Fibromyalgia and Medical Insurance

Fibro Cloud

One of the hardest things about any long term illness is dealing with insurance companies constantly looking for a way to deny your claims. And that’s especially true with fibromyalgia, which many insurance providers are skeptical about. When it comes to getting fibromyalgia covered, you need to expect that the insurance provider will be looking for reasons to deny your claim.

So figuring out what not to say to your insurance provider when you have fibromyalgia is actually an important part of getting the coverage you deserve. Why do insurance providers not want to cover fibromyalgia, and what are some things you should never say when you talk to them?

Why Insurance Providers Don’t Want To Cover Fibromyalgia

If you’ve dealt with an insurance company in the past, you know it’s hard to get them to pay out for fibromyalgia benefits. The reason for this is simple: money. Insurance companies work by taking in more money in premiums and investments from those premiums than they pay out in benefits.

So, remember all that money you were paying them so that you didn’t have to worry about being able to afford treatment for something like fibromyalgia? Well, turns out they would still prefer to keep it now that you have fibromyalgia. The insurance company will look for ways to deny your claim for something like disability.

And fibromyalgia is a disease that is easy to deny since it doesn’t have any outward symptoms. And because everyone’s fibromyalgia is different. Some people with fibromyalgia are completely disabled, and some can still work. So getting an insurance claim for fibromyalgia depends on not just proving that you have fibromyalgia, but that it’s severe enough to need intensive treatment or to qualify for disability.

That’s why you have to be aware of what not to say to your insurance provider when you have fibromyalgia.

What Not To Say To Your Insurance Provider When You Have Fibromyalgia

It’s important when you make an insurance claim for fibromyalgia that you are honest about your symptoms, and as specific as possible about what they are. If you leave any room for interpretation, an insurance provider can interpret it in a way that lets them deny you coverage. And if you exaggerate your symptoms, deliberately or otherwise, then an insurance company can prove that they aren’t as bad as you claim and use that to deny you.

You have to be extremely careful about what you say and avoid certain phrases or words. Here are some examples of things you should never say when you’re making a claim:

I hurt everywhere.

If you have fibromyalgia, you probably deal with at least a fair amount of pain on a daily basis. But the pain is focused on 18 specific points on your body. It technically isn’t spread over your entire body (though 18 points on your body basically amount to the same thing).

But doctors use these 18 points to diagnose fibromyalgia, and so do insurance providers. If you tell them you have pain somewhere other than those 18 points, they will tell you that whatever you have is not fibromyalgia.

The pain comes and goes. You probably know that fibromyalgia comes with good days and bad days. Or you know that fibromyalgia flare-ups can make the pain worse sometimes than it usually is.

But to an insurance provider, saying that the pain goes sometimes means that your illness isn’t that severe. After all, if there are days when you don’t hurt, then you aren’t completely disabled. Make it clear that your pain is constant and disabling.

I can’t walk. At the same time, don’t tell an insurance provider that you can’t walk. Now, you may find walking extremely difficult and even going to the bathroom can be extremely difficult for you.

But if you tell an insurance provider that you can’t walk and you are ever seen walking (even if it’s through some extreme pain) then they can declare your disability fake and decide you were lying about the entire thing.

I can’t get out of bed. In the same way, don’t tell a provider that your fatigue or pain is so severe that you can’t get out of bed. Or that you sleep all day.

All a provider has to do is prove that you’re spending some portion of the day out of bed, say to go to the kitchen, and they can use that to deny you coverage.

My doctor doesn’t understand. Many doctors aren’t up to date on the latest information about fibromyalgia. And many don’t know how to treat it effectively. With that being said, you don’t want to tell an insurance provider that your doctor doesn’t know how to treat you.

An insurance provider is going to take your doctor’s word over yours when you tell them that your medication doesn’t work. And they will assume that you are deliberately refusing the treatment your doctor recommends. Or they’ll think your symptoms are in your head and that’s why they don’t respond to treatment.  Thus, they’ll be more likely to deny your claim.

The important thing to remember is be honest. You run the risk of being accused of fraud if you lie about your condition in an attempt to make sure it’s covered. And if you have a legitimate claim that is denied you have the option of suing. So just tell the truth about your fibromyalgia and it should be covered.


The preceding article is from and is posted here for sharing purposes only. No copyright infringement intended. For additional information, please visit their website or consult your physician.

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