The cost of denial, delay, and dismissal in medicine, policy, and insurance

By Robert Groysman, MD

It’s been over four years since SARS-CoV-2 began its march across the globe. We’ve gone from panic to vaccines, from ventilators to antivirals — and now, in many ways, the world is moving on. But not everyone can. For millions of Long COVID patients, the acute phase of the virus ended, but the disease never did.

Despite thousands of studies, patient advocacy, and even recognition from global health agencies, mainstream medicine and insurance systems are still getting Long COVID wrong — in ways that are delaying care, denying coverage, and worsening outcomes.

1. The Medical System Still Doesn’t “See” It

Despite estimates from the CDC and WHO suggesting that up to 10–20% of COVID survivors develop Long COVID, many doctors still respond to patients with:

• “Your labs are normal.”
• “It’s probably anxiety.”
• “There’s no treatment anyway.”
• “You just need to decondition.”

This isn’t just dismissal — it’s harmful medical gaslighting. Many clinicians aren’t trained in the evolving science of viral persistence, immune dysregulation, or dysautonomia. Instead of admitting uncertainty, they default to psychologizing symptoms or minimizing their impact.

The result? A trust gap. Patients are turning to support groups and social media instead of their providers. This undermines the therapeutic alliance and drives vulnerable people into unregulated treatment spaces. This is what I am trying to combat with our out of the box approach, proper tests, this paid group, and my protocols. I hope to create a better alternative to social media for long covid suffers. Check out of group at longcovidfamily.com

 2. The Science Is Advancing — But Medicine Is Not Keeping Up

Scientific research has exploded around Long COVID:

• Mitochondrial dysfunction and oxidative stress
• T cell exhaustion, microglial activation, mast cell dysregulation
• Microclots and endothelial injury disrupting tissue oxygenation
• Autonomic dysfunction (like POTS and orthostatic intolerance)

Yet most front-line providers — even specialists — have not integrated this science into their clinical lens. Long COVID isn’t a single disease, and there won’t be a single biomarker. But absence of evidence is not evidence of absence.

We’ve seen this before — in ME/CFS, fibromyalgia, Gulf War illness — where lack of understanding is misinterpreted as lack of legitimacy.

3. Insurance Isn’t Built to Handle Complex, Chronic Post-Viral Disease

The U.S. healthcare reimbursement system is optimized for acute care and clear diagnostics — not multi-system, medically complex conditions like Long COVID.

Key challenges include:

Problem	Example
Lack of ICD specificity	ICD-10 code U09.9 (“Post COVID condition”) is too broad for nuanced billing
Pre-authorization barriers	Medications like low-dose naltrexone, propranolol, or immunomodulators may be denied as “off-label”
Denied referrals	Patients can’t access neurologists, immunologists, or functional medicine specialists
Disability skepticism	Patients are told to return to work despite cognitive, cardiovascular, or respiratory impairment

The net result is that patients pay out-of-pocket, spend months or years without care, and face devastating financial and emotional strain.

4. We Have No National Standard of Care

Unlike diabetes or heart failure, there is no standardized treatment algorithm for Long COVID in most medical institutions. Many academic centers offer vague “recovery clinics” that:

• Perform limited testing
• Emphasize symptom diaries over functional evaluations
• Rarely provide interventional treatments
• Often push psychotherapy as the first-line tool

Meanwhile, cutting-edge strategies — like vagus nerve stimulation, stellate ganglion block, mitochondrial support, or even repurposed drugs like maraviroc — are only accessible through private practices or clinical trials.

This creates a two-tiered system: those who can afford to explore innovative treatment, and those stuck in symptom management with little relief.

5. What Needs to Change

If we are serious about helping Long COVID patients, we need:

• Medical education reform: Integrate Long COVID pathophysiology into CME, medical school, and residency.
• Clear diagnostic protocols: Establish guidelines for dysautonomia testing, mitochondrial dysfunction, and immune workups.
• Insurance policy updates: Cover evidence-supported treatments even if off-label; accept Long COVID as a legitimate disability.
• Funding for real treatments: Invest in therapeutics, not just tracking symptoms.
• National care models: Develop multidisciplinary clinics with cardiology, neurology, endocrinology, rehab, and mental health.

In Closing

Long COVID isn’t rare. It isn’t psychological. It isn’t going away.
It’s a complex, multi-system, post-viral condition that deserves the same seriousness as cancer, autoimmune disease, or stroke recovery.

Getting it wrong — by minimizing, delaying, or underfunding care — is not just a policy failure. It’s a moral one.

We owe patients better.