Geisinger TV rep can’t get a Geisinger policy: Stroke brings rejection when insurance sought [The Times Leader, Wilkes-Barre, Pa.]

Apr. 16--NANTICOKE -- Local musician Lou Marino, a recent TV spokesman for the Geisinger Heath System, has been rejected for insurance coverage -- by the affiliated Geisinger Health Plan.

Marino, 35, of Nanticoke, suffered a stroke in 2008 and has recovered to the point that he has lost weight, works out vigorously and is looking to return to the workplace.

Marino was insured by Aetna at the time of his stroke and was treated at Geisinger hospitals in Plains Township and Danville, and he will tell you the treatment he received was fantastic.

"I guess that's the irony here," Marino said. "I guess I was good enough to be in a television ad for Geisinger, but I'm not good enough to be covered by their insurance."

Marino said doctors have told him that his stroke was "completely random" and "a fluke" and "rare." He said he has been told there is little likelihood of it happening again.

Marino raved about the doctors, nurses and staff at the Geisinger facilities where he was treated, and that's why he agreed to share his story with the world.

"I was happy to do pro-Geisinger commercials," he said. "They aired during the Olympics and on the premiere episode of this year's 'American Idol.' "

So when Marino was laid off recently from his job as an information technology network administrator -- a job he held for 10 years -- he thought first of Geisinger when he was seeking health insurance.

But on Wednesday, when Marino opened his mail, a letter he thought would confirm his coverage with Geisinger Health Plan turned out to be a rejection. Signed by William Byron, vice president for customer service operations for Geisinger Choice, Marino was told his application for insurance was declined.

Geisinger Choice is one of the coverage options within the Geisinger Health Plan, which operates separately from Geisinger Health System.

"Our decision to decline your application for insurance was based on the following reasons: STROKE," the letter stated. "According to the non-group underwriting standards and guidelines, the above mentioned condition is disqualifying."

The letter stated Marino's medical information was reviewed and did not meet the medical underwriting criteria required by Geisinger Choice.

"I'm not angry," Marino said. "I guess I kind of expected it. But I am disgusted, hurt and offended. When I needed health insurance, I immediately thought of Geisinger, and I really thought it would be easy. I thought it would be a no-brainer."

Now Marino is worried about himself and his two kids -- Aleigha, 8, and Lou, 4. He said he has been offered COBRA benefits through his former employer, but at $600 per month just for him, Marino said it's cost-prohibitive.

"I've stopped working out and riding my bike," he said. "What if I get hurt -- break a leg? How can I afford the cost? Somebody told me, and I guess it's true, we're all one sickness away from bankruptcy if we don't have health care."

Marino said he does not agree with the new national health care program, but he said if it were in effect, he would qualify for health care because pre-existing conditions would not preclude him from gaining coverage.

He has not yet looked anywhere else for coverage. He said he was hoping the rejection letter was an administrative mistake.

"Me and my kids were used on TV to preach how great Geisinger is," Marino said. "They knew who I was. You would think I could get approval."

Dr. Howard Grant, executive vice president and chief medical officer for Geisinger Health System, issued a statement on the situation.

"Geisinger Health System provides care for all patients who seek services from our medical professionals, without regard to their ability to pay for that care," Grant said. "We have been and will continue to be privileged to provide health care services for Lou M., as well as every patient who comes through our doors."

Grant said the denial of individual health insurance coverage for Marino and other people with pre-existing medical conditions seeking individual coverage highlights a national problem that he said will "hopefully be corrected" as the recently enacted health insurance reform is implemented.

"Geisinger supports health insurance coverage for all; however, in order for Geisinger Health Plan to offer a product in the voluntary individual market, the health plan must apply medical underwriting guidelines on a uniform basis," Grant said. "Further, current insurance regulations prohibit Geisinger Health Plan from treating like individuals differently. As a result, exceptions cannot be made for Lou, who was not previously covered by Geisinger Health Plan, or other similar patients."

Grant said Geisinger is proactive in working with patients to explain potential coverage options, and also offers "a generous charity program to assist patients who are unable to pay for the medical services we provide.

"We are reaching out to Lou to explain these options and assure him that we will continue to care for him regardless of his ability to pay," Grant said.

Dave Jolley, Geisinger Health System spokesman, said the story of the care provided to Marino by Geisinger medical professionals -- and Lou's personal recovery -- "is very compelling, and we were happy to share it with others.

"We stopped using the ad at Lou's request." Jolley said.

Marino said a Geisinger Health Plan representative suggested that he file for disability -- an option Marino flatly rejected.

"I rock climb and I ride my mountain bike," Marino said. "I'm not disabled. The ads said how far I've come, and now they want me to say I'm disabled?"

Marino has not returned to performing -- he's a singer and guitarist. His last appearance was at the Arena Bar and Grill a few days before his stroke.

Bill O'Boyle, a Times Leader staff writer, may be reached at 829-7218.

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