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Insurance for Fibromyalgia
6 Replies
bwelladjusted - March 9

Has anyone else had trouble getting health insurance because of a fibro diagnosis? My dad is an insurance agent, and he has been running quotes with different companies for me. None of them have denied me completely, but they are putting a rider on for Fibromyalgia. I don't take any medicines, receive any treatment, or have any regular doctor visits. But fibro is such a vague, multi-faceted syndrome that I'm afraid they'll try to deny any claim that could even remotely be related to my fibro. I do have group insurance offered at my work, but for flex force, it's almost $200 a month for just me! With a reasonably high deductable, too. If I go full time the pricing would be better, but it means an extra 10 hours a week. Another 2 hours a day shouldn't be that big a deal breaker, but it seems like torture during a bad flare! At this point I'm stuck trying to pay the $200 for now, maybe I'll move up to full time after the spring rainy season is over! :( If anyone else has found a good insurance company that will cover this condition, please let me know! Thanks all!

 

Fantod - March 9

From what I understand, Fibromyhalgia (FMS) is pretty much a deal breaker for most insurance companies. What you are paying right now is actually quite reasonable for insurance. And, you are quite correct to be concerned about being denied for any claim that could be perceived as related to FMS. Even with insurance, many of us have to fight with our insurers on a regular basis over coverage. Often we run into the insurer thinking needed treatment is "excessive" which results in a denial. Then the doctor has to be dragged into it to get the issue straightened out. This is just another "perk" of having FMS. Take care.

 

Canada17 - March 9

I am with ManuLife Insurance through my Employer. They cover what is "reasonable and customary".

I have not had any trouble being compensated for out of pocket medical expenses. The "reasonable and customary" description does get a little annoying when trying to re-coop costs for alternative medicine. The more experienced doctors charge more so some of the expense isn't covered.

However, I have submitted receipt after receipt after receipt and they always cover what the policy says they will, no questions asked. My doctor has even cautioned me before with new medications (new as in new to the market, not just new to me) that they are expensive and not all drug companies cover them. So, I would call and give the DIN and make sure before purchasing anything. I've never had a drug come back as unapproved.

I pay about $60 per month for my family (my husband and I and our daughter) plus a $25 deductible which comes off my first claim of each calendar year.

They didn't even ask any health questions or anything like that. At my last job when I signed up for insurance I got a call from a CSR who wanted to ask me questions about everything from fainting to hospital visits.

 

Fantod - March 9

In the US, coverage is very different. Insurers have the right to refuse coverage for many conditions. Or, some will accept you if you are willing to pay a grossly inflated premium. Most people can not afford the latter. These days, US insurers look for any loophole that may be applicable to deny or drag out paying a medical claim. It isn't ethical but they do it anyway. Leaving the chronically ill to spend hours on the telephone and writing letters to get the coverage they have paid for. Good luck bwelladjusted.

 

Noca - March 10

I'm covered under ODSP for life and I'm also covered by a 2nd insurance company through any school I attend. The ODSP makes most dental free, most generic meds $2 with the exception of section 8 to cover brand names, and they dont cover anything else. My 2nd insurance makes me pay the remaining cost of the med up front and will reimburse me 80% of it. It's limit is $1000 a year though and it takes FOREVER to make a claim(6-8 weeks). My 2nd insurance also covers a bunch of other things like psychologists, optical care, and what not.

 

iliveinpain - March 10

I have health insurance thru my job, but when I was laid off a few years ago, I couldn't get coverage anywhere. I called every insurance company I could think of, and every one of them told me the same thing. Fibromyalgia is an immediate denial of health insurance coverage. I live in Illinois, I don't know if it's different anywhere else. It's truly a terrible thing. It's just one of those pre-existing conditions that they'll deny coverage for. It was like a double edged sword for me. When I finally got a diagnosis of fibromyalgia, it was a relief to know I wasn't crazy, and there was actually a reason for my pain. But then, couldn't find health insurance anywhere to help me to live with that pain. So, I go to work everyday, still able to do full time. Work all day in pain, and mostly to make sure I keep my insurance. It's really a joke isn't it? Very unfair...

 

bwelladjusted - March 10

Thanks everyone! Sorry, Canada 17 and Noca, I don't live in Canada. But thank you for your help! I have pretty much run out of companies to try, so I'm just going to take the group insurance, maybe try to move into full time soon. I'm with you, iliveinpain. I was so glad to have a diagnosis, now I wish I didn't! I also live in Illinois, but I don't think it's much different anywhere else.
Thanks again!

 

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