Individual Insurance & Fibromyalgia

Fibromyalgia is a chronic condition that involves widespread pain in ligaments, muscles and tendons, accompanied by overall fatigue. This condition affects about 2 percent of residents in the United States and women are more likely to suffer from fibromyalgia than men according to Mayoclinic.com. You should be familiar with your individual insurance plan and how it covers fibromyalgia if you suffer from this condition.

Fibromyalgia Symptoms

• Fibromylagia affects multiple tender points on the body where slight pressure causes significant pain. The severity of fibromyalgia symptoms can vary, depending on the weather, stress level, physical activity or even the time of day. The most common pain areas of fibromyalgia are the back of the head, between the shoulder blades, the sides of the neck, chest, hips, elbows and knees. Many people experience sleep disturbances and chronic fatigue with fibromyalgia. Other conditions that coincide with fibromyalgia are headaches, irritable bowel syndrome, depression and rheumatoid arthritis.

Fibromyalgia and Health Insurance Problems

• Firbromyalgia is a condition that doctors are still learning about and do not fully understand. This syndrome seems to have many accompanying conditions and insurance companies know there most likely will be many health insurance claims. There may be restrictions with your insurance company when notifying them that fibromyalgia is a preexisting condition. It is best to review the restrictions with your individual insurance company about preexisting conditions because the restrictions can vary. You could be denied coverage because of a preexisting condition when applying for new insurance coverage.

Insurance Options for Fibromyalgia

• If you had credible health insurance prior to applying for insurance with a new group health plan, there are rules that could help you. The federal Health Insurance Portability and Accountability Act, or HIPPAA, states that if you had 12 months of continued insurance coverage by a group health plan before applying for a new group health plan, then you will not be placed on a waiting period before the new plan covers a preexisting condition. You will not be denied coverage for fibromyalgia as your preexisting condition, according to health-insurance.org.

  If you are applying for private health insurance and not a group health plan, then you may have a higher premium, because these are governed by individual states. You also could be denied coverage because HIPPAA only protects group health plans and not individual ones.

High-risk Insurance

• Most Americans obtain insurance through an employer, which is group health insurance. If you have a high-risk condition and fibromyalgia could be considered one, there are options and you may be able to purchase high-risk insurance offered by your individual state. However, this insurance is usually more expensive than individual insurance plans, but allows you to get health insurance coverage. This may be an option for you if you were turned down by another health insurance plan.

Health Reform and Preexisting Conditions

• The Patient Protection and Affordable Care Act, signed into law in March 2010, will eliminate preexisting condition requirements by health plans. Beginning in September 2010, children under age 19 will not be denied health insurance due to a preexisting condition. In September 2014, this provision will cover adults as well.