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
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.
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
That’s what I was thinking. Sounds illegal.
If you think that’s discrimination, don’t look at the marketing industry.
Discrimination based on biological factors is literally what insurance companies do.
I will look into that. Thank you for brining it to my attention ❤️
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
- 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
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?
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.
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.
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?
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.
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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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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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.
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.
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.
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.
That’s wild. When I go to any NHS services I don’t provide anything unless I want my visit be recorded in my patient card for future references.
I think you’re just supposed to die now…
I don’t believe I can afford to, though. 😓
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.
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.
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.
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.
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.
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
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.
What the hell? Was someone drunk when they drew up that policy?
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Too much cocaine
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.
Unfortunately, insurance is insulated from public backlash because it’s not something that is easy to shop around for. Many people get insurance though work and have limited options to start with and a specific time window for make plan changes. When all options equally suck there isn’t an affordable place to switch your business too.
This sort of change would need to be legislated, but public opinion has very little impact on public policy.
Healthcare is broken in the US and no one with any real power to make change will do anything about it because it’s far too profitable the way it is now.
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.
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.
![[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}