Laura Burwell was weeding her backyard vineyard last summer when she was bit by a rattlesnake. She rushed to a Chico hospital for antivenin and morphine, which eased the pain during an overnight stay.

Then came the unexpected sting of a $73,000 hospital bill -- and shock upon learning her health insurance would cover a mere $3,000.

"It was one of the longest, most stressful periods in my life," said Burwell, a self-employed wine shop owner whose financial security was shattered by the snake bite.

"I'm probably a typical insurance purchaser," said Burwell, who had to scramble to find a solution for the steep bill. "I believed what I was told by the person selling it to me."

While much of the American health care discussion has focused on providing coverage to the country's 46 million uninsured, there is growing concern about millions more who are underinsured, or whose policies require them to pay thousands of dollars out-of-pocket before coverage kicks in.

The debate has also raised questions about affordable health insurance premiums and minimum coverage standards in an industry that markets a dizzying array of plans.

"There are products that are so limited in what they cover, or are so deceptive in what they say they cover, that they are junk masquerading as coverage," said Anthony Wright, director of Health Access California, an advocacy group.

"It may sound good, but underneath, it provides a false sense of security. People need to know what they're getting," Wright said.

Three competing federal proposals attempt to address underinsurance concerns by requiring that insurance companies provide minimum coverage. While a final overhaul package is months away, each proposal also seeks some simplification of insurance coverage options for consumers.


One proposal would create four categories in which the myriad commercial plans would be classified. Each level would have to meet government-defined benchmarks for coverage, but companies would be free to package coverage according to their competitive needs.

The proposal would cap consumers' out-of-pocket expenses at $5,000.

Insurance companies say these efforts could come at a cost to flexibility of choice.

Today, choosing a plan is "a very tall order," said Marian Mulkey, policy analyst with the California HealthCare Foundation. "Even well-informed, smart and motivated consumers can't reasonably be expected to absorb all the details about every benefit feature."

Enticed by pitches for inexpensive coverage, some consumers buy ill-fitting policies, or go into deals with unrealistic expectations. Some don't ask the right questions or neglect the fine print.

"The consumer should be informed when they are out there looking for a health insurance plan. … They need to know what's important to them. They should know what they're getting," said Nicole Kasabian Evans, the spokeswoman for the California Association of Health Plans.

"We do support simplifying choices for consumers, but we need to preserve flexibility so they can find the right plan for them that is affordable," she said.

Two state agencies regulate the state's insurance providers. The Department of Managed Health Care oversees health maintenance organizations -- HMOs. The Department of Insurance enforces regulations on a host of insurance companies, from automobile to health. But neither has the authority to fully dictate the products insurers can sell.

Critics say the industry does not do enough to help consumers choose.

Insurers say they have policies to fit every need, but the myriad choices can sometimes lead to confusion. As a result, some consumers don't end up with coverage they expected.

The California Legislature, troubled by so-called junk insurance, has taken up the issue. Assemblyman Dave Jones, D-Sacramento, introduced a bill that would establish categories of coverage and standardizes how companies describe their plans, which could make it easier for consumers to compare coverage costs and benefits.

It also would cap consumers' out-of-pocket expenses at $10,000. That doesn't sit well with insurers, who say a cap could keep them from covering their costs.

Uncertainty over federal legislation in the works is pushing state legislators to act.

"We have to move forward in California," said Jones, who introduced the bill on behalf of Health Access California.

A similar measure was part of Gov. Arnold Schwarzenegger's failed effort two years ago to overhaul California's health care system.

Most Americans get coverage through employers, but a significant number -- 2.5 million in California -- purchase health insurance through the individual market.

Without employer subsidies, premiums for comprehensive coverage can be costly. As a result, some people take their chances and choose not to buy private health insurance. Others purchase low-premium policies with high deductibles and bare-bones coverage.

Burwell, 60, thought she was getting a deal four years ago when her COBRA coverage ran out and she found a low-cost, low-deductible plan. She bought a policy from a friend -- an insurance broker who, she said, was looking out for her.

Burwell's policy was underwritten by a Texas-based firm that initially charged her a $281 monthly premium. She had a $500 deductible and was promised $50,000 in hospital coverage.

She didn't realize the hospitalization coverage was capped at $3,000 a day.

"There I was thinking that I would be covered for $50,000," Burwell said.

The hospital later reduced the bill to $7,400 under a state program that limits charges for qualified low-income patients -- a program she learned about on the Internet.

"If I weren't Internet savvy, I would never have been able to have found out about the information," she said.

Other consumers, such as Cathy Lee-Everett, 43, a self-employed acupuncturist, found they have few choices but low-premium, high-deductible plans

"I feel restricted because of my budget," she said.

With a $2,500 deductible, she forgoes some health services because she would rather not spend the money. Her 3-year-old daughter also has a $2,500 deductible.

When she bought her policy years ago, she was enticed by its low premium, but the price tag has since escalated. Coverage for herself and her daughter costs $444 a month.

"I got on the plan because I was worried about something catastrophic," Lee-Everett said, admitting she never fully understood her coverage.

"It's pretty hard to figure out," she said. "Even my doctors can't figure out how much I pay until they bill the insurance company."

Call The Bee's Bobby Caina Calvan, (916) 321-1067.

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