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Teacher Billed $164,941 for Heart Attack; $108,951.31 Not Covered by Insurance

Read about the latest featured OUTRAGEOUS Medical Bill of the Month in Shots: Health News from NPR here

How could a teacher with health insurance be stuck with a medical bill more than twice his annual salary? Self-funding insurance plans are part of the answer. NPR writer Chad Terhune notes: "About 60 percent of people with employer health benefits are covered by self-insured plans, but many don't even know it, since employers typically hire an insurer to administer the plan and employees carry a card bearing the name of Blue Cross Blue Shield or another major insurer." Significantly inflated cost markups from the providing hospital are another part of the answer.

To learn about self-insured plans (plans where health services for workers are paid from the employer directly, rather than by employer-purchased insurance) and how federal law exempts self-funded plans from most state insurance laws and consumer protection regulations (including reserve requirements and mandated benefits) click here. Read more from the self-fund insurance business itself, here and here. Note how self-funding has led to the creation of subsidiary businesses created to protect employers from losses with “stop-loss” and other mechanisms. Without adequate governmental regulations and consumer protections, who will protect the insured health consumer from such outrageous costs? More importantly, without a form of Single Payer healthcare delivery, what will stop the creation of more symbiotic and parasitic profit-driven healthcare-related "insurance" schemes?

Four general but useful tips to fight inflated and unfair medical bills are provided at the end of the article, but the most important takeaway from this piece is this: until we secure a Single Payer system, the profit-driven health-related "insurance" racket will find more and more devious ways to enrich itself at the expense of consumers.

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