this post was submitted on 25 Jun 2023
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Mildly Infuriating

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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.

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[–] [email protected] 22 points 1 year ago (6 children)

Sounds like discrimination based on sex. A clear violation of the Civil Rights act of 1964.

[–] [email protected] 5 points 1 year ago

That's what I was thinking. Sounds illegal.

[–] [email protected] 5 points 1 year ago (1 children)

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?

[–] [email protected] 5 points 1 year ago (2 children)

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.

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[–] [email protected] 12 points 1 year ago

That's more than mildly infuriating....

[–] [email protected] 8 points 1 year ago (1 children)

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

[–] [email protected] 7 points 1 year ago (4 children)

How is the us a real place wtf?

[–] [email protected] 4 points 1 year ago (8 children)

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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[–] [email protected] 8 points 1 year ago (1 children)

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?

[–] [email protected] 9 points 1 year ago

This is correct… there is 2 things to remember here

  1. CVS only has nurse practitioners, nurses, or pharmacists that are doing the screening, and must refer for certain cases
  2. 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

[–] [email protected] 7 points 1 year ago

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.

[–] [email protected] 6 points 1 year ago

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.

[–] [email protected] 5 points 1 year ago (2 children)

What the hell? Was someone drunk when they drew up that policy?

[–] [email protected] 3 points 1 year ago

Too much cocaine

[–] [email protected] 5 points 1 year ago (1 children)

I think you're just supposed to die now...

[–] [email protected] 4 points 1 year ago

I don't believe I can afford to, though. 😓

[–] [email protected] 5 points 1 year ago* (last edited 1 year ago) (4 children)

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.

[–] [email protected] 2 points 1 year ago

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.

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[–] [email protected] 4 points 1 year ago* (last edited 1 year ago) (1 children)

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.

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[–] [email protected] 4 points 1 year ago

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

[–] [email protected] 4 points 1 year ago

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.

[–] [email protected] 4 points 1 year ago

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.

[–] [email protected] 4 points 1 year ago

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.

[–] [email protected] 4 points 1 year ago (1 children)

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?

[–] [email protected] 4 points 1 year ago (6 children)

Probably.

We knowingly vote for this shitty health care system every two years, so why would they ever change?

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[–] [email protected] 4 points 1 year ago (5 children)

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!!

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[–] [email protected] 3 points 1 year ago (9 children)

I'm living in Turkey. All health care is free.

[–] [email protected] 5 points 1 year ago (1 children)

but if you live in turkey you get hate for being gay

[–] [email protected] 6 points 1 year ago (1 children)

You get that in the US too, so what's the difference?

[–] [email protected] 3 points 1 year ago
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[–] [email protected] 3 points 1 year ago (1 children)

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.

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[–] [email protected] 3 points 1 year ago (1 children)

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?

[–] [email protected] 3 points 1 year ago (2 children)

Correct, they sure are. And abortion rights are under attack. Those teens won't even have a chance.

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[–] [email protected] 3 points 1 year ago (3 children)

That moment when it's better to live in Russia than in US...

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[–] [email protected] 2 points 1 year ago

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.

[–] [email protected] 2 points 1 year ago (1 children)

That's so fucked up! I'm sorry OP.

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[–] [email protected] 2 points 1 year ago

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.

[–] [email protected] 2 points 1 year ago

Mildly infuriating?

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