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> total cost of this service is between $1,500 and $3,000.

As a non-us person, I can't understand how medical bill works in the state.

Surely this is some marked up price for insurance?

In Hong Kong, this is HK$215 ( ~US$30) per shot. You can get everything you need under US$200

> Surely this is some marked up price for insurance?

Maybe. But they’ll absolutely try to get you to pay the full price. They might also demand payment up front. In either case you might be able to pay less if you negotiate, but maybe not.

If you’re insured you’ll pay between $0 and the full price of the discounted insurance rate (which this may already be close to—it depends where the numbers come from) depending on the insurance plan you have and how exactly it’s already been used. If you’ve already spent a lot of money “out-of-pocket” this year, you may have hit a limit that triggers 100% from insurance until the year’s up, usually a calendar year (try not to split a pregnancy over two calendar years…)

Then there’s whether the hospital’s in-network for your insurance, and maybe separately whether the doctors are and whether any testing facilities used are—that is, whether the insurance will pay for service from these providers (which may sure look to you like just one provider-entity, but might not be) at all. Sometimes almost nothing is in-network once you’re more than a couple hundred miles from home (and plenty within that radius might not be either), depends on the plan.

[edit] oh and if you ask anyone involved what you are going to have to pay, they’ll treat you like a moron. If you persist, they’ll send you on a wild goose chase of paperwork and billing codes and talking to more people who act like you’re a moron for thinking that was a reasonable question. You probably won’t ever figure it out, just have to wait for the bill. And then the inexplicable second bill. Then three more bills scattered over the rest of the year, two for entities you can’t identify without some phone calls, usually without even specifying on the bill WTF they’re asking you to pay for.

$30K for post exposure is even more crazy. Idk about Hong Kong, but in saner parts of Europe it's either free or like $15-$30 for the whole course.

The prices make no sense and nobody is quite sure why it's so fucked

But someone somewhere must be making a killing. Probably the middlemen

In the US, the pre-exposure course is now often just two doses, although three is possible (and used to be more common). The per-dose price at most pharmacies in the US is $400-500.

You'll generally need either a referral or a travel clinic consultation to get one (unless you work in a job where it's deemed essential to get the rabies pre-exposure course). In more reasonable states, you can do something like the Costco Travel Vaccine consultation service (which runs ~$40) and, if you indicate you are traveling to remote areas in certain countries, get a recommendation for the rabies vaccine course.

In some cases, insurance will cover the rabies pre-exposure course. But that is generally rare.

So, in general, best case if you just want to voluntarily receive the vaccine in the US? Around $800 if you live in a state that is reasonable and use an inexpensive travel consultation service (like Costco's offering). And, if you want the full three dose series? That will generally set you back around $1200 minimum.

So, for a lot of people in the US, the cost will be under the $1500-3000 range that was noted. However, it's still expensive, even in the best case in the US!

> Vaccines are for pre exposure.

That is correct for most vaccines. However, it's different for rabies. The vaccine is also effective post exposure (as long as it is given soon enough). Human rabies immune globulin (HRIG) is also part of the post exposure treatment, but the vaccine is critical here too.

Also of note: if one has received a course of rabies vaccinations as part of a pre-exposure treatment (high risk jobs, certain types of travel, etc), then the post exposure treatment consists of only a few extra doses of the vaccine (and not HRIG).

I travel to relatively remote places, and hike in those places, so I decided to pay for a course of the rabies vaccine a few years ago (the three dose course). If I do ever end up with a feral dog bite, for example, that makes treatment much easier - the vaccine is much more available globally than HRIG, and the timeframe is more relaxed if you've had the pre-exposure jabs. Granted, that immunity eventually wanes, so I'll occasionally need a booster to maintain enough protection.

I suspect ones medical provider or an urgent care center could do the same thing. My Dr has fit me in same day for something quick before and an urgent care might be only a $100 copay for the visit.

Also most people's deductable isn't 15k

Also its basically impossible to Google medical prices in America because actual negotiated prices are normally a fraction of the cash price.

> or an urgent care center could do the same thing.

It's a lifesaving treatment. People usually don't bother themselves with frugality in either price or expertise at this point; although, I'm glad you can have this high confidence in your General Practitioner and his schedule.

> Also most people's deductable isn't 15k

The question is "why don't we just vaccinate people?" So while you're saying is true you're actually validating my point. The cost difference is not noticeable to most people and the cost of just the pre exposure vaccine is pretty high to begin with.

> its basically impossible to Google medical prices in America

No, it's entirely possible, because customers discuss these things openly and you can find those discussions. You can't establish an exact price that has any predictive power but you can establish a common range. It's not as if this is some mystery that only the Gnostics can tame.

I believe rabies is one vaccine that is effective after exposure.

https://en.wikipedia.org/wiki/Rabies_vaccine#After_exposure

>> I got it about 10 years ago

> It's not a permanent vaccine, is it?

From Wikipedia [0]:

> Following administration of a booster dose, one study found 97% of immunocompetent individuals demonstrated protective levels of neutralizing antibodies after ten years

[0] https://en.wikipedia.org/wiki/Rabies_vaccine#Additional_dose...

with rabies, if you're infected with the virus, it doesn't become unstoppable deadly until it hits your central nervous system. At that point it's pretty much too late unless a near medical miracle of good luck saves you. before that, the virus spreads towards your CNS at a rate (If I remember right) of about a centimeter per day, and during all that time, you can still save yourself through prophylactic vaccination and (if you were never vaccinated before exposure) with a dose of immunoglobulin, which can be pricey anywhere.

As for why it's so insanely expensive in the U.S, not a fucking clue except to pass the responsibility on to the country's insanely byzantine medical billing and services systems.

In the country I live in (Mexico), the rabies vaccine (not immunoglobulin) costs about $50 per dose in a high-end private clinic and a dose of immunoglobulin about $200. There are also about 350 public health centers nation-wide that offer it for free if you're lucky enough to be close to one.

Do you know if those Mexican prices are available foreigners? I've thought about getting a rabies vaccine just for peace of mind as I often travel to weird places in weird ways.

If you visit Mexico, they certainly are. I'm not sure if they might be higher close to the U.S border (a common tendency for many products and services in Mexico, I suspect because of higher demand from American visitors) but anyone visiting any private clinic wherever in the country can simply pay for services at the same price charged to any local. These prices are often posted on CLINIC websites or publicity material, so it's usually easy to know if they're honestly being applied.

As for the quality of doctors and the authenticity of medicine in reputable private clinics, in my experience problems are exceptionally rare, Though language barrier might be an issue in some cases.

Not promoting anything specific here either, just describing personal experience from years of living here (and sometimes having needed medical services or medicines)

I think live attenuated vaccines produce a stronger and more durable immune response than inactivated vaccines.

Yeah this is the problem. And there is NO way to bypass the system and just get the vaccine if you want it. The only place that will give it to you is the ER. Thus forcing a 15k payment or a very large deductible payment. But yet, you can go to your vet and get it for your dog for 20 bucks. The u.s. system is totally jacked.