Finding Coverage for Chronic Epstein-Barr/Mono/Etc.


New Member
Hi, all. I'm new here and greatly appreciate all the advice I've already found just by browsing through the forum. What a great environment!

I'm writing to find out whether any of you have recently experienced trying to cover any of the "autoimmune" syndromes like chronic epstein-barr (CAEBV), chronic mono (same thing), CFS, etc.

Most companies I work with define eligibility like this:

- 1 occurrence, no further symptoms = standard
- more than one occurrence, no further symptoms = case by case basis
- chronic, recurring = automatic decline

Here's what I don't get. My client handles symptoms herself. She knows there's no treatment/cure, so she doesn't go to the doctor for flare-ups. Her symptoms are relatively minor (fatigue, some muscle pain). Her medical record supports this "smart" approach to keeping costs contained. So, why would it be an automatic decline? The treatment is basically rest, vitamins, and exercise. No Rx costs.

I get the feeling these syndromes aren't covered because they're so "unknown" -- a little like HIV when it first appeared. They can't guarantee it won't turn into/be caused by something more serious, so they're leery of covering it. Is that the thinking on the part of the carriers?

Finally, does anyone know of a plan that will take chronic autoimmune syndromes as a rider? The client would be perfectly happy with that. Note: she is 30 and has no other medical conditions besides the occasional bronchitis/cold -- as we all do this time of year.

P.S. I am not, by any means, a "super genious." How do I change that in my profile? Don't get me wrong -- I'm brilliant in many other areas. I'm just new to the industry and will need some time before I label myself superior. :wink:
Insurance companies look at potential risk. If you're diabetic are you gonna go blind? Most likely not, but it could happen so they decline.

As for your question, I can't tell if if a carrier would take a condition with a rider unless I knew the details about that condition. You're free to email me with specifics and I can do some shopping for you.
Every carrier I know will decline CFS and related auto-immune situations. If the individual has been symptom free for 5 years, you may get a hearing from a few carriers, but I would not get my hopes up.

Carriers have quite a bit of history with such illnesses and while each case is different, carriers underwrite for the norm. Just because someone is under control now does not mean it will stay that way. Even though she is not on any meds now does not guarantee the same for the future.

With auto-immune disorders there is no way to rider the condition.

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