What aggrevates me is that my insurance will pay for me to go to a very long list of doctors and specialists that know absolutely nothing about my illness. However, if I want to see a doctor that has actually treated patients with my illness, and knows something about it, insurance does not cover.
I understand not covering expensive experimental treatments for CFS, but it would sure be nice to have the co-pay just to have discussions with a doctor who knows what I am talking about and has actually seen patients like myself. At least I can learn what the possible options are and have a professional listen and make some suggestions based on experience. This would also help the doctors learn more about CFS. I'm completely disabled with this disease but I pay more into the insurance company than they pay out. It's really a disaster. The insurance company could still make money off me it they only paid for me to visit someone familar with my illness.
Sorry for the digession. As to the topic of this post, I would not pay the thousands to see any CFS specialist now. There should be an option to have insurance or medicare pay for a visit to a specialist, as in most other diseases, even those without many helpful treatments.
It depends to some degree on how much you want to fight your insurance company and also how they view ME/CFS. You could, for example, ask how many ME/CFS patients a particular specialist has seen or followed; if there isn't anyone with the background, you could argue that the current network contains no one with the expertise and they need to send you to an outside expert. The difficulty is that they may not view Me/CFS as a distinct illness needing specialty care and decide you only need general medical care. This type of effort will also take knowledge and time, more than what you want to expend. You could also argue that some symptoms, such as POTS/OI or bowel symptoms related to ME/CFS, are better handled by someone familiar with ME/CFS. That way, you might save them money in the long run in regard to ER visits/ seeing even more specialists/ getting more tests done. [Not sure if this would be true, but argument's sake.]
My health insurance has certain good things to it so I've kept it but rather than waste my energy on arguing, I was fortunate to have the funds and just decided to spend them to see specialists. I don't expect miracles necessairily but they help to guide me through the symptoms I experience, know what's usual vs. not for ME/CFS, keep me up-to-date on the latest stuff, and I also consider it a social good: i.e. the more patients they see, the more experience they can develop. BUT if you are on tenuous financial standing, I would not recommend spending the money right now.
[Devil's advocate point: sometimes I wonder if ME/CFS sufferers went to the doctor/ ER/ etc. every single time an unusual or worsening symptom came up and/or demanded more testing (although these acts have negatives as well), whether the insurance industry/ government would pay more attention to us. Become a money pit and they might start to look into why.]