[Final Update] My insurance won't cover UTIs for males. Yes, I'm in the US.
She literally called me at the time of the appointment to tell me she can't see me. She was so apologetic, but was like "I absolutely can treat you, but I'm not allowed by your insurance". Fuck this country.
Update: I went to urgent care. Before leaving home, I called to be sure they would accept my insurance (Aetna). They said yes.. After arriving for my appointment, they told me they do not accept my insurance. I will simply leave without paying.
Final Update: I can understand that that differences in physical biology demand different attention. That's not what I'm complaining about. It's the way it's set up. I was told that at my appointment. Why not just refer me to a specialist? The website could've even just referred me to urgent care (yes, my insurance requires a primary care physician's referral for urgent care, according to the urgent care facility). But, no, their goal is to obfuscate and irritate until the patient gives you and pays out-of-pocket.
I was able to receive care at a cost I could not afford. I won't discuss what I had to do to "find" the money to pay for care and prescriptions. That being said, the condition I was diagnosed with was more serious than a simple infection, and I'm glad that I saw a doctor. I need further treatment and just hope I can get insurance to cover any of it.
If you're an American reading this, please consider ways to get involved in organizing in support of Medicare For All in your community. Here is one resource I have found. We don't need to live like this. We deserve better. Stay safe and healthy, friends.
Sounds like discrimination based on sex. A clear violation of the Civil Rights act of 1964.
That's what I was thinking. Sounds illegal.
It might be, but some health related coverage is legitimately divided along sex lines. I don't know what the answer is, but it might not be so simple.
Stupid either way though.
Different genitals. But all genders have bladders so why the hell wouldn't the insurance just cover it for everyone
a few people have mentioned it's because of anatomy and how it makes male UTIs more complicated + require more complex care. it's not a case of insurance not covering it, op just needs to go somewhere else
but females dont need to fart and males dont need to urinate!11!
I cannot stress enough how true this is.
If you think that's discrimination, don't look at the marketing industry.
Discrimination based on biological factors is literally what insurance companies do.
Car insurance companies are literally allowed to discriminate by sex and will openly tell you that they do so, why would health insurance be different?
Civil Rights Act of 1964 prohibits different treatment of insured persons on the basis of their sex in connection with pension funds. This was a supreme court ruling, so kind of linked but not quite.
https://www.jstor.org/stable/253100
Interestingly, in UK and EU it became illegal to discriminate by sex for car insurance from about 2012, without very careful use of data - which doesn't happen. It is allowed to be linked on things like jobs though.
newsflash: US never cared about civil rights and despite it being "law" it gets regularly ignored on an institutional scale
That's more than mildly infuriating....
Are you sure this isn't just a CVS thing? It says the same thing for me and I know my insurance covers UTIs for everyone. Maybe try an urgent care?
This is correct… there is 2 things to remember here
FYI it has nothing to do with insurance
My friend, you need to do two things --
One, get treated. It seems you've visited urgent care. They are "real" doctors and, assuming the hospital or clinic the urgent care is associated with is well-staffed and stocked, should be able to get your sorted today. Be sure to get any prescriptions you need filled on-site, if possible, before you leave.
Two, review your healthcare plan. While the Affordable Care Act mandated certain minimum coverages several things happened since that allow people to purchase plans that do not conform to the ACA mandates. On those so-called "catastrophic" plans, insurers can deny or decline to cover all sorts of things. Patients often simply shop by monthly premium cost and don't check coverages. Make sure your health plan is ACA-compliant, and, if not, look into a way to get covered by a compliant plan.
If it IS ACA-compliant, then treating a UTI, even in a male, is covered. You may be selecting providers that are not in-network, or do not have the proper staffing to treat this fairly rare condition, though. It may be worth a visit to your primary care provider if you can't get something like CVS or another "Doc in a Box" to treat it.
I can't help but wonder what happens to girls 15 and under when they get UTIs. Insurance company says sucks to be a girl?
Probably.
We knowingly vote for this shitty health care system every two years, so why would they ever change?
What the hell? Was someone drunk when they drew up that policy?
Too much cocaine
So a few things. This is a CVS minute-clinic visit, not a visit to a general provider. The minute clinics have contracts with insurance companies that look a bit different in terms of what and who they are permitted by the insurance companies to treat. There are some really odd variations in these contracts by insurance companies for reasons that are not always grounded in science.
This, as you've noted, is an unfortunate reality of a for-profit health care system that is dictated by private companies, insurance companies, and mind-bogglingly complex contracts that sit between providers and patients. The most annoying part IMO is that insurance companies provide zero transparency into these contracts and the justification behind decisions. It's all "business decisions" at the end of the day, not decisions that are medically sound and in the best interest of the patient.
And for those wondering why OP maybe just didn't go to a "regular doctor" - the U.S. has a horrible shortage of general practitioners (primary care) physicians. This shortage is worse in some areas than others. And even if you're lucky to live in an area that has general practitioners, the waiting list to get into their practices might be long. This leaves many people relying on a "doc in the box" aka CVS Minute Clinic or some similar outfit. These doc in the box clinics often only have a nurse or nurse practitioner on site, with a supervising physician off side. They are for-profit entities and they work with the insurance companies to design their contracts to maximize profit.
If you ever find yourself in OP's physician, one easy way to get around this is to indicate that the visit is for something more general, like abdominal pain or unexplained fever. While the staff still might refer you off to another provider, it might be a good way to at least "get in" with someone.
Another option is to visit a local urgent care clinic if one is available and covered by insurance. These are often staffed by actual physicians so they can treat a wider range of conditions. Many often even have testing facilities right on site for a number of issues.
Finally, another option is to call your insurance company and see if they have an over-the-phone nurse consultant available. They can usually help direct you to the right location for treatment based on your symptoms and insurance coverage.
But yes, OP, I agree with you that we need something better. Medicaid and Medicare have slowly been expanding and my hope is that they will eventually expand enough to cover all Americans. it has been proven that they can still operate without completely decimating the insurance industry (see Medicare and Medicaid managed care). While I don't agree with for-profit health insurance, the reality is that they are a lobbying force that has to be worked with if we are going to get everyone universal coverage.
Source: Health policy professional by trade, extensive experience within the health care industry
How is the us a real place wtf?
And it's not like we learn this stuff in school. It's not written out anywhere. We have to rely on word of mouth, people with experience, or people like the commenter above you who are familiar with the ins and outs.
The bottom line is that it is complicated on purpose and designed to wear you out so you don't get coverage for your most basic human needs - like peeing without your urethra being on fire.
Back in my day we always pee'd with our urethra on fire after we walked to school and back uphill both ways - and we liked it!
Back in my day we peed on each other around the fire and instead of school a man would come around the house and hit us over the head with an encyclopaedia for 6 hours in the hope we'd learn by osmosis, and we were happy to have that.
Wat
Just ask yourself, could a rich person make money off of this? And it all falls into place. Over the last several decades the people of the United States have been increasingly treated like a mined resource.
I think you're just supposed to die now...
I don't believe I can afford to, though. 😓
The entirely of modern America could be summarized with "Mildly Infiruating", tbh.
It is utterly baffling to me how the US has not figured out nationalized healthcare. Literally every other developped nation in the western hemisphere has at this point.
Its crazy that a politician could come out and say "my number one priority is to ensure that every American has access to healthcare, paid for by the state", and would instantly be villified by like half the country.
The covid national emergency is declared over. Potentially up to 15 million people will lose Medicaid expansion. Florida already kicked off 600,000 people. An 87 year old who had a daily care taker lost access even though they were qualified after the cut. A 7 year old boy will now die because they took access to his leukemia treatment. About half the people still qualify but they are making everyone reapply.
My dad some how affords stupidly expensive healthcare. Premiums are $4,000 a month. ER copay is $1000. ER deductible is $18,400 per family. My mom is now on a medication that costs $1400 a day. With other meds her medication is $15,800 a month for the rest of her life (she is 59). With insurance it goes down to $28 She has had $100,000 in medical bills. She has some super rare condition. Our insurance said one of the out of network doctors was covered. My mom verified multiple times. Now they don’t want to cover that doctor so we are stuck with a $25,000 medical bill. My mom says she will put it on the lowest amount a month for the rest of her life.
In other words if my dad couldn’t afford this insurance she probably would be dead now or in a few months.
Crazy is that we are all Canadian and if we lived there we could go on OHIP plus extra insurance for a few hundred bucks a month. For those who say Canadian’s have wait times, so do we. The difference is you will be seen and will not go medically bankrupt or denied care because you are too poor.
The excuse is that Canadians come to America for better doctors with lower wait times. They do. But when you realize they come to the States they don’t have long term insurance. Meaning they pay out of pocket. So it’s wealthy Canadians that can afford insanely high prices.
All my family in Canada says my father is pissing away money. He is.
God Bless American Healthcare! /s
TLDR Doug Ford can sod off and go to hell.
A handful of bastards at the top are making unfathomable amounts of wealth at the cost of the lives and future of the country. A majority of the country is in support of nationalizing health care. I've even met conservatives who agree. It's these sick fucking parasites who won't allow us to have it.
All the fuckers writing the laws have socialized healthcare. It's the untouchables who don't.
Because the healthcare industry makes money. A shitload of money. Why would they "fix" that? The problem is the fact that it is an industry.
That moment when it's better to live in Russia than in US...
There are 0 objectively good reasons to live in Russia.
I’m pretty sure this is one of them…
Free healthcare in this instance.
For non citizens?
No one in A&E checks your passport. I mean I'm not in Russia, but in the UK and the only reason some medical professional might check your ID here is when you're signing up for GP services - these are territorial in the UK. Otherwise you just go to the clinic or hospital and get a treatment. I'm migrant from an xUSSR country, so healthcare there should be close in structure to Russian I believe. And again - no one checks your IDs, except for when you sign up for GP.
And even when you need a GP, there is usually a framework for non-citizens. Usually when you sign up for GP they check your tax paying status. You pay taxes? Free healthcare for you! And in the UK if you don't work and don't pay taxes you can pay NHS contributions separately and then you will get all the treatment you want.
So I believe Russia should be somewhere along these lines as well.
Someone, ie insurance, has to pay for that medical coverage. I'm Czech and when I go to my doctor I give them my insurance card before I get treated. However, medical insurance isn't "free" (well, government funded) for non citizens here either.
There is no fucking shot she is correct. If your insurance won’t cover it then man just cancel it, they’d probably not even cover an ER visit, it should be cheaper to not have it.
Also, report them to your state’s DOI.
Is it because CVS is out of network? Have them bill, get denied, and then appeal it. Put that it would be cheaper than an ER visit for them.
Yea it will. Just not at a minute clinic. You need to go to an actual urgent care or primary care doctor.
Just want to throw my 2c in. I'm a physician and from our perspective male UTIs are rare and warrant a much more thorough medical evaluation by a professional, compared to female UTIs which are extremely common and don't require a thorough (or even in-person) evaluation in most cases. If I had a male patient with a UTI and no other know medical history I would insist they are seen by a physician for a complete evaluation. From other comments here it seems that CVS does not employ physicians in their clinic.
So the guy gets no care because the system is not fit for purpose?
No, not what I said. His insurance will cover a primary care visit. The staff at the cvs are simply not qualified to treat a male UTI.
People are dense. You straight out said this man needs more complete care to ensure that he can be helped because his condition could be more serious than if he were female, and they read "more thorough treatment" as "no treatment" like morons.
CVS MinuteClinic is for super minor stuff. Doctors are for more serious things.
There is a cause and there is a solution for our disgusting system.
Conservatives (including neo-liberals) serve corporations, not citizens. If we can marginalize conservatives (including neo-liberals), then we can have nice things like the other 31 developed nations on earth.
This cannot improve while conservatives (including neo-liberals) have power in our nation's government. Period.
This is mildly infuriating, I can give you a little more context though if you're interested. I don't know exactly about contracts between insurance companies and CVS so I can't speak to that definitely. Probably something related to how much insurance is willing to pay minute clinic for such a short visit, and what things are feasible to address in such a short visit (hence CVS only allowing certain complaints).
I think this is something to do with the concept of "uncomplicated" vs "complicated" uti. Complicated utis are when there's an increased danger of serious complications from a uti or increased likelihood of failing a typical antibiotic therapy. Utis in men are much much rarer than women, and are considered to be an automatic "complicated" uti by many. The greater length of the urethra in men helps prevent bacteria from being able to travel up to the bladder, whereas in women the short distance allows for this to happen much more frequently. So when a male has a UTI there is a much greater chance there will be complicating factors like prostate issues, structural problems, kidney stones, kidney infection, catheter use, atypical bacteria, etc. If you look more into their info on utis, they also state if they suspect any of those things, even in women, they won't treat it and will just refer you to someone else, probably the Ed or a real urgent care clinic. Since the odds of that are much greater in men, they probably aren't allowed to have longer appointments in minute clinic based on what insurance will pay for what they're providing, they just decided to not see that at all in minute clinic. Looks like they do see men for sexually transmitted infections though, which are actually the most common cause of utis in young men, so if that's a concern looks like they would be able to see people for that.
But I totally agree with you, fuck insurance companies in general.
That's very interesting, and I appreciate you taking the time to explain this in so much detail. I looked at urgent care near me, but my insurance requires a referral from a primary care physician first. I will continue to explore my options.
Did you read the top 2/3 of that reply? UTIS in MEN are HARDER TO TREAT. Go, please, see a doctor ASAP, even if it's an out of network doctor. You're overthinking this. Do not risk kidney stones because you're mad at CVS or America or whatever. You need a doctor, not a Lemmy lawyer.
Thank you for your concern, and for talking some sense into me. I'm in pain and not being as rational as I usually am. I decided to go to urgent care and just.. not pay. I'll figure out my next move when I recover.
I've never heard of urgent care requiring referral from a pcp, that wouldn't make any sense as the whole point of urgent care is being seen more urgently than your primary physician can accommodate. And seeing people who don't have a primary physician and keeping them out of the ed if not necessary. I would ask your insurance for that policy in writing, that can't be right. And if it is it should be reported to that state insurance commission because that's totally asinine. I mean never underestimate the dumbness of insurance companies but I think something might be being lost in translation here.
I would call the insurance company and ask where to get care. The point of urgent care is to bridge the gap between wait times for PCP and people going to the emergency room. It's a lot more expensive for people to go to the emergency room than to an urgent care, and a big reason people go to emergency rooms is healthcare needs that arise when primary care docs aren't available. So, I'm not sure that your insurance company would require a PCP visit prior to an urgent care visit, but you definitely need to ask them (insurance co) what you need to do since you need care now and don't know where you need to go.
You are presuming that it is a UTI and and coding it wrong for insurance purposes. Do a visit for something more generalized that is covered like abdominal pain and doctor will know how to code it properly for insurance.
I'm living in Turkey. All health care is free.
but if you live in turkey you get hate for being gay
You get that in the US too, so what's the difference?
true that
Unless you are unemployed. Then you have to pay the unemployed tax (GSS) whether you use the healthcare services or not.
That sounds so fucking stupid
You're unemployed so pay us money you can't recoup until we make you homeless
That sounds expensive. So when you don't have an income source they charge you a tax for it?
It makes sense if you think about it (assuming my thoughts are correct, I'm in the US). If you're employed, you are contributing through your taxes. Just because you're unemployed, it doesn't mean your contributions pause. Now, should they? That's a good question, but the current implementation makes sense. I imagine it does incentivize people to look for employment.
No. No, it does not. A poor tax makes no sense.
We can discuss where the money comes from, but the idea isn't pie-in-the-sky wild. I don't disagree with you.
This is so ridiculous! Our system is beyond broken. If you're sick you almost have to scrape by before Medicaid limit or pay out the ass and have excellent job with very good insurance. It's so fucked up. This is truly nutty.
That's disgusting if you ask me.
Also, you have to be 18+ for getting a contraception appointment. I guess teens in the US are also having sex like teens in other parts of the world and would very much need access to contraceptives, right?
Correct, they sure are. And abortion rights are under attack. Those teens won't even have a chance.
Yeah, they'll have to be responsible and only have sex using condoms. Or keep their legs shut.
You can be as responsible as you want, but condoms don’t have a 100% success rate.
The extreme profit oriented business culture of the US combined with the human nature of bandwagons make these sort of disgusting practices possible.
Corporations are justified, by default, in anything they can do to increase profit, and will do so until there's enough public backlash to negate the amount of profit that practice makes.
The public backlash is tied to the social momentum the idea has. Because profitability is the default idea to be promoted, you can't say something like "don't do this obviously profitable thing because it's bad for people" unless there's enough people around you who'll get on the bandwagon. If suddenly some influential person or a critical number of schmucks say the opposite, then everyone is defending the corporation's, not only the right, but the duty to be profitable.
It's an unpleasant way to live, really, but people are creatures of habit and won't easily go against the culture they grow up in.
I'm never paying into health insurance in the US again, fucking scam of a shit system.
Gawd, I know it happens more often in women but my husband had a nasty recurring UTI for a few months - they absolutely took it seriously and treated him! WTF, I hope you manage to get treated. ETA: UK
The OP's screenshot shows that the entity turning him down is a CVS MinuteClinic. MinuteClinic is staffed by nurse practitioners, not physicians, and it is limited in the scope of problems that it can treat. Evidently, male UTIs are outside of that scope. OP needs to seek treatment from a different office, and probably a regular physician, either at a primary care clinic, or at an urgent care center.
Are the people in the comments bots or real people? It's too good to be true that so many people have switched to Lemmy!!
Everyone on Lemmy is a bot except you.
I checked and am definitely a robot.
https://en.wikipedia.org/wiki/Dead_Internet_theory
We are the robots https://youtu.be/VxF0aja7rLU
This is why mens' rights activists exist. Unfortunately, just like the feminist movement, they were invaded by psychopaths.
thats what you get for having a penis.
Or being born American.
smh should have known better
The grass is the same color everywhere.
There's grass where you at? I wouldn't know. Ain't no grass around here.
The most developed country in the world ladies and gentlemen.
I hope they don’t catch you op.
Get D.Mannose and take like 2 grams a day till it's gone. Mileage may vary, but it cured my wife of recurrent UTIs after more than 20 infections.
A lesson I learned the hard way is the only way you can tell what your insurance actually covers is to read the fine print. The insurance company service reps can't be relied upon and the medical office reps just make up an answer if they don't know. Nor can you be sure the coverage statement from the insurance company is right wen they finally send it. That's wrong a significant percent of the time too.
Since nobody addressed this, if you (anyone reading this) have a bladder infection, go to the women's section of any pharmacy. Usually somewhere near pads/tampons, and find a box of this blessed relief. It has cleared up all but the most stubborn infections I've had.
just FYI to anyone reading this, this stuff is indeed magic pain relief, BUT it's not an antibiotic and you still need to see a doctor. UTI's can spread and it doesn't feel very good. I would up in the ER getting IV antibiotics over Thanksgiving one year. it sucked.
You're a lifesaver!
Hypothetically, in an emergency situation, you could get fish antibiotics from your local pet store. Not the best idea but an untreated infection isn't good either.
Aww man you poor sods. In any other civilised country that wouldn't be so much of a worry. 😭
This shouldn't be infuriating at all. As others have said a Nurse Practitioner is not a Medical Doctor. Go to the "clinic", whether its a hole in the wall $25 place or a local hospital with a clinic attached. A Medical Doctor can help and can even write prescriptions that include the words "medically necessary" which trumps most insurance denials.
Should have just said that you identify as a woman, probably solved. /S
But in all seriousness that's just terrible. Everyone no matter if your a man or woman should be treated equally.
These days that might legally even go through in some states lol
It’s painful to read stories like this. I really feel for all the people who can’t afford to see a doctor whenever they need it.
I live in Spain and here we have a social security network paid by the people through taxes. It has its flaws, as probably everything has, but we have people here saying that it doesn’t work and we’d be better paying for private insurances to get better attention and pay less taxes.
The thing is that today a private insurance can cost 50-100€ per person, something completly affordable, but what the people saying this doesn’t take into account is that the private companies have a backup with the national health service. The private insurance is great for small things, seeing your physician, a small surgery… but if you have a serious problem they’ll send you to the national health service to be treated.
I hope you can have a proper treatment for your illness and that it doesn’t cost you an arm and a leg. I also hope that your country can find a way to help everyone equally and not just those who can afford it.
Have you try other online services (no insurance need) like GoodRX care? I don’t see you need 16 or older for UTI in their options.
I'm not USian but I'd be astonished if that was legal, even in the barbaric hellhole that is the US healthcare system.
Ask her to put it in writing and then challenge the insurance company.
I’m not going to defend health insurance companies, but this is not because of your insurance. CVS will only see patients with simple medical problems because they 1) are not equipped for more in-depth diagnosis and treatment and 2) don’t want the liability associated with such. UTIs in males are medically complicated, by definition which has a very specific meaning. Males don’t just get UTIs like females do, because the male urethra is significantly longer, providing significantly more protection from bacterial retrogression to the bladder. The long story short is that if you are a male with a UTI you need to go to an actual healthcare facility and see a qualified professional, not an NP/PA at your local CVS.
Source: am a pharmacist
The issue here is the clown medical delivery system that enables these scenarios. At this point, people have better chances of diagnosis and treating themselves than rely on a chain of clowns, if only medical devices and pharmaceuticals were easily available.
You explained how getting UTIs for men is different than women, but you don't really explain how treating it is more complicated.
Because it's much less likely for men to get a UTI in the first place, it's much more likely that if they have one, that it's not a simple "throw some bactrim at it and it will go away" situation. With a male UTI, there's a higher chance that the UTI is in fact a symptom of a more serious issue, rather than the issue itself. And determining that requires diagnostics that are beyond the scope of what can be done at a minute clinic.
So why no referral?
Because someone needs to collect a comprehensive history from the patient to decide what kind of/if a referral is needed. The assembly line care at CVS isn’t geared for this.
I had one a while back and it was literally just a round of antibiotics. It's not some invasive, complicated procedure that only affects women. That insurance is stupid.
Well you see, every dollar spent on care is one less dollar shareholders get, so...
This is a CVS thing and not an insurance provider issue. If you go to an in-network provider, they will treat your UTI.
Two years ago I passed a kidney stone, that led to a UTI, and then sepsis. My insurance treated me without blinking. In fact, the only out-of-pocket costs I paid, was a $50 co-pay for the ER/hospital stay, and $8 co-pay for my aftercare antibiotic.
I am sorry this is happening to you. I cannot even phantom why this is the case, anyone could please explain to me why UTIs are not covered for men?
There is a documented thing insurance companies have started doing where they deny claims until you appeal them. AI was being used somehow to determine which cases.
I think most everyone knows this would have to be in the USA.
Sorry OP, I really hope those greedy assholes just made some shitty mistake.
💀
What kind of facility ask for a diagnosis before care. You tell me if I have a UTI.
Because UTIs are common in women, like I'm pretty sure it's extremely rare to never even have 1. Because of that we are VERY familiar with the symptoms and can immediately tell it's a UTI. I don't even go anywhere, I just go to an online doctor and say it's a UTI and I can immediately get antibiotics instead of waiting for an appointment. Studies have shown this is an effective way to treat women with UTIs, it's not less effective than making them wait and running tests.
There are some situations where you NEED to go in and get tests done when there are symptoms of a bladder or kidney infection, like pain in your lower back or fever. These are screener questions when you complete any request for UTI medication.
As someone who has had several UTIs, I am happy I don't need to wait around at a urgent care for my turn or wait for an appointment. UTIs are HELL
Just tell them you identify as female. They won't be able to say shit unless they start throwing religion at you.
Gotta be careful doing this. It gives them more ammunition behind the vitriol of transgender people.
He shouldn't have to pretend to be part of a minority group in order to be treated for something.
It works for getting jobs too!
Have you since received treatment? Bad news, men don't really get UTIs.
When I had it, it was because of kidney stones.
Penis owners can absolutely get UTIs, but since the urethra is much longer, they're less likely to develop into bladder infections.
Health care is communism!