Fainting in America

Kirk Nielsen takes the pulse of the nation's emergency health care costs by passing out and getting gouged.

There's really no good time or place for a blackout, though some are significantly worse than others. Mine, one subzero evening in downtown St. Paul, Minn., last December, fell solidly on the inauspicious side of the spectrum.

The Level 2 lobby of the Ordway Center for the Performing Arts was teeming with people waiting for the second half of a fine production of Irving Berlin's White Christmas to begin. I was standing with my mom, sister and her three young-adult kids. Through the windows of a dazzling curtain-wall that spans the front of the trapezoidal building, I was admiring the golden lights on the canopy of trees in the park across the street. On the warm side of the glass, a professional trio of carolers had just finished a short intermission set. I was in a good mood; a fantastic woman in Duluth was expecting my call after the show to finalize plans for our first date the next night.

Suddenly, I felt weirdly lightheaded, so I turned to hasten to my seat. I took three steps, got the spins and took a nosedive, just missing the edge of a wine and coffee bar. Upon impact, I regained some consciousness and sat half-sprawled with my elbows on the carpet. A short-haired middle-age woman was crouching next to me, asking me if I knew my name, what day of the week it was, where I was. I did, which eliminated the possibility of stroke. "You blacked out ... I'm not a doctor ... That happens to me ... You should lay down," I recall her saying.

Assuming the dead man's pose in the Ordway lobby sounded fairly embarrassing, so I resolved to head for one of the lobby's posh benches several paces away. With someone's help, I got to my feet, and within two steps, a heavy wave of dizziness nearly sent me back down. I made it to the bench and sat, feeling exhausted and nauseated, and exchanging glances with the horrified faces of my mom and sister. I hoped my nieces and nephew were inside watching the rest of White Christmas, not their uncle's freak show.

There was talk of an usher who was also a paramedic. He — a polite young man in a dark suit — appeared and took my blood pressure, which was very low as was my pulse. He said calmly that one option was to call an ambulance. I was afraid, I thought I might be dying, I was thinking about my deductible. The number "$2,500" flashed through my mind. Or was that my maximum "out of pocket"?

I knew for sure that I was enrolled in a $129-per-month emergency and hospitalization plan with Blue Cross Blue Shield of Florida. Like everyone, I'd heard that a trip to an emergency room could cost several grand.

"I can't afford that," I muttered.

"Now isn't the time to worry about money," my sister responded, slightly scolding.

Then my eyes rolled upward into my skull as I blacked out again, my chin dropping to the top of my chest and the rest of me still just sitting there.

Moments later, I awoke from a frenzied dream, intensely disoriented, then realized I was still on the bench. The usher was looking at me. "You did it again," he said. Not certain I wasn't in the early stages of some kind of gradual heart failure — I had felt some weirdness in my chest before my sprawl on the carpet — I consented to the ambulance ride.

Within a few minutes I was rolling feet-first on a stretcher, into the elevator, out into the subzero air and aboard the rescue truck. As I recall they affixed an intravenous tube into my arm and asked me to open my mouth so one of them could toss in some tiny nitroglycerine pellets, which dilate the blood vessels. "I bet you don't wear those shoes in Miami," one of the paramedics joshed, referring to a pair of (my dad's) old brown rubber jobbies that clashed badly with my black wool suit pants. Then they put an oxygen mask over my mouth.

Soon I was in an emergency room bed at United Hospital in downtown St. Paul, still connected to an IV while nurses further hooked me up to an EKG and drew blood from my arm to start testing for heart attack enzymes.

Within an hour came the impression from my emergency-room doctor, a serious, trim, capable-looking man. I had suffered syncope, a manly term for fainting. The question now, the doctor continued, is why. There were many possible causes of syncope. "When your heart rate drops to 40 all of a sudden and you pass out, it's a good idea to find out what's going on," he said tersely. Thus, I would be spending the night in the hospital, having my heart monitored and my blood analyzed.

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?