If you have been reading most of our articles, you should have realized by now that Rabies is one of our main concerns; which is also one of the biggest concerns for most international tourists visiting this beautiful little island. With so many stray dogs roaming free on the streets, it’s only natural to prevent the worst and prepare beforehand, although, like you might have read in our other articles on the issue, it’s been handled by the local government by administering routine Rabies shots to every dog in the island.

Still, it is always a good idea to check beforehand what your insurance plan covers in accordance to health care, and specifically how it works overseas. Will it cover your health expenses while you’re visiting another country? Which hospitals accept your insurance plan? What procedures should you follow to get you covered? You know; the technicalities. With different bureaucracy to face, it’s really important that you understand what to do in order to make it work.

As an international melting pot, Bali is swarmed with millions of foreigners every year, Whether you come from the UK, the EU, the USA, Asia or Africa, you may have different insurance plans according to the law of your respected countries. Although it might be different for each insurance companies out there, we think it should be safe to point out what regulations are set by your governments about health plan coverage.

First of all, though, what is Rabies, really? Rabies is a serious disease caused by a virus. It is mainly a disease of animals; but humans can get it when they are bitten by infected animals. At first there might not be any symptoms. But weeks, or even months after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis.

Human rabies is almost always fatal. Wild animals, especially bats, are the most common source of human rabies infection in the world. Skunks, raccoons, dogs, cats, coyotes, foxes and other mammals can also transmit the disease. However, between 16,000 and 39,000 people are vaccinated each year as a precaution after animal bites in the USA. Also, rabies is far more common in other parts of the world, with about 40,000 -70,000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases. Rabies vaccine is made from dead rabies virus which cannot cause rabies any more. When given to people at high risk, Rabies vaccine will protect them if they are exposed. It can also prevent the disease when given to a person even after they have been exposed. That’s why it’s important that you get one before going to a country where Rabies still poses a threat.

If you’re coming from the USA, there is a set of 10 categories of services that health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services. Plans must offer dental coverage for children, while dental benefits for adults are optional.

Treatment after a potential exposure to rabies consists of one dose of human rabies immune globulin and four doses of rabies vaccine over a 14-day period. The immune globulin and the first dose of rabies vaccine need to be given very soon after the bite or scratch. The additional doses of rabies vaccine are given on the third day after the first shot and on days seven and 14. In the United States, about 40,000 to 50,000 people are vaccinated against rabies each year, the CDC says.

Cost for the treatment varies, but it is not cheap. A course of rabies immune globulin and four doses of vaccine given over a two-week period typically exceeds $3,000, according to the CDC. That’s a bargain, however, for the cost per life saved from rabies, which ranges from $10,000 to $100 million, the federal health agency says. Fresno County Department of Public Health staff says the price for a 2-milliliter vial of immune globulin is $662, and a person typically needs more than one vial.

Rabies shots for a dog or cat cost a few dollars, but for humans, it is so expensive. A pre-exposure series of three shots costs about $900. Many insurance plans do not cover it. The emergency department bill for immune globulin shots, a first rabies vaccine and a tetanus shot: $25,509.50. The price of the immune globulin drove up the bill: 10 vials of immune globulin, for which the hospital charged $21,324.90.

In one case, the insurance company had negotiated rates with the hospital; which ended up with the company covering $23,089.50 off the hospital bill, leaving $2,250.89 of the total charges for the patient to pay. However, there is no set hospital charge for rabies treatment because no two cases are exactly the same. The hospital’s costs, and ultimately the charges, will vary depending on the amount of drugs used, whether surgery was needed, time in the hospital and other factors.

Second of all, who should get a Rabies Vaccine? Until recently, the conventional thinking among travel medicine professionals was that the length of the trip and the destination should be the main deciding factors. That is, pre-travel rabies vaccination was for people travelling to, or living in, a country with a high incidence of rabies for more than one month – particularly if they were at higher risk of animal bites because they‘re backpacking in rural areas, travelling by motorbike or bicycle, working with animals etc. For stays of less than a month, a warning to avoid contact with animals and to seek medical treatment urgently if bitten was thought to be enough.

There are some reasons behind this thought: Firstly, rabies deaths remain rare among travellers. This may be because rabies infection is usually slow to appear and most westerners do eventually get treatment after they get bitten, preventing infection. Yet an estimated 55,000 people die from rabies each year, according to the World Health Organisation, with most of its victims failing to access timely post-exposure treatment (or unable to afford it).

Secondly, the cost of the vaccine – around $300 for the 3 doses – is prohibitive. Travellers on a budget were reluctant to get it when they were already up for other travel immunisations to protect them against diseases considered a higher risk. Thirdly, rabies vaccine is administered over at least 3 weeks (the standard 0, 7, and 28 days can be accelerated to 0, 7, and 21 days). All too frequently, travellers don’t leave themselves the ideal 4-6 weeks to begin vaccinations prior to travel. All of which often puts the subject of rabies vaccination firmly in the dog house during pre-travel medical consultations.

However, our view of pre-travel rabies vaccination has changed. Recent scientific studies on travellers bitten by animals confirm that the length of stay is less critical than the destination itself when it comes to deciding who should consider pre-travel vaccination. The studies consistently show that more short-stay travellers (those overseas for less than a month) are being bitten, mainly by dogs, but also monkeys and cats. The most exposure with Rabies occur in Asia, particularly India, Indonesia, China, Nepal, or Vietnam (among the most popular destinations with travellers the world over). To make things worse, effective post-exposure treatment is often very difficult to obtain in many countries and, when available, it’s expensive.