2y ago

[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.

172 comments

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

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.

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.
  
  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.
- 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.

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 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.

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.
- 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.
- 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."
- 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.
- 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.

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.

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?

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…
  
  Free healthcare in this instance.
  
  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.

What the hell? Was someone drunk when they drew up that policy?
- Too much cocaine

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.
- 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.

I think you're just supposed to die now...
- I don't believe I can afford to, though. 😓

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.
- Well you see, every dollar spent on care is one less dollar shareholders get, so...

I'm living in Turkey. All health care is free.
- but if you live in turkey you get hate for being gay
  
  You get that in the US too, so what's the difference?
- Unless you are unemployed. Then you have to pay the unemployed tax (GSS) whether you use the healthcare services or not.
  
  That sounds so fucking stupid
  You're unemployed so pay us money you can't recoup until we make you homeless
  
  That sounds expensive. So when you don't have an income source they charge you a tax for it?

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.
  
  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.
- 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

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

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 wen they finally send it. That's wrong a significant percent of the time too.

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!!

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.

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.
  
  Yeah, they'll have to be responsible and only have sex using condoms. Or keep their legs shut.

BREAKING: Men do, in fact, pee

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.

I'm not USian but I'd be astonished if that was legal, even in the barbaric hellhole that is the US healthcare system.
Ask her to put it in writing and then challenge the insurance company.

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 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.

That's so fucked up! I'm sorry OP.
- Thank you ❤️

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
- 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.
  
  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.
- 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.

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.
  
  My thoughts as well. It's likely not covered at this clinic due to male UTIs not always having as straight forward of a cause/treatment as a UTI in a female does.

I am sorry this is happening to you. I cannot even phantom why this is the case, anyone could please explain to me why UTIs are not covered for men?
- There is a documented thing insurance companies have started doing where they deny claims until you appeal them. AI was being used somehow to determine which cases.

do get it treated OP, however one does that in that joke of a country you're unfortunate enough to live in. Do know that unlike female UTIs which are relatively common and often uncomplicated if treated, male UTIs are not common and CAN herald some other underlying pathologies (such as urinary stones, blockages, anatomical problems etc) which should be properly investigated. So do go see a doctor if you're able to.
- I'm actually surprised that the CVS provider still offered to treat him, for this exact reason. I'm a trans guy who went through a bout of recurring UTIs during the height of the pandemic. For all medical purposes I could have been treated the same as any cis woman, but actually accessing the virtual-only care that's readily available to cis women was a trial for me because the systems are set up to filter out men.

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.

Mildly infuriating?

It's a good thing we have private insurance in the US. You have the freedom of choice! (/s)
Can you visit a general practitioner for treatment? It'll take a lot longer... but I would imagine they can give a prescription - even if it's not covered.

What does UTI means ?
- urinary tract infection

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.

This is why mens' rights activists exist. Unfortunately, just like the feminist movement, they were invaded by psychopaths.

I'm never paying into health insurance in the US again, fucking scam of a shit system.

Aww man you poor sods. In any other civilised country that wouldn't be so much of a worry. 😭
- The fuck did you just call us?

Since nobody addressed this, if you (anyone reading this) have a bladder infection, go to the women's section of any pharmacy. Usually somewhere near pads/tampons, and find a box of this blessed relief. It has cleared up all but the most stubborn infections I've had.
- just FYI to anyone reading this, this stuff is indeed magic pain relief, BUT it's not an antibiotic and you still need to see a doctor. UTI's can spread and it doesn't feel very good. I would up in the ER getting IV antibiotics over Thanksgiving one year. it sucked.
- You're a lifesaver!

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.

Yes, I'm in the US
Yeah, I don't think you needed to say that considering we're the only developed nation in the world that has a system where this happens.

What exactly is a UTI for males?

This country is ripe for a revolution.

I think most everyone knows this would have to be in the USA.
Sorry OP, I really hope those greedy assholes just made some shitty mistake.

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

💀

Land of the free

Have you try other online services (no insurance need) like GoodRX care? I don’t see you need 16 or older for UTI in their options.

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.

172 comments