital facility to make sure I had medication for other ailments, the doctor there recommended it to me, and there was just enough time to get two treatments within the medically accepted timeframe. So I went with it.
Now, I knew they were expensive. I fully expected that each shot would cost roughly $350, so about $700 total for two shots. But then I got home from my trip and expense summary turned up.
Pharmacy services: $700. Vaccination: $300. Times. Two.
$2,000.
See, my shitty Obamacare plan basically didn’t accept any travel clinic as in-network, so when I went to Big Hospital for a travel consult, they made me sign a waiver indicating that I planned to pay out-of-pocket. I wasn’t too concerned about this, as I really wanted to do the responsible thing and make sure I had medication for things like traveler’s diarrhea. When the JE vaccine was recommended, I just rolled with it. I had paid $1,200 for rabies vaccination, so how bad could it be? Turns out really bad, because our health care system is part of the clown world.
I was actually deeply confused by the charges at first – I thought they had double-charged me for pharmacy services. After talking with my insurance, though, which was actually very helpful, I learned that the “pharmacy” charge was for the vaccine itself, and the vaccination charge was the fee for a nurse shooting it into my arm. Yes, I paid $300 for a nurse to inject me with a vaccine. And then I paid another $300 a week later for a nurse to inject me with the vaccine again. When things like this are in-network, I believe they are typically negotiation down, but since this was out-of-network, nobody cared. It’s like going to Kohls on one of the rare days their sales aren’t active, because we all know the sale price is the real price. Sigh.
Before I start wallowing in a pool of my own self-pity, I really want to make something clear: my trip to Nepal was absolutely amazing. Yeah, there were a few times I legitimately feared for my life, but ultimately, everything worked out. I don’t even know how to celebrate that to it’s full potential. I mean…everything worked out. I made it up both passes, I even made it without the use of diamox. I got traveler’s diarrhea twice, but was ultimately perfectly fine because I had that amazingly effective prescription on hand. It’s difficult to put a price on a successful journey. Something I’ve wanted to do for years and years, a dream finally realized, actualized, lived. So while it’s rather unpleasant to come home to a $2,000 summary [no bill yet], I’ve also been saving money in HSAs for the past 5-8 years, and the cost is just a more-painful-than-usual scratch, tax-free nonetheless. So I know that it doesn’t make sense to be too resentful.
But I am bothered by my naivete. As far as I’m aware, Walgreens doesn’t really have an extra charge for administration. The hepatitis A vaccine was like $100 and insurance covered it entirely, and that was that. I keep wondering how much cheaper it might have been to arrange the JE vaccine through them. For what it’s worth, I also received an adjuvanted Hep B vaccine as a precautionary booster, and when I am due for dose two of that, I think I will arrange it locally.
But at the same time, I’m so glad I took the vaccinations into my own hands instead of leaving them all up to a travel clinic, because I think I got some pretty sweet deals overall. Hep A, polio, and Tdap cost me nothing, I think typhoid was like $100. Considering my insurance is cheap, I think I’ve actually gotten decent value from it, for one of the first times in my life. But you don’t get something for nothing, especially not in healthcare.
I’ll swallow my pride and pay the money. But in the world of finances, you need to be a bit shrewd when it comes to healthcare costs, and I really wish there was a way to study this sort of thing. Considering health is one of the most expensive things in life, it behooves you to pay attention to it. Which is also perhaps my reminder why I should lose weight and eat healthier, because if you think a $2,000 vaccination costs money, imagine the cost of lifestyle diseases that brings you to the hospital for constant “fixing”. From that perspective, I think $2,000 for preventative care is maybe not the worst of things in the world.