COLUMN ONE : Navigating the Maze of Insurance : Even for Americans who have coverage, the cost of health care is soaring. Choosing a policy can be difficult--and frustrating.

The people you are about to meet should be breathing sighs of relief. They have health insurance. They are not among the 35 million Americans who must live without it.

But these days even the haves are routinely confronted by uncomfortable choices, reminders that America’s patchwork system of health insurance is creating increasingly painful inequalities.

There is Leo Frischman, the owner of a Hollywood messenger service, who is shopping for a traditional “indemnity” policy that will let him go to any doctor he chooses--all the while fretting about the fact that most of the men and women who work for him no longer have insurance.

There is Frank Cicero, a self-employed Anaheim draftsman who recently had to give up his family doctor of 30 years because his new insurance is a “preferred provider” plan, in which he is restricted to a list of physicians approved by his insurance company. He is lucky to have that. His last policy was cut off after heart surgery, and his wife had to come out of retirement and take a lesser job to obtain family coverage through her employer.

There is Henry Berliner, an aerospace mechanic from Encino who enjoys complete coverage for himself and his family--no deductibles, no co-payments--through a health maintenance organization. His premium: just $4 a week under a contract his union negotiated--a once commonplace deal that workers are finding rarer.

What follows are personal portraits of how the insurance system works. They underscore a mounting dissatisfaction among the medically insured who many social critics believe will be more politically powerful than those outraged over the plight of the uninsured.

Leo Frischman runs Fast Delivery messenger service out of a converted wood-frame home where his father once ran the same kind of business. He has 30 employees. He used to pay for their health insurance.

“It was worth it to get the top employees,” he said.

Then, in the mid-1980s, when premiums began soaring, he began requiring employee co-payments. Today, new workers who want insurance through Fast Delivery’s group policy must pick up the full $140-a-month premium. After six months, Frischman will pay a third of the cost; after one year he will pay half. For workers who have been with the company two years or more, he will pay two-thirds of the premium.

Still, only about 10 workers, most of them drivers whose pay averages $450 a week, are covered. Many say they cannot afford even a share of the premium, Frischman said.

“I worry about it, but if you don’t have the money, what can you do?” said Stephanie Brokop, 21, who takes delivery orders. Even though Frischman would pay half of her premium, “I can’t afford it. All the bills I have are saying ‘no,’ ” she said.

Frischman, a socially conscious, devoutly religious man, said the situation tortures him. He became a supporter of the presidential campaign of Sen. Robert Kerrey, (D-Neb.), the only candidate who made national health insurance his top issue.

“It’s a disastrous situation,” he said.

Frischman pays more than $700 a month for a “preferred-provider” policy that covers him and his family. He has wanted to shift to another company to save money, but believed he would not be able to find a company willing to cover his wife, who for two years has had an undiagnosed neurological problem that causes blackouts. In an increasingly vigorous effort to cut costs, insurance companies commonly refuse coverage of pre-existing conditions when issuing new policies.

Under Frischman’s policy, his carrier, Blue Shield of California, picks up 90% of the cost as long as Frischman and his wife use carrier-approved doctors.

But, desperate to find a cure for his wife’s problem, Frischman has spent thousands of dollars on chiropractors, Asian medicine specialists and a Nevada homeopath, who specializes in treating disease with minute doses of a remedy that would produce symptoms of that disease in a healthy person.

Because none of these physicians were on the insurance company’s list--and because in some cases their care fell outside the policy’s definition of “reasonable and customary” treatment--only 30% to 40% of the cost was reimbursed. Prescription drugs also were not covered because Frischman does not pay a monthly premium for prescription coverage.

In recent weeks, Frischman said, his wife’s condition appears to be improving with drugs. He hopes this will free him to purchase indemnity coverage, in which carriers usually pay 80% of the cost of all doctor and hospital charges.

He is less optimistic about the national health insurance system.

“I’m frightened about the present,” he said the morning that Kerrey dropped out of the presidential race. “I’m even more frightened about the future.”

Frank and Roberta Cicero, both 57, married since they were teen-agers, parents of three, grandparents of eight, live on a street of attractive two-story homes a few miles west of Disneyland. A Cadillac and a Mercury are parked next to their perfectly trimmed lawn.

Inside is where the chaos is.

The Ciceros had health coverage through an indemnity policy issued by Great Republic Insurance Co. of Santa Barbara. Through the 1980s their monthly premiums rose from $238 a month to $610 a month, but Frank’s steel-fabrication drafting company was doing well as long as the construction business boomed. So was the firm Roberta had started, which processed loans for builders.

In 1989, Frank had a heart attack and quadruple-bypass surgery. Eight months later, Great Republic canceled an unprofitable small-group insurance plan that covered 14,000 Californians, including the Ciceros--an action legal under state law. Two weeks later Frank had a second heart attack, followed by another operation. Great Republic covered both operations, but the Ciceros had to come up with $31,000 to cover their 20% share and medical procedures not covered by insurance.

They also had to find another insurance company, one willing to insure a man who was a heart-attack victim and a woman who had had breast cancer surgery a few years earlier.

Roberta found a series of 90-day policies for herself through an insurance broker. Frank lived without insurance for six months, paying about $4,000 for his heart medication, treadmill tests and other costs.

Finally, an executive at the couple’s bank, who knew of their troubles, bailed them out. She offered Roberta a part-time job as a teller. The job included family insurance coverage--with no exclusions for pre-existing conditions.

“It was very hard, it was degrading,” said Roberta, who had retired several years before when her business was grossing a half-million dollars a year. But she had no choice. For the last year she has worked three days a week, becoming part of a huge group of people paralyzed by insurance-related “job lock.”

Twenty-four percent of Americans say either they or a member of their family has decided to stay put in a job in the past two years primarily because they fear their health benefits would decline if they left, according to a Washington Post-ABC News survey taken last December.

The Ciceros’ new policy is a preferred-provider plan, issued by Roberta’s bank. She pays a $250-a-month premium. The plan pays 80% of expenses charged by a list of physicians who agree to the plan’s fee schedule. Frank’s longtime family doctor was not on the list. Neither was the lab where Roberta had her regular mammograms performed.

But it is life, and they live with it. Relatively speaking, Roberta Cicero is lucky to have a job that offers insurance. Little more than half of American workers--57%--receive health coverage through their employers.

The Ciceros do not know the Wilsons of Yucca Valley, but they would have a lot to talk about.

Don Wilson was an $80,000-a-year pet food company executive who retired, kept his health benefits for 18 months--the maximum guaranteed under federal law--and then went looking for a new policy. Because he has high blood pressure, the only policies Wilson could find excluded coverage for a heart attack.

So, like Roberta Cicero, Wilson went back to work. At 59, he’s a four-day-a-week, $6-an-hour hardware store clerk--with group insurance coverage that includes heart problems.

“We retired so we could do a little more traveling,” Wilson said. “I have a 34-foot Pace Arrow (mobile home) in my back yard that we can only use three days a week. It’s just ridiculous.”

Henry Berliner, a jack-of-all-trades mechanic at Lockheed Aircraft’s Burbank plant for 30 years, is a reminder of what was once a commonplace union contract: fully paid health benefits.

Under Lockheed’s contract with the International Assn. of Machinists, the company pays virtually all health premiums. Berliner has $4 a week deducted from his paycheck for his membership in the Kaiser-Permanente health maintenance organization, the largest and oldest HMO.

From his home in Encino, he can drive to either the Kaiser complex in Panorama City or Woodland Hills. He chooses Woodland Hills, a five-mile freeway trip, because it is a newer facility. He has his choice of seeing the same Kaiser doctor each visit, or switching to another.

He knows how lucky he is. On his own, he would pay between $360 and $420 a month to Kaiser to cover his wife and child.

“You don’t have to tell me,” Berliner said.

Berliner, 62, has sat on his union’s local bargaining committee during the past two contract negotiations. In the last contract, settled in 1990, the local agreed to pick up a share of the Kaiser premium for the first time.

“With that, they (Lockheed) were able to negotiate a better group rate with Kaiser,” Berliner said.

He recognizes that there will be more employer pressure when the contract expires next year to increase the share Lockheed workers pay for their benefits.

Employer health-care costs rose 12.1% last year, to $3,605 per worker, according to a survey of 2,400 employers by the consulting firm of A. Foster Higgins & Co. That was four times the overall rate of inflation. Companies responded by continuing to raise deductibles, co-payments and out-of-pocket maximums. The median family deductible last year was $400, meaning half paid more and half paid less. The median out-of-pocket maximum for family coverage was $2,100.

A decade ago, most employers covered 100% of hospital expenses. Last year only 42% did, according to another consulting firm study. Almost all policies now require an insurance company to pre-certify hospital treatment, virtually unheard of a decade ago.

Like Berliner, Joanel Lubin, an $8-an-hour cook at a hotel near Los Angeles International Airport, was enrolled in an HMO, CIGNA Healthplans of California. Unlike Berliner, Lubin’s non-union employer required him to pick up a large share of the premium.

Lubin, 48, of Hawthorne, paid $147 a month for coverage for himself and his 8-year-old daughter, who was living with Lubin’s estranged wife.

The premium cost ate up a large chunk of his income. After deductions for health insurance and taxes, he was taking home about $800 a month, nearly half of which he paid for rent.

“I felt very poor,” said Lubin, who was born in Haiti and immigrated to the United States in the early 1970s. “You’re working but you’re just working for food. It reminded me of when I was a kid; my daddy used to have men who worked for him like that, working for food and someplace to sleep.”

The problem is that many policies cover employees for nominal rates, but require far higher premiums to include dependents.

Lubin escaped from that crucible a few months ago when his ex-wife began working at a job that offered family coverage. He was able to drop his daughter from his coverage, cutting his insurance premium payment to about $18 a paycheck.

He also dropped CIGNA coverage in favor of indemnity coverage. He was willing to accept paying 20% of his medical bills, he said, “because I want to pick my own doctor.”