Will new insurance cover UTI treatment?
January 5, 2011 3:20 PM Subscribe
Will an insurance company cover a UTI and/or bacterial infection possibly acquired before getting insurance? What if these infections are recurrent over the past 12 months, but the treatments have been paid for out of pocket?
Background:
My fiancee has been fighting either the same UTI that never goes away, many acute UTIs (5+), or conditions that are being misdiagnosed as UTIs for the past year to a year and a half. We’re in North Carolina, and we’ve reached the conclusion that we need to stop going to Planned Parenthood to receive the same sort of treatment. We want to pursue a different set of eyes. We reached this conclusion after she still felt that something was wrong after yet another week’s course of antibiotics that the doctor was absolutely certain would cure her.
Main concern:
We’ve decided on a Blue Cross and Blue Shield of North Carolina insurance plan. BCBSNC did not ask if she had ever had a UTI or bacterial infection, and we did not notice any of the medications that she has taken on the list of questions. However, we’re concerned that the insurance company may not want to pay for treatment for a UTI (and possibly a bacterial infection, which she’s had on and off too) within a month of receiving insurance. From phone conversations with BCBSNC (from an alternate phone number) and a medical receptionist, it seems that the main concern is whether she filed with insurance for a UTI, which she has not in the last 12 months. There should be no paper trail on UTI treatments; the UTI treatments in the past 12 months have been paid for out of pocket because she hasn’t had insurance for the past 3 years.
My concern is that if the new doctor prescribes a treatment that would not be prescribed for an acute UTI, the insurance may pick up on this and suspect a preexisting condition. I realize that you are not my doctor or insurance agent, but I’d like some fresh prospectives on this, in addition to guarded conversations with insurance companies and brokers.
As an aside:
What we don’t need is more suggestions on how to prevent UTIs (cranberry pills, cotton panties, no sex, etc.) because she’s tried them and still gotten UTIs within days of finishing a treatment. We understand the value of these steps, but these steps and typical treatment alone have not made progress thus far.
Background:
My fiancee has been fighting either the same UTI that never goes away, many acute UTIs (5+), or conditions that are being misdiagnosed as UTIs for the past year to a year and a half. We’re in North Carolina, and we’ve reached the conclusion that we need to stop going to Planned Parenthood to receive the same sort of treatment. We want to pursue a different set of eyes. We reached this conclusion after she still felt that something was wrong after yet another week’s course of antibiotics that the doctor was absolutely certain would cure her.
Main concern:
We’ve decided on a Blue Cross and Blue Shield of North Carolina insurance plan. BCBSNC did not ask if she had ever had a UTI or bacterial infection, and we did not notice any of the medications that she has taken on the list of questions. However, we’re concerned that the insurance company may not want to pay for treatment for a UTI (and possibly a bacterial infection, which she’s had on and off too) within a month of receiving insurance. From phone conversations with BCBSNC (from an alternate phone number) and a medical receptionist, it seems that the main concern is whether she filed with insurance for a UTI, which she has not in the last 12 months. There should be no paper trail on UTI treatments; the UTI treatments in the past 12 months have been paid for out of pocket because she hasn’t had insurance for the past 3 years.
My concern is that if the new doctor prescribes a treatment that would not be prescribed for an acute UTI, the insurance may pick up on this and suspect a preexisting condition. I realize that you are not my doctor or insurance agent, but I’d like some fresh prospectives on this, in addition to guarded conversations with insurance companies and brokers.
As an aside:
What we don’t need is more suggestions on how to prevent UTIs (cranberry pills, cotton panties, no sex, etc.) because she’s tried them and still gotten UTIs within days of finishing a treatment. We understand the value of these steps, but these steps and typical treatment alone have not made progress thus far.
Best answer: Agreed with abirae. There is no proof of a pre-existing condition. Even if this turned out to be something that's not UTIs, like interstitial cystitis, she hasn't had that diagnosis prior to getting onto the insurance.
If it's a UTI problem, UTIs are almost always E coli bacteria (sometimes a few other types), but there's no way for them to say "hey, this E coli's the exact same E coli that infected you previously!" Especially given you've been getting treatment for them 'off the grid' at Planned Parenthood.
And as a side note, if this turns out to be UTIs, maybe your fiancee could benefit from prophylactic therapy, like daily Macrobid, for a while.
posted by treehorn+bunny at 8:08 PM on January 5, 2011
If it's a UTI problem, UTIs are almost always E coli bacteria (sometimes a few other types), but there's no way for them to say "hey, this E coli's the exact same E coli that infected you previously!" Especially given you've been getting treatment for them 'off the grid' at Planned Parenthood.
And as a side note, if this turns out to be UTIs, maybe your fiancee could benefit from prophylactic therapy, like daily Macrobid, for a while.
posted by treehorn+bunny at 8:08 PM on January 5, 2011
Best answer: I had antibiotics prescribed to treat a sinus infection about 2 weeks after I got new insurance, and I had the same worry - I had a cold, it turned into a sinus infection, when it started wasn't really clear, etc. The insurer never brought it up with me. Obviously insurers vary - but I honestly don't think they're worried about bacterial infections when they're screening for preexisting conditions. They're worried about things that are expensive to treat and chronic. UTIs are not even close to meeting either of those criteria, in most cases.
I had recurring UTIs and was prescribed Macrobid that I only took after intercourse. I haven't had a UTI since, and it's been almost 7 years. It was totally lifechanging and if you guys haven't tried it, you really should now that you're insured and have a doctor who can look after you.
posted by little light-giver at 8:53 PM on January 5, 2011
I had recurring UTIs and was prescribed Macrobid that I only took after intercourse. I haven't had a UTI since, and it's been almost 7 years. It was totally lifechanging and if you guys haven't tried it, you really should now that you're insured and have a doctor who can look after you.
posted by little light-giver at 8:53 PM on January 5, 2011
Response by poster: Thank you so much for the very positive and informative answers. We've found that nitrofurantoin/Macrobid is the only medication that makes her feel 100% better after taking, at least for a little while. However, we didn't know that it can be prescribed in the ways that you guys are describing.
We're going to schedule an appointment and delve into the problem a bit deeper, while worrying a bit less about the insurance company.
posted by Tres at 10:21 PM on January 5, 2011
We're going to schedule an appointment and delve into the problem a bit deeper, while worrying a bit less about the insurance company.
posted by Tres at 10:21 PM on January 5, 2011
This thread is closed to new comments.
People (I) get UTI's all the time, so I don't think there's any reason an insurance company would consider a UTI an "underlying condition". They're generally acute, and require immediate treatment. It's possible that your girlfriend has something other than a UTI, but she hasn't been diagnosed with a pre-existing condition, so she acted in good faith getting health insurance, and the insurance company should cover the doctor visit to find out what's wrong and make it go away for good.
UTIs suck, and I wish you and your girlfriend all the best. Feel free to private message me if you have any questions. Good luck.
posted by abirae at 4:21 PM on January 5, 2011 [1 favorite]