A 10-year look at stock market movements for five major insurance companies, including WellPoint, Cigna, Unum, Allstate and AIG, reveals an industry on the rise. While profits have seemingly soared, local insurance agents and others paint a grim picture of health care costs amidst already stifling gas and food prices.

'Definite problem'

Randy Cheek with Nationwide in Clemson, who predominantly works with five or six insurance companies to provide coverage, said, "Basically, if you need it, we can get it for anybody."

That is, if one can afford it.

“It’s expensive now," he said. "Just looking at my own, I’m amazed at how much it went up.”

Highlighting numerous demographics of people, he said those who are overweight, use tobacco products or are in their senior years will pay more. Others, even in their formative years genuinely needing coverage because of a medical condition, find it increasing difficult to cover the costs.

“It's just really expensive, and I tell anybody on a fixed income and trying to have health insurance now, I really feel sorry for them," Cheek said. "It’s tough right now. It’s really tough.”

“It’s out of control," he added. "Something needs to happen."

Addressing how the health insurance industry has measured up against other businesses in the current struggling economy, Gene Atkins with Gene Atkins & Associates of Seneca, said the country has a "definite problem with our health care coverage for Americans" and came short of defining the insurance industry as financially strong.

"I have the unfortunate job sometimes to sit across from someone who needs health insurance and can’t get it,” he said. "Because their height and weight are not in the limits of the insurance company, but they can get coverage, but it will exclude a situation that they need the insurance for.”

‘Face the facts’

While Atkins said his office has always offered preferred provider organization (PPO) plans, health maintenance organization (HMO) plans are still part of the insurance landscape.

Cheek explained that HMOs tend to be cheaper, but patients are often limited to where they can be seen, while PPOs offer wider treatment options at a higher expense. His office offers both, including other plans like health savings accounts, in which the insured can deposit funds into an account to be used for future medical needs.

Greg Fischer, vice president of marketing and sales with Blue Cross Blue Shield of South Carolina, said his company has “the largest network in the state” of in-network providers, which include all hospitals in the state and more than 9,000 physicians.

Under HMO plans, Fischer said patients can “receive some very preferential pricing” and can obtain a higher level of managed care because of a partnership existing between providers. The disadvantage is that only a portion of hospitals and physicians, some of which compete against each other, are enrolled in HMO plans. Blue Cross’s HMO subsidiary is called Blue Choice.

Some costs for non-group plans are as follows:

• Individuals seeking coverage outside of insurance available through an employee, monthly premiums range from about $145-$250 with a $1,000 deductible for a healthy 30-year-old male.

• For a family of four, costs range from about $445-$875.

Laura Duvall, an agent with the Seneca State Farm office, recommended sticking with a group plan.

“We don’t sell a lot of health (insurance) to be honest with you because it’s so expensive for people," she said. "... The best way to go is through group insurance with your company.”

While the various plans and the companies behind them do ensure medical care for many, agents said the crux of insurance companies’ interests lies elsewhere.

“Let’s face the facts," Atkins said. "Insurance companies are in business to make a profit, bottom line, but they aren’t going to have a bunch of people to insure knowing they will not make a profit."

When asked if insurance companies deny and grant coverage based on a list of conditions a potential customer may have, Cheek said, "Yeah. What they’ll do is companies will go in and rate certain illnesses, and they’ll exclude certain things if you have a pre-existing condition."

He added that some people with a pre-existing condition may be granted coverage after a certain waiting period.

Fischer said at Blue Cross, pre-existing conditions defined under the Health Insurance Portability and Accountability Act (HIPAA) look back six months at patients’ medical history. If a person can show 12 months of “creditable coverage” through an employer without a 63-day break in coverage, the patient can come under a plan even with a pre-existing condition.

“The government has set that to say, ‘Here’s what you have to do at least,” Fischer said. “If you didn’t have creditable coverage, we can deny that coverage for a year, which is standard” under HIPAA.

Top 10

But what if the year waiting period is too long and the illness too severe?

A report by Washington, D.C.-based American Association for Justice ranked the 10 worst insurance companies for consumers based on a "comprehensive investigation of thousands of legal documents and financial filings." It found Allstate, Unum, AIG, State Farm and Conseco to be at the top of the list.

In a release issued Wednesday by the organization, the actions of Unum, which ranked second behind Allstate, were said to be "even more shameful considering the type of insurance it sells: disability."

"Unum’s behavior was epitomized when it denied the claim of a woman with multiple sclerosis for three years, stating her conditions were 'self-reported,' contrary to doctors’ evaluations," the release said. "In 2005, Unum agreed to a settlement with insurance commissioners from 48 states over their practices."

As for Allstate, the release said: “’While Allstate publicly touts its ‘good hands’ approach, it has instead privately instructed its agents to employ a ‘boxing gloves’ strategy against its policyholders,’” said American Association for Justice CEO (chief executive officer) Jon Haber. “‘Allstate ducks, bobs and weaves to avoid paying claims to increase its profits.’”

The release made these concluding points based on the findings: “ The insurance industry takes in over $1 trillion in premiums every year. It has $3.8 trillion in assets, more than the GDPs of all but two countries.” and “The CEOs of the top 10 property / casualty firms earned an average of $8.9 million in 2007. The CEOs of the top 10 life / health insurance earned an average of $9.1 million.”

On consumer minds

Cheek said many are being forced today to make choices between food, gas and medical care, given the nation’s economy.

“Everybody’s being affected by it,” he said. “People that are in the situation I just described, they’re not even thinking about buying insurance right now.”

“You come to feeding your family or buying health insurance, what are you going to do?” he added. “You’re going to feed your family. That’s what anybody would do.”

On a positive note, Fischer said at Blue Cross based on feedback he receives, many in the working-class age demographic, between about 25 and 60 years old, have requested greater transparency from insurance companies and are beginning to want to take a greater role in managing their own care. He said some are looking toward the future and investing in plans like health savings accounts.

“I think they’re starting to get more involved with consumerism,” he said. “... That group is starting to at least understand, ‘Hey, I’d like to have some money and have some choices that I can spend it on.’”

He said Blue Cross in January 2009 will begin offering plans geared toward a younger, first-time market of patients. The plans would feature lower premiums to encourage that demographic to get insured for less, thus allowing patients to be treated at doctors’ offices, rather than more expensive emergency rooms. The plan would be more cost-efficient for both the provider and patient.

“We need to make sure we have price points that young adults can qualify for,” Fischer said.

Many who aren’t insured don’t consider health insurance until they need it, Duvall said. She recommended obtaining coverage and holding onto it.

“The best thing to do is get it while you’re healthy,” she said. “Same thing with life insurance. Get it while you’re young and healthy and keep it. That’s if you can afford.”