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.
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.
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.
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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.
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’s more than mildly infuriating…
I think you’re just supposed to die now…
I don’t believe I can afford to, though. 😓
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
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.
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.
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.
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
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?
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.
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 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.
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.
This is why mens’ rights activists exist. Unfortunately, just like the feminist movement, they were invaded by psychopaths.
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.
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.
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.
American healthcare and insurance is only “mildly infuriating” if you’ve never had to deal with it. If you had, you’d probably characterize it as “goddamn fucking enraging.”
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.
BREAKING: Men do, in fact, pee
Should have just said that you identify as a woman, problem 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
![[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}