A Fainting Spell After A Flu Shot Leads To $4,692 ER Visit

by Phil Galewitz January 28, 2019

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Matt Gleason fainted at work after getting a flu shot, so colleagues called 911 and an ambulance took him to the ER. Eight hours later, Gleason went home with a clean bill of health. Later still he got a hefty bill that wiped out his deductible. Logan Cyrus for KHN hide caption

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Logan Cyrus for KHN

Matt Gleason had skipped getting a flu shot for more than a decade.

But after suffering a nasty bout of the virus last winter, he decided to get vaccinated at his Charlotte, N.C., workplace in October. “It was super easy and free,” said Gleason, 39, a sales operations analyst.

That is, until Gleason fainted five minutes after getting the shot. Though he came to quickly and had a history of fainting, his colleagues called 911. And when the paramedics sat him up, he began vomiting. That symptom worried him enough to agree to go to the hospital in an ambulance.

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He spent the next eight hours at a nearby hospital — mostly in the emergency room waiting area. He had one consult with a doctor via teleconference as he was getting an electrocardiogram. He was feeling much better by the time he saw an in-person doctor, who ordered blood and urine tests and a chest X-ray.

All the tests to rule out a heart attack or other serious condition were negative, and Gleason was sent home at 10:30 p.m.

And then the bill came.

The patient: Matt Gleason, who works for Flexential, an information technology firm in Charlotte. He is married with two children.

Total bill: $4,692 for all the hospital care, including $2,961 for the ER admission fee, $400 for an EKG, $348 for a chest X-ray, $83 for a urinalysis and nearly $1,000 for various blood tests. Gleason’s insurer, Blue Cross and Blue Shield of North Carolina, negotiated discounts for the in-network hospital and reduced those costs to $3,711. Gleason is responsible for that entire amount because he had a $4,000 annual deductible. (The ambulance company and the ER doctor billed Gleason separately for their services, each about $1,300, but his out-of-pocket charge for each was $250 under his insurance.)

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Service provider: Atrium Health Pineville (formerly called Carolinas HealthCare System-Pineville), a 235-bed nonprofit hospital in Charlotte and one of more than 40 hospitals owned by Atrium.

Medical service: On Oct. 4, Gleason was taken by ambulance to Atrium Health Pineville’s emergency room to be evaluated after briefly passing out and vomiting following a flu shot. He was given several tests, mostly to check for a heart attack.

What gives: Fainting after getting the flu vaccine or other shots is a well-described phenomenon in the medical literature. But once 911 is summoned, you could be facing an ER work-up. And in the U.S., that usually means big money.

The biggest part of Gleason’s bill — $2,961 — was the general ER fee. Atrium coded Gleason’s ER visit as a Level 5 — the second-highest and second-most expensive — on a 6-point scale. It is one step below the code for someone who has a gunshot wound or major injuries from a car accident. Gleason was told by the hospital that his admission was a Level 5 because he received at least three medical tests.

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Gleason argued he should have paid a lower-level ER fee, considering his relatively mild symptoms and how he spent most of the eight hours in the ER waiting area.

The American Hospital Association, the American College of Emergency Physicians and other health groups devised criteria in 2000 to bring some uniformity to emergency room billing. The different levels reflect the varying amount of resources (equipment and supplies) the hospital uses for the particular ER level. Level 1 represents the lowest level of ER facility fees, while ER Level 6, or critical care, is the highest. Many hospitals have adopted the voluntary guidelines.

David McKenzie, reimbursement director at the American College of Emergency Physicians, said the guidelines were set up to help hospitals charge appropriately. Asked if hospitals have an incentive to perform extra tests to get patients to a higher-cost billing code, McKenzie said: “It’s not a perfect system. Hospitals have an incentive to do a CT exam, and taxi drivers have an incentive to take the long way home.”

The guidelines don’t determine the prices hospitals set for each ER level. Hospitals are free to set whatever prices they want as long as their system is consistent among patients, he said.

He said the multiple tests on Gleason suggest the hospital was worried he could be seriously ill. But he questioned why Gleason was told to stay in the ER waiting area for several hours if that was the case. It’s also not clear if Gleason’s history of fainting and overall good health was considered.

Blue Cross and Blue Shield of North Carolina said in a statement that the hospital “appears to have billed Gleason appropriately.” It noted the hospital reduced its costs by about $980 because of the insurer’s negotiated rates. But the insurer said it has no way to reduce the general ER admission fee.

“We work hard to negotiate discounts that reduce costs for our members, but costs are still far too high,” the insurer said. “This forces consumers to pay more out of pocket and drives up premiums.”

Itemized ER Bill (PDF) Itemized ER Bill (Text)

Gleason in fighting his bill actually got the hospital to send him its entire “chargemaster” price list for every code — a 250-page, double-sided document on paper. He was charged several hundred dollars more than the listed price for his Level 5 ER visit.

“In this specific example, the price of admission to the ER was more than $2,960. That was on top of more than $1,000 for the medical procedures actually performed. We won’t significantly bring down health care costs until we address the high prices like these,” BCBS-NC said in the statement.