Ohio Employee Files $5 Million Health Insurance Claim

Aug. 23--BUTLER COUNTY -- A more than $5 million health insurance claim -- the largest ever handled by Butler County's insurance provider -- could impact the county's ability to get lower rates from other health insurance companies for at least a year and cost taxpayers and county employees more.

County officials won't release any details surrounding the health insurance claim, including when the claim was filed or what happened to the employee, citing health privacy laws.

Jim Davis, the assistant director of human resources for Butler County, said the claim was the highest ever handled by the county's insurance provider, the County Employee Benefits Consortium of Ohio. The consortium provides health care benefits for 26 counties in the state.

The county is protected from paying large sums in the event of a catastrophically high health insurance claim with stop-loss insurance, which covers up to $5 million worth of claims

"It was a claim that busted through their $5 million stop-loss threshold," Davis said.

County Administrator Charlie Young said no worker's compensation claims were filed as a result of the medical claim.

The claim comes around the same time the county is bracing for a 7 percent increase in the health insurance benefits provided to employees for next year.

During a County Commissioner meeting earlier this month, human resources officials estimated taxpayers will pay an extra $800,000 for health insurance benefits, while county employees themselves might, collectively, pay an extra $200,000 next year.

Commissioners directed the human resources department to look at a number of options, such as providing incentives for county employee spouses to select their own health insurance, to drive down health insurance premium costs for next year. County employees pay an average co-pay of 20 percent for medical care, Davis told commissioners.

"I'm not happy with the increase," Commissioner Don Dixon said. "Tell us all the different options we can do. We need comparisons to what the private sector is paying."

Finding a different health care provider is an unlikely option for the county to lower rates.

A handful of health insurance providers have refused to even give a bid on providing health insurance for the county because of the county's "claims experience," Davis said during the meeting earlier this month.

The more than $5 million health insurance claim will stay on the county's record for a period of 15 months, Davis said.

Health experts said its must have been a "truly unusual" case for such a costly claim.

Eric Seiber, an associate professor of health services, management and policy at The Ohio State University, said a $5 million claim is extremely rare. For example, the multi-million dollar claim dwarfs the cost of an open-heart surgery which, including both care and stay at a hospital, typically costs around $80,000, Seiber said.

"This is (a claim) that people would take notice of," Seiber said. "That's a lot of money ... It would have been severe. It must have been something truly unusual."

Seiber said the final bill payments the health insurance provider makes on the claim will probably be lower than $5 million because the provider will negotiate with care providers to lower the costs.

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