Fainting in This Country Can Carry a $10,000 Price Tag

By Kirk Nielsen, Miller-McCune.com. Posted April 1, 2009.

The doctor had me recap my day. I live in Miami Beach. Flew to Minneapolis a few days ago. Didn't eat much today. Went for a three-mile run this afternoon (in 7-degree weather). Felt great afterward. Had a glass of wine at dinner a few blocks from the theater. Saw first half of White Christmas. Etcetera. The doctor mentioned something about blood sometimes "pooling" in people's legs when they sit or stand for extended periods of time. Then he left. Eventually, I was rolled upstairs to a room in the cardiac wing.

The nocturnal heart monitoring, followed by a midday echocardiogram, turned up nothing but a very healthy heart. Diagnosis: a case of dehydration-induced syncope. Dehydration (apparently caused by the cumulative effects of my Miami to Minneapolis plane ride, a long hot sauna at my parents' house, too much alcohol and coffee, not enough glasses of water and the desiccating air of a very cold, extraordinarily dry Minnesota winter) had reduced my blood volume. It pooled in my legs as I mingled in the Ordway lobby. There wasn't enough left to make it to my head. My low heart rate was from conditioning, the doctors said, because I tend to run for an hour about several times a week (in Florida). 

I was discharged, my sister picked me up, and off we went to enjoy a white Christmas. I put the ordeal behind me and managed to forget about my deductible -- until late January, when the bills started arriving at my Miami Beach apartment.

I received six of them from the hospital -- for "Emergency Department Visit," for "Initial Hospital Care," for "Facility Service," for "Hospital Discharge Day," and more -- and one from the ambulance company. They all added up to thousands of dollars. I'm still not sure how much I really owe.

To their credit, the folks at Blue Cross Blue Shield send their customers concise statements that summarize medical services rendered and billed. According to the one I recently received, the total cost of my fainting emergency: $10,260.

But lucky me. I owe only $2,267. "Your savings: $7,992.87," the summary states. Good thing I paid BCBS $1,500 in premiums over the past year to cover me for emergencies, one of which is now costing me an additional two thousand. 

Of course, I was relieved, if not grateful, to learn that I'm not liable for the whole $10,260, and thus not like guys who faint and don't have emergency coverage. But upon further inspection of my statement I noticed a curious and disturbing thing. BCBS had to pay only $2,582 -- about one-fourth -- of that $10,260. So who paid the balance of my $7,992 in "savings"? I wondered.

No one.

The $7,992 was all discounted because hospitals let BCBS and other big insurance companies pay lower rates than ordinary, underinsured Americans.

Similarly, the statement indicates that BCBS would have gotten a huge discount on, and had to pay only one-fourth of, the $1,409 ambulance bill that St. Paul Fire & Safety Service is now pressuring me to pay in full. I'm responsible for all but $17.65 of it, BCBS says, because the ambulance service was "out of network." BCBS has been kind enough to cover less than half of the $48 worth of oxygen I inhaled during my ambulance ride. Hence the check for $17.65 that BCBS mailed me. Some of the oxygen was "in network," I guess.

A few years ago, in order to control price gouging, Congress ordered up a national fee schedule for Medicare payments to ambulance services. According to that legally binding schedule, Medicare, like BCBS, would have to pay St. Paul Fire & Safety Service only about one-fourth of the $1,409 the company says I owe.

My date in Duluth gave me a break. When are America's health care givers going to give all of us one?

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