By: Kate MacDonald

For decades, Billy Joel has lit up stadiums across the globe, delighting fans with classic hits like “Only the Good Die Young,” “Uptown Girl,” and “Scenes From an Italian Restaurant.” People of all ages can recognize his songs with just a few notes on a piano. A musical icon since his debut in the early 1970s, Joel has won six Grammy Awards and has watched 43 of his songs make it to the Billboard Hot 100 chart.

His most recent song to make it onto the Hot 100 was the somewhat ironically named “Turn the Lights Back On,” his 2024 comeback single. Unfortunately, it might be sometime until his fans see him perform under stage lights again.

Joel recently announced that he’s suffering from normal pressure hydrocephalus (NPH), a rare brain disorder, and decided to cancel the rest of the shows on his 2025-2026 tour. The legendary singer-songwriter posted a statement to his social media accounts, explaining that the condition has taken a toll on his hearing, vision, and balance, making stage performances dangerous, and was resting, per his doctors’ advice. The announcement also explained that treatment will include specific physical therapy for the condition, and that the singer is aiming to make it back to the stage.

In March, Joel had to postpone several concerts due to a condition that required surgery and follow-up physical therapy. No further details were given, and it’s unknown whether this was related to NPH.

NPH occurs when cerebrospinal fluid flows in from around the brain and spinal cord and amasses inside the skull, which disrupts brain function. Symptoms include an unsteady gait, memory and thought processing problems, balance trouble, and bladder control difficulty.

While this is a rare disorder (0.2 percent of people from 70 to 80 suffer from NPH, and 6 percent of individuals over 80 will experience this condition), one’s sex, race, or ethnicity do not factor into the equation. Thus far, researchers are unsure if it passes down through genes.

Diagnoses for NPH can happen via CAT scan or MRI, where doctors can spot the cerebrospinal fluid buildup, but this can most definitively be confirmed with a spinal tap. When caught early, NPH is usually a treatable condition.

However, that brings up another issue, one that plagues many Americans no matter the diagnosis: NPH is often misdiagnosed. Given the symptoms (walking problems, incontinence, memory issues), NPH can be overlooked, dismissed as simply normal signs of aging.

For sponsors of self-insured plans, it is crucial to consider all facets of plan document language when considering possible diagnoses during the plan drafting process. For example, if a participant is experiencing new symptoms but they are brushed off because of their advanced age or because their situation is deemed a common ailment, they may want to examine their plan language for a “second opinion” provision, which may not be included in benefit language, but instead potentially nestled in the utilization management section. After all, as the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence noted, approximately 12 million Americans are misdiagnosed every year, which results in harm to about four million.

Otherwise, the plan participant should be aware that even if they are diagnosed with a rare condition, the course of treatment may be somewhat commonplace as is the case with Billy Joel. Covered individuals should consult with their physicians about treatments, review their plan documents, and discuss next steps. For example, where NPH is concerned, potential surgery and physical therapy are common treatments (and typically covered by plans).

Catching many illnesses and ailments early can mean the difference between life and death, or at least a shorter course of treatment and a longer road ahead. While Billy Joel convalesces, he has fans across the globe sending him well wishes. For the average plan participant, although they may have more home-grown support, they can also count on the backing of strong self-funded plan language in their corner.