Medical Insurance May Not Cover Chronic Fatigue

Normally the medical profession agrees on the diagnosis and treatment of most illnesses. However what happens if you develop a condition where there is disagreement. How does this affect your health insurance claim?

ME (Myalgic encephalomyelitis and myalgic encephalopathy) or alternatively known as Chronic Fatigue Syndrome is an example of a condition about which there is still some controversy. The symptoms of ME are wide ranging but mainly they are: extreme exhaustion which is not alleviated by extra sleep, muscular aches and pains, poor immune response, poor cognitive function and various other symptoms. However the NICE guidelines recommend Cognitive Behaviour Therapy as a treatment for ME which suggests that it is a psychosocial condition rather than a biomedical one.

The belief is that ME has depression as a characteristic and that it is therefore a form of depression but opponents of this view say that there are various physiological differences between people who have ME and people who are depressed although they agree that patients with ME will often become depressed due to their illness.

Because of the NICE guidelines private health insurance companies are within their rights to refuse cover if an applicant's policy does not include psychiatric cover.

ME suffers disagree that the condition is psychiatric or psychological and are campaigning to have their case heard. We can point out that ME was formally classified by the World Health Organisation as a neurological disease in 1969. On the 12th February 2009 two suffers, Douglas Fraser and Kevin Short launched a challenge of the NICE guidelines and appeared in court asking for a judicial review.

Beagent, the solicitor acting for Fraser and Short said: "There is a huge strength of feeling about the way insurance companies deal with these suffers. The main grievance is the way they handle claims. Often insurers send around medical experts who reach the conclusion that it is a psychological disorder."

Sue Waddle, representative of ME Research UK told BUPA that, 'Doctors get quite frightened by illnesses that they don't understand

'If research increases understanding of the condition then doctors will be more confident in dealing with patients, so hopefully we can move away from the psychological aspects and concentrate on the biological.'

One of the suspected causes of ME is an autoimmune reaction to high levels of stress or a viral infection and it is said to affect 250,000 in the UK. In the 80's it was dubbed 'Yuppie Flu.' With more and more people reporting higher levels of stress ME may be on the increase. But with this level of controversy it is important that insurance companies are clear on their policies. Beagent points out that the committee that drew up the NICE guidelines on chronic fatigue included two private medical insurance representatives.

A spokeswoman from the Association of British Medical Insurers (ABI) said that 'When insurers assess claims they have to be guided by the medical profession. However, on this issue the medical profession is divided about both the causes and prognosis of ME, therefore clarification of the medical guidelines would be helpful.' If there is a medical opinion which concurs that it is a psychological condition then private healthcare companies can refuse cover.

Action For ME is a UK charity available to offer information and support for ME sufferers.