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[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.

229 comments
  • 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

  • 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.

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

  • 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 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

  • Man that is bad. And I must say there are more countries moving that way. You can get cheaper insurance but then you need to go to the connected health institutes and otherwise they won't pay. Fuck that, I want to choose where I get my care. I don't want health insurance providers to have a say in how my doctor treats me (but they do, unfortunately).

  • 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.

  • 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.

  • Have you tried contacting the insurance company? It might be a simple matter of them not having the correct coverage codes for UTIs on your account. I had to deal with a similar situation prior to a surgery last year where my account was missing the codes and they wouldn't cover my treatment until I bugged them enough to get them added.

  • 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.

229 comments