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.
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
Yes, this is the problem.
If you think that’s discrimination, don’t look at the marketing industry.
Discrimination based on biological factors is literally what insurance companies do.
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
but females dont need to fart and males dont need to urinate!11!
I cannot stress enough how true this is.
That’s what I was thinking. Sounds illegal.
I will look into that. Thank you for brining it to my attention ❤️
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.
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
- CVS only has nurse practitioners, nurses, or pharmacists that are doing the screening, and must refer for certain cases
- 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
I figured there was some kind of reason. I didn’t know about complicated vs uncomplicated, appreciate the explanation!
That’s more than mildly infuriating…
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.
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.
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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.
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.
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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.,
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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.
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.
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.
A lot, and I do mean it, of third-world countries have better access to medical care and universal healthcare than the US.
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?
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.
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.
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.
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.
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.
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.
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…
That is a fully incorrect statement. Just because objectively its better to live in US than Russia at this moment, does not mean that there is 0 good reasons to live in Russia. Stop thinking in extremes, every place has pros and cons, its just that some places have a lot more cons than pros.
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.
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.
Seems like they’d be liable because a male uti could end up not clearing up and creating an antibiotic resistant strain? Either way it’s a lot harder for a man to get a UTI and it means something is really fucky. Examples of a complicated UTI include: Infections occurring despite the presence of anatomical protective measures (UTIs in males are by definition considered complicated UTIs) Infections occurring due to anatomical abnormalities, for example, an obstruction, hydronephrosis, renal tract calculi, or colovesical fistula. UTIs are less common in men than in women, as men have a longer urethra that makes the passage of bacteria into the bladder more difficult. Overall, people with vaginas are more prone to UTIs. However, penile UTIs are more difficult to treat, and may require longer courses of antibiotics. This is because the bacteria that causes these infections may linger inside tissues of the prostate gland.
Again I think a nurse should not be allowed to treat something that dangerous.
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.
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.
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.
Cancer and other life saving drugs in Canada can still be very expensive, we don’t have universal drug coverage in Ontario. You can get coverage if your income is below a certain threshold (ie you are very poor) but if you don’t have drug insurance here you are still fucked and can go into debt trying to stay alive or not suffer. It’s better than America but it’s not all sunshine and rainbows up here either.
Even most developing countries have nationalized healthcare alongside private options.
It’s… complicated. The US is more like the EU. Every state is practically its own country. Every state has its own health department. State wealth varies greatly and each state has their own opinion on what level of trust should be placed on federal government. The one example we have of federal health care (VA for military veterans) is shit.
Maybe things will change based on the current trajectory… corporate buy outs have been rampant and experienced doctors are retiring to cash in before they can’t afford to run their own practice. It takes weeks to get appointments and most corporate doctors just want to stick to the treatment script they are provided. In other words, corporations are doing exactly what most people fear the feds would do.
I think you’re just supposed to die now…
I don’t believe I can afford to, though. 😓
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.
Yea its a complicated uti vs uncomplicated. I’m many cases that should be investigated further than a minute clinic. But it’s also the insurance
What the hell? Was someone drunk when they drew up that policy?
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Too much cocaine
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.
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.
![[Final Update] My insurance won't cover UTIs for males. Yes, I'm in the US.](https://lemmy.world/pictrs/image/3f7f2fe9-6596-4427-a750-ca0a16636fcc.png){kind=link}