tl;dr:
For 2 months I (33M) have had symptoms consistent with prostatitis, but the cause is unknown – no positive bacterial test results. I was prescribed antibiotics empirically, but the symptoms haven’t improved after a few weeks. Quality of life impact is significant, and I’m concerned about the small risk of cancer or some other cause (I also have had significant weight loss over the last year). I really want to go to a urologist for more tests, but my PCP is so busy and no one will take my insurance (Anthem Blue Cross Medi-Cal), so I have to file a grievance and/or wait until 2022. Wondering what are my best options to get more testing done quickly – can I buy insurance temporarily, or should I try to pay out of pocket?
My problem (sorry this is so long, it’s all context for why I feel like I need to see a urologist):
33yo male on Blue Cross Medi-Cal in the San Francisco Bay Area, no history of medical problems. Lost job when the pandemic started and haven’t found work again yet. About two months ago the following symptoms started: Constant pain in the urethra, difficulty urinating, painful urination, painful ejaculation, sore prostate. I also lost 50 pounds over the last year which I can’t really explain since I got virtually no exercise and had only minimal dietary changes.
I have been in and out of the doctor’s office, mostly urgent care, seeing a different doctor almost every time, and repeated tests for UTI and STI were all negative. My PCP hospital has good doctors but they seem very busy.
Digital rectal exam found my prostate to be a bit sore, so main doc suspected bacterial prostatitis and gave me a long course of antibiotics. It’s probably the best treatment plan for the time being, but I’m concerned that the illness could actually be cancer. I know it’s unlikely at my age, but my understanding is that cancer is best treated early, so I don’t want to wait to find out. The weight loss is why I started worrying; people were asking me “How did you lose weight?” and I realized it doesn’t really make sense, since I have been mostly sitting around throughout the pandemic and not eating particularly healthy. The only thing that turned up in my blood work is “Bandemia” (high white blood cell count?) which I believe can indicate an infection but also a number of other things including cancer.
Also I believe I was allergic to one of the antibiotics (after 2wks of Bactrim I got a fever, headaches, itching everywhere, agitation, memory loss and apathy [fun!] until I stopped taking it) and I’m concerned about the effects of continued long-term Abx usage. I’m on Doxycycline now. Antibiotics have caused no noticeable improvement of my symptoms. Actually the constant pain and difficult urination seem to be slowly getting worse. Maybe they would be *even* worse without Abx, and I know this treatment is supposed to take a long time, but still I think the ineffectiveness of Abx so far could conceivably point to a non-bacterial diagnosis.
I could switch to a harder Abx like Ciprofloxacin, but after reading about the side effects I am kind of scared to take it. If I could confirm that my problem is bacterial or at least rule out some other causes, then I would take Cipro in a heartbeat.
The tests I want to do are a PSA test, mycoplasma and ureaplasma test, semen culture, bladder cystoscopy, transrectal ultrasound (for prostate), and a CT scan.
My PCP eventually referred me to Urology after repeated requests, but when I called to schedule I was told the ward had been partially shut down due to Covid-19, so they are very backed up and I can expect a call back in 2022.
I talked to my insurance today but they couldn’t find a urologist in the area who will take it, so the rep filed a grievance on my behalf and told me to wait 10 days for resolution (5 for an acknowledgment letter + 5 for the response).
If I knew for sure I was getting a timely appointment in 10 days, then I probably wouldn’t bother posting here, but I’m not sure what the response will be, so I want to figure out an alternative ahead of time.
Currently this illness is causing serious anxiety and relationship problems. The pain makes it hard to be productive or focus on job search, can’t have sex, can’t go out in the sunlight during day (due to Abx), and not knowing what’s wrong with me or how long it will last makes it worse. I want to be a hardworking citizen again and not be on Medi-Cal, but I’m a wreck right now. At least if I can confirm it’s not cancer, cysts or whatever then I can take some comfort in that and hope it goes away eventually.
So here are my ideas for how to see a urologist! Followed by my overthinking/concerns about each..
(Note – these are all assuming that I don’t miraculously find a job with good benefits in the immediate future. Which would of course be preferable but unlikely :D)
1.) Buy health insurance. I don’t have the money but I’ll borrow it.
-Covered California says I’m ineligible for any subsidized plans, so it’s Medi-Cal or nothing with them (fair enough I guess) – is there some other kind of marketplace or do I have to buy direct from insurance companies?
-Is there an easy way to shop plans based on which providers I’ll have access to? It sounds like UCSF has a good prostate cancer center for example. I’d like to be able to go there in a worst-case scenario.
-What if the cheaper HMOs also make it hard to see a urologist? My girlfriend says to get Kaiser, but friends with Kaiser have told me about long wait times to see a specialist there too.
-What is the benefit of expensive PPOs that let you go out of network, if the deductible is so high that it won’t even cover anything? Is it just the ability to go to those better hospitals/specialists?
-I can only borrow enough for a really good plan for a few months. What mechanisms does the industry have to stop somebody like me from just buying good insurance for a few months, and then canceling it once I get cured, or after I get the tests I want? I’m worried Medi-Cal won’t want to take me back, haha.
2.) Contact urology clinics and pay out of pocket. In theory all the procedures would cost a couple thousand total, which is acceptable for something this important.
-Am I likely to encounter a lot of hidden fees for paying OOP? For example I see on health cost sites that a transrectal ultrasound in my area costs about $300. A small price to pay, in spite of my brokeness, to confirm that I don’t have a tumor in my prostate. But I’m worried that my bills could somehow end up being much higher.
-Could paying out of pocket for this jeopardize my eligibility for free healthcare in the future?
-How do I find a good urologist? I’m guessing Yelp is not the best way. A lot of urology clinics I see there seem to focus on vasectomies.
-It sounds like most of them expect a referral too. My PCP said they can transfer my referral after my insurance approves something. I’m hoping that if I pay out of pocket somewhere I can still transfer my referral there.
-I’m worried that I’d be ripping myself off if there is a free/subsidized option I don’t know about – but I also don’t want to wait.
-This is the option I’m leaning towards at this point, just getting the cheaper tests done out of pocket (maybe leave out the CT scan and cystoscopy for now).
3.) Switch addresses (basically make my girlfriend’s house my official address instead of my parents’ house) and hope that I can get assigned a new PCP with a less busy Urology dept/less busy overall. My girlfriend lives in a more affluent area so I might get lucky.
-Of course this could turn out to be a waste of time and not help at all, or be even worse. Also ethical concerns, although I really do divide my time between the two addresses and was planning to move officially there anyway, so I don’t think it is dishonest, I still worry about wasting public resources or making it harder on the medical staff by shuffling my care around for no reason.
Well, if anyone actually read all that, thank you so much. Any sort of advice would be greatly appreciated. I know very little about insurance, when I had jobs I would just pick the most expensive employer plan and never use it. Very grateful this helpful sub exists!
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tl;dr: For 2 months I (33M) have had symptoms consistent with prostatitis, but the cause is unknown – no positive bacterial test results. I was prescribed antibiotics empirically, but the symptoms haven’t improved after a few weeks. Quality of life impact is significant, and I’m concerned about the small risk of cancer or some other cause (I also have had significant weight loss over the last year). I really want to go to a urologist for more tests, but my PCP is so busy and no one will take my insurance (Anthem Blue Cross Medi-Cal), so I have to file a grievance and/or wait until 2022. Wondering what are my best options to get more testing done quickly – can I buy insurance temporarily, or should I try to pay out of pocket? My problem (sorry this is so long, it’s all context for why I feel like I need to see a urologist): 33yo male on Blue Cross Medi-Cal in the San Francisco Bay Area, no history of medical problems. Lost job when the pandemic started and haven’t found work again yet. About two months ago the following symptoms started: Constant pain in the urethra, difficulty urinating, painful urination, painful ejaculation, sore prostate. I also lost 50 pounds over the last year which I can’t really explain since I got virtually no exercise and had only minimal dietary changes. I have been in and out of the doctor’s office, mostly urgent care, seeing a different doctor almost every time, and repeated tests for UTI and STI were all negative. My PCP hospital has good doctors but they seem very busy. Digital rectal exam found my prostate to be a bit sore, so main doc suspected bacterial prostatitis and gave me a long course of antibiotics. It’s probably the best treatment plan for the time being, but I’m concerned that the illness could actually be cancer. I know it’s unlikely at my age, but my understanding is that cancer is best treated early, so I don’t want to wait to find out. The weight loss is why I started worrying; people were asking me “How did you lose weight?” and I realized it doesn’t really make sense, since I have been mostly sitting around throughout the pandemic and not eating particularly healthy. The only thing that turned up in my blood work is “Bandemia” (high white blood cell count?) which I believe can indicate an infection but also a number of other things including cancer. Also I believe I was allergic to one of the antibiotics (after 2wks of Bactrim I got a fever, headaches, itching everywhere, agitation, memory loss and apathy [fun!] until I stopped taking it) and I’m concerned about the effects of continued long-term Abx usage. I’m on Doxycycline now. Antibiotics have caused no noticeable improvement of my symptoms. Actually the constant pain and difficult urination seem to be slowly getting worse. Maybe they would be *even* worse without Abx, and I know this treatment is supposed to take a long time, but still I think the ineffectiveness of Abx so far could conceivably point to a non-bacterial diagnosis. I could switch to a harder Abx like Ciprofloxacin, but after reading about the side effects I am kind of scared to take it. If I could confirm that my problem is bacterial or at least rule out some other causes, then I would take Cipro in a heartbeat. The tests I want to do are a PSA test, mycoplasma and ureaplasma test, semen culture, bladder cystoscopy, transrectal ultrasound (for prostate), and a CT scan. My PCP eventually referred me to Urology after repeated requests, but when I called to schedule I was told the ward had been partially shut down due to Covid-19, so they are very backed up and I can expect a call back in 2022. I talked to my insurance today but they couldn’t find a urologist in the area who will take it, so the rep filed a grievance on my behalf and told me to wait 10 days for resolution (5 for an acknowledgment letter + 5 for the response). If I knew for sure I was getting a timely appointment in 10 days, then I probably wouldn’t bother posting here, but I’m not sure what the response will be, so I want to figure out an alternative ahead of time. Currently this illness is causing serious anxiety and relationship problems. The pain makes it hard to be productive or focus on job search, can’t have sex, can’t go out in the sunlight during day (due to Abx), and not knowing what’s wrong with me or how long it will last makes it worse. I want to be a hardworking citizen again and not be on Medi-Cal, but I’m a wreck right now. At least if I can confirm it’s not cancer, cysts or whatever then I can take some comfort in that and hope it goes away eventually. So here are my ideas for how to see a urologist! Followed by my overthinking/concerns about each.. (Note – these are all assuming that I don’t miraculously find a job with good benefits in the immediate future. Which would of course be preferable but unlikely :D) 1.) Buy health insurance. I don’t have the money but I’ll borrow it. -Covered California says I’m ineligible for any subsidized plans, so it’s Medi-Cal or nothing with them (fair enough I guess) – is there some other kind of marketplace or do I have to buy direct from insurance companies? -Is there an easy way to shop plans based on which providers I’ll have access to? It sounds like UCSF has a good prostate cancer center for example. I’d like to be able to go there in a worst-case scenario. -What if the cheaper HMOs also make it hard to see a urologist? My girlfriend says to get Kaiser, but friends with Kaiser have told me about long wait times to see a specialist there too. -What is the benefit of expensive PPOs that let you go out of network, if the deductible is so high that it won’t even cover anything? Is it just the ability to go to those better hospitals/specialists? -I can only borrow enough for a really good plan for a few months. What mechanisms does the industry have to stop somebody like me from just buying good insurance for a few months, and then canceling it once I get cured, or after I get the tests I want? I’m worried Medi-Cal won’t want to take me back, haha. 2.) Contact urology clinics and pay out of pocket. In theory all the procedures would cost a couple thousand total, which is acceptable for something this important. -Am I likely to encounter a lot of hidden fees for paying OOP? For example I see on health cost sites that a transrectal ultrasound in my area costs about $300. A small price to pay, in spite of my brokeness, to confirm that I don’t have a tumor in my prostate. But I’m worried that my bills could somehow end up being much higher. -Could paying out of pocket for this jeopardize my eligibility for free healthcare in the future? -How do I find a good urologist? I’m guessing Yelp is not the best way. A lot of urology clinics I see there seem to focus on vasectomies. -It sounds like most of them expect a referral too. My PCP said they can transfer my referral after my insurance approves something. I’m hoping that if I pay out of pocket somewhere I can still transfer my referral there. -I’m worried that I’d be ripping myself off if there is a free/subsidized option I don’t know about – but I also don’t want to wait. -This is the option I’m leaning towards at this point, just getting the cheaper tests done out of pocket (maybe leave out the CT scan and cystoscopy for now). 3.) Switch addresses (basically make my girlfriend’s house my official address instead of my parents’ house) and hope that I can get assigned a new PCP with a less busy Urology dept/less busy overall. My girlfriend lives in a more affluent area so I might get lucky. -Of course this could turn out to be a waste of time and not help at all, or be even worse. Also ethical concerns, although I really do divide my time between the two addresses and was planning to move officially there anyway, so I don’t think it is dishonest, I still worry about wasting public resources or making it harder on the medical staff by shuffling my care around for no reason. Well, if anyone actually read all that, thank you so much. Any sort of advice would be greatly appreciated. I know very little about insurance, when I had jobs I would just pick the most expensive employer plan and never use it. Very grateful this helpful sub exists!
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