Home to all things "Mildly Infuriating" Not infuriating, not enraging. Mildly Infuriating. All posts should reflect that.
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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?
It might be, but some health related coverage is legitimately divided along sex lines. I don't know what the answer is, but it might not be so simple.
Stupid either way though.
Different genitals. But all genders have bladders so why the hell wouldn't the insurance just cover it for everyone
a few people have mentioned it's because of anatomy and how it makes male UTIs more complicated + require more complex care. it's not a case of insurance not covering it, op just needs to go somewhere else
That's more than mildly infuriating....
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.
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.
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.
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, and that's insane.
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.
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.
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.
Yea it will. Just not at a minute clinic. You need to go to an actual urgent care or primary care doctor.
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.
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
FYI it has nothing to do with insurance
The most developed country in the world ladies and gentlemen.
I hope they don’t catch you op.
Most powerful. The most developed is arguably in Europe, probably one of the Nordic countries.
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.
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.
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 why mens' rights activists exist. Unfortunately, just like the feminist movement, they were invaded by psychopaths.
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.
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.
That's disgusting if you ask me.
Also, you have to be 18+ for getting a contraception appointment. I guess teens in the US are also having sex like teens in other parts of the world and would very much need access to contraceptives, right?
Correct, they sure are. And abortion rights are under attack. Those teens won't even have a chance.
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?
BREAKING: Men do, in fact, pee
I think you're just supposed to die now...
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.
Aww man you poor sods. In any other civilised country that wouldn't be so much of a worry. 😭
Gawd, I know it happens more often in women but my husband had a nasty recurring UTI for a few months - they absolutely took it seriously and treated him! WTF, I hope you manage to get treated. ETA: UK
The OP's screenshot shows that the entity turning him down is a CVS MinuteClinic. MinuteClinic is staffed by nurse practitioners, not physicians, and it is limited in the scope of problems that it can treat. Evidently, male UTIs are outside of that scope. OP needs to seek treatment from a different office, and probably a regular physician, either at a primary care clinic, or at an urgent care center.
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.
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.
A lesson I learned the hard way is the only way you can tell what your insurance actually covers is to read the fine print. The insurance company service reps can't be relied upon and the medical office reps just make up an answer if they don't know. Nor can you be sure the coverage statement from the insurance company is right when they finally send it. IME that statement's wrong a significant percentage of the time too.
I've had to argue with my insurance company's reps about what is covered, actually read them the policy details, and provide the page and paragraph numbers because they have no idea what the policy their company sold actually says.
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.