Interesting trivia - health insurers kind of don't care about these big bills, despite what most people think: https://www.propublica.org/article/why-your-health-insurer-d...
higher bills means more money insurance companies can skim off the top without patients objecting. direct costs are basically pass-throughs to policy holders. the risks are higher but execs are in it for salaries and bonuses, so that exhibits the principle agent problem.