Health insurers have made an enticing pitch to local governments across the country: When your workers see doctors outside your health plan’s network, costs can balloon, but we offer a program to protect against outrageous bills.
Cities, counties and school districts have signed up, hoping to control the costs of their medical benefits.
Then come the fees.
In Shelby County, Tenn., the insurer’s charges for administering the program climbed last year to $1.3 million — more than the county budgeted this year for long-term disability insurance for all of its roughly 6,000 employees.
In Hoboken, N.J., the charges sometimes exceeded the amount paid to doctors for providing treatment. And in a stretch of California’s Central Valley where two counties share a health plan, the fees unexpectedly quintupled in one year to more than a quarter-million dollars, contributing to a plan deficit.
From southern Florida to the Pacific Northwest, local governments have paid similar fees, often with little awareness that their taxpayer dollars have become a lucrative revenue stream for some of the nation’s largest insurers, according to a review of documents obtained in two dozen public records requests and interviews with city and county officials and benefits consultants.