[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.

emc,
emc avatar

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

nameless_prole,

You explained how getting UTIs for men is different than women, but you don't really explain how treating it is more complicated.

MortalWombat,

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.

Ragnell,
Ragnell avatar

So why no referral?

emc,
emc avatar

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.

emc,
emc avatar

It’s different because it requires significantly more diagnostic effort to determine the root cause, which corresponds to more effort to treat. Women have a urethra that’s extremely short. They can get a UTI from routine activities like having sex or wiping from back to front after having a bowel movement. The treatment for cases like these is extremely simple: just prescribe an antibiotic.

With males, the urethra is so long that it’s almost impossible to get a UTI because of things like these. When males get a UTI, they are caused by things like kidney stones, anatomical abnormalities, indwelling catheters, etc. Your average CVS practitioner is not going to be able to order imaging and determine whether your kidney stone needs to be broken up. Or make the determination as to whether surgery is needed to correct some other abnormality. Additionally, these complicating factors that cause UTIs in men can lead to more complications down the road. For example, if you have a kidney stone causing a UTI, you don’t have cystitis (infection of the bladder) but rather pyelonephritis (infection of the kidney). Giving an antibiotic will not treat this because the stone will continue to seed the infection. Meanwhile, you are at increased risk of having the infection spread to your blood (sepsis), which doesn’t generally happen with cystitis.

CVS cannot help you with this. Frankly I wouldn’t trust CVS with my primary care even for the categories that are in OP’s picture because CVS’s exam room care is meant to make money, not provide comprehensive care.

gk99,

I'm not saying you're incorrect, but this is inconsistent with my experience. I have had about 6 or 7 UTIs, and across multiple urgent care facilities, the experience has mostly just entailed me getting urinalysis, something a MinuteClinic is capable of, and being prescribed antibiotics. Once they sent me to an ER instead and that time I was giving imaging, but it seems like plenty of places are willing to just make the call to prescribe antibiotics and recommend following up with a primary care provider afterwards. This has also always been covered by insurance. I'm not saying they've ever solved the root problem, but they have no issue treating the symptom. I'm not sure what I'm missing or if my city's healthcare just sucks or what.

And yes, I know that statistically something is wrong with me. I've talked with my new primary care provider about it and they're basically just telling me to monitor it and give them a call if it happens again.

sadreality,

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.

throwaway38575061,

Riiigghhttt! 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. But, no, their goal is to obfuscate and irritate until the patient gives you and pays out-of-pocket.

Liontigerwings,

What kind of facility ask for a diagnosis before care. You tell me if I have a UTI.

pizza_rolls,
pizza_rolls avatar

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

sputtersalt,

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?

DRx,
@DRx@lemmy.world avatar

This is correct… there is 2 things to remember here

  1. CVS only has nurse practitioners, nurses, or pharmacists that are doing the screening, and must refer for certain cases
  2. There are 2 types of UTIs….
  • complicated and uncomplicated
  • Men ALWAYS have a complicated uti due to the anatomy of where the uti is located
  • women can have either, these NPs are only allowed to treat UNCOMPLICATED UTIS and must refer all complicated cases to a physician.

FYI it has nothing to do with insurance

sputtersalt,

I figured there was some kind of reason. I didn't know about complicated vs uncomplicated, appreciate the explanation!

runawaycorvid,

Thankfully I found this before I felt obligated to post. NPs/PAs at these clinics operate via protocols signed off by physicians.

And adding on to what you and a few others have said — it isn’t normal for men to get UTIs, hence the ‘complicated’ description. They often get treated with antibiotics for longer durations at a minimum.

FuzzyDoublePumper,

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.

nameless_prole,

Real life dystopia shit.

To anyone considering this, just remember that there is a reason that the FDA exists. Fish antibiotics aren't FDA regulated, so you really have no idea what you're taking and how much.

racer983,

Please don’t do this, it is dangerous and could potentially make the whole situation much worse, costing you more money in the end. This is a CVS minute clinic/insurance interaction thing, CVS wants just really simple complaints that they can address in a very brief amount of time. Insurance companies don’t consider a male UTI a simple complaint for some reasons I address in a comment above. A real urgent care will have no issues billing insurance for this issue.

aeternum,

You don't want to fuck around with infections. Go to a doctor if you can afford it/it's free in your country.

VanillaGorilla,

This sentence is so American, it started to look for oil.

LostCause,

So wtf, they want you to let it get worse until that infection spreads to kidneys or something and then pay 100x the amount to an emergency room? How does that make sense for their profits anyway?

Treatment is just a test to confirm and some antibiotics I think. Hope you can find some other way to get treated.

nightscout,
@nightscout@lemmy.world avatar

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

GreenCrush,
@GreenCrush@lemmy.world avatar

This is great. Thank you for providing such great info to lemmy. A lot of people in the US suffer from a lack of information, and this more than certainly helps.

FierroGamer,

How is the us a real place wtf?

Maggoty,

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.

musicalcactus,

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.

Rando,

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!

Confuzzeled,

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.

c2h6,

Wat

axtualdave,

The bottom line is that it is complicated on purpose and designed to wear you out

The real kicker is you're wrong. It's not designed that way. That's just a happy accident of capitalism run amok. Almost no one involved in the system is an intentionally bad actor. Almost everyone wants to do the right, good thing.

The doctors want to provide care, but they can't because their boss says, "No."

Their bosses don't want to say no, but they have to refuse some people so they can help the rest or the insurance companies won't pay at all.

Insurance companies wan--actually, no, they're fucking evil soul-sucking sacks of shit that can die screaming in a fire. Fuck 'em.

markr,

No sorry that is wrong. The need for profit and growth in profit absolutely pushes health insurance organizations to limit their costs, and denying service is routine, planned and not some mysterious accident.

axtualdave,

Which statement of mine do you disagree with? Did you maybe not make through the whole comment?

markr,

undefined> The real kicker is you’re wrong. It’s not designed that way. That’s just a happy accident of capitalism run amok. Almost no one involved in the system is an intentionally bad actor. Almost everyone wants to do the right, good thing.

That statement.,

axtualdave, (edited )

Keep reading....

Oh my. Y'all really didn't read the whole comment did you?

Maggoty,

You should really look into the history of modern US healthcare. Johnson nearly passed a public health system. They consciously decided to go with this instead. This is absolutely by design. The people in charge simply fire anyone not making a profit until they find someone willing to do anything to create a profit, legal or not. (See Wells Fargo for this too, it's an old playbook at this point.) They play naive but they are totally aware of what is done to create those profits.

Also we recently found this with the Opiate stuff too and that entire family exchanging messages clearly indicating they knew the illegal activities and lies being told for profit. They just played dumb publicly.

The_weapon_x,

First world country which treats its citizens as third world, that's what we live in. Follow the money, because if something isn't making money for someone, then we don't get it.

EchoVerse,

A lot, and I do mean it, of third-world countries have better access to medical care and universal healthcare than the US.

porkins,

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.

Totonyus,

What does UTI means ?

dystop,
@dystop@lemmy.world avatar

urinary tract infection

Alpagu,
@Alpagu@lemmy.world avatar

I'm living in Turkey. All health care is free.

akira,

but if you live in turkey you get hate for being gay

acupofcoffee,

You get that in the US too, so what's the difference?

akira,

true that

Nobody5585,

Unless you are unemployed. Then you have to pay the unemployed tax (GSS) whether you use the healthcare services or not.

assa123,
@assa123@lemmy.world avatar

That sounds expensive. So when you don't have an income source they charge you a tax for it?

PKRockin,

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.

throwaway38575061,

No. No, it does not. A poor tax makes no sense.

PKRockin,

We can discuss where the money comes from, but the idea isn't pie-in-the-sky wild. I don't disagree with you.

Taxxor, (edited )

In germany, the state is paying for your health insurance when you're unemployed(along with other social insurances). More precisely the job centers are paying it, but they are ultimately paid by the state so...

funkless,

there is so much money in the world, and food/water, and housing that literally everyone - theoretically - could be fed and healthy without needing to pick on the unemployed first.

utopianfiat,

It's not a matter of amount, it's a matter of allocation. You have water shortages in a lot of places because agriculture uses massive amounts of potable water to irrigate (and can afford to do so- because water is and should be cheap). If agriculture were more efficient, we would have a lot more potable water- but making it more efficient takes money, resources, work, and ongoing maintenance. Similarly, the existence of vacant housing and homeless people doesn't imply that we have enough housing to go around. A lot of vacant housing is vacant for a reason- it's not ok to be shoving homeless people into collapsing apartments, unsafe buildings, a sixth-floor walkup when they're in a wheelchair, etc. Food also is way more than the production cost, it's also transporting the food to a place where it can be made available, keeping the food fresh and safe, and preparing it. For a lot of countries with an unstable food supply, the problem is much less that they don't have enough food and more that it's difficult or unsafe to get food to the tables of people who are hungry.

This might have been implied in your comment but it's far more nuanced than "we just need to care more about feeding everybody"- there are real tradeoffs and real commitment of real work and resources, and important sacrifices both known and unknown to any system you design.

x4740N,
@x4740N@lemmy.world avatar

That sounds so fucking stupid

You're unemployed so pay us money you can't recoup until we make you homeless

UnstuckinTime,

This country is f****** crazy. I remember like 8 years ago I was trying to get into rehab to kick opiates which I eventually did in 2015. When I got into a free bed for a detox, they wouldn't let me in because it said my insurance wasn't accepted. The irony was I didn't have insurance anymore, they still had me listed as being insured with some s***** Blue Cross program at my old job.

I actually had to get proof that I wasn't insured so the state would cover my bed.

Any other OECD Nation pretty much and you get treated like anyone else. And the sick part is both political parties are okay with this, and militantly fight any serious ever for a public health care system with one single risk pool where everybody is automatically opted in.

haxguru,

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!!

ikidd,
@ikidd@lemmy.world avatar

https://en.wikipedia.org/wiki/Dead_Internet_theory

zombuey,

I checked and am definitely a robot.

Alpagu,
@Alpagu@lemmy.world avatar

We are bots😃

softpboy,

We are the robots https://youtu.be/VxF0aja7rLU

SomethingBurger,

Everyone on Lemmy is a bot except you.

fne8w2ah,

Aww man you poor sods. In any other civilised country that wouldn't be so much of a worry. 😭

utopianfiat,

The fuck did you just call us?

markon,

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.

mirror_slap,

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.

Uriel238,

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?

FlashMobOfOne,
@FlashMobOfOne@lemmy.world avatar

Probably.

We knowingly vote for this shitty health care system every two years, so why would they ever change?

Uriel238,

At the federal and state levels, we knowingly vote against King Heron so he doesn’t eat all the frogs. (That is, we vote against Republicans who are actively working to neuter democracy).

Getting social safety net stuff, justice reform or even election reform will require grassroots pressure bigger than yhe George Floyd / BLM protests.

And without those things, instead were going to get genocide politics and civil war.

FlashMobOfOne,
@FlashMobOfOne@lemmy.world avatar

I think we convince ourselves we're voting the way we do for good reasons, but since Reagan, our votes have resulted in conservative outcomes no matter who we elect. Obama even had a supermajority for six months of his presidency, and we still had to hear the usual excuses people make in order to deflect from criticism of Democrats.

I say this as someone who voted Biden fully expecting him to govern as a conservative because I thought we needed a cultural victory against the resurgence of fascism. And, even with the 1/6 domestic terrorist event, we haven't seen any real movement to stop those elements. If anything, they've grown stronger.

I agree with your main point though, meaningful change is impossible now. It would take an existential threat greater than COVID for it to happen, and in a country where 40,000,000 people can't afford to miss a day of work, it's just impossible.

GnothiSeauton,
@GnothiSeauton@lemmy.world avatar

Obama even had a supermajority for six months of his presidency, and we still had to hear the usual excuses people make in order to deflect from criticism of Democrats.

Another way of saying this is that with only 72 days of congress that Obama actually had a supermajority, he passed the largest expansion of healthcare coverage for Americans since medicare/medicaid.

I guess that's a conservative outcome to you though.

markr,

And as usual he had to deal with a bunch of Democratic shitheads like Lieberman who held the bill hostage until it was weakened to their satisfaction.

FlashMobOfOne,
@FlashMobOfOne@lemmy.world avatar

he passed the largest expansion of healthcare coverage

Only if you can absorb being price gouged, otherwise you're left in an ER to die. He had the power to enact universal health care and sided with lobbyists, and deserves full credit for it.

It should also be noted that Obamacare was modeled off of the system Mitt Romney implemented when he was a state governor. It's literally a conservative system.

GnothiSeauton,
@GnothiSeauton@lemmy.world avatar

I'm going to assume you weren't politically aware when Obamacare was being passed. It barely made it through as it was. There was absolutely zero chance universal health care could ever have been passed at that time. To claim Obama had the power to enact it is insane.

Also, since Obamacare contained huge expansions for medicaid eligibility, and Obamacare is, as you claim, "literally a conservative system", wouldn't medicaid for all be the most conservative system of them all?

Finally, no, no one is left in ERs to die, insured or not. Heck you don't even need to be a citizen. That hasn't been true since 1986. That said, you would get a hefty bill if they actually know who you are and I do fully support a system where that is not the case and one can get treatment without worrying about the cost.

Uriel238,

Technically, if the only thing he could pass was a conservative system because the conservatives would block anything further left of it, then yeah, that explains how the ACA is a conservative system.

Obama was very much a neoliberal who mostly continued George W. Bush policies. (Bush was a far-right conservative, even if he was overshadowed by Trump). Curiously, Biden is continuing Trump policies, even to the point of letting people in crisis die.

The Democratic party has had stopgaps to keep it neoliberal (that is establishment, corporate-sponsored) since Carter, who was too left wing for its tastes. In both cases of Carter and Occasio-Cortez, party policy was changed to assure that no-one like them could be elected again. (Though the policy change of the DCCC after Occasio-Cortez was allegedly reversed due to public pressure.)

As Oxford noted, the US is not a true democracy, but an oligarchy with small democratic features. And now the GOP wants to make sure it’s a one-party system, so they don’t even have to bother campaigning.

UnstuckinTime,

Yeah you're only option in that situation is probably to show up at an emergency room. There is still a law that says they have to treat you although not necessarily comprehensively. But they will at least give you an appointment with the doctor you'll have to wait a long time and you will get a bill for it.

Your follow-up care is not necessarily guaranteed but you will get something.

It's just so twisted and disgusting.

heili,

There are different regulations regarding treatment dispensed directly by a pharmacist than those dispensed by a physician. Under 16 would generally have to be seen by an a doctor, often a pediatrician.

  • All
  • Subscribed
  • Moderated
  • Favorites
  • •
  • mildlyinfuriating@lemmy.world
  • DreamBathrooms
  • InstantRegret
  • thenastyranch
  • magazineikmin
  • khanakhh
  • rosin
  • Youngstown
  • slotface
  • mdbf
  • cisconetworking
  • kavyap
  • cubers
  • everett
  • ngwrru68w68
  • JUstTest
  • Durango
  • osvaldo12
  • tacticalgear
  • modclub
  • normalnudes
  • Leos
  • ethstaker
  • GTA5RPClips
  • tester
  • anitta
  • provamag3
  • megavids
  • lostlight
  • All magazines
    •