Biologically male procedures only. EDIT: If the two people who downvoted this question could explain their reasoning, I would be super interested. No judgements. This is a safe space!
I’d double- and triple-check the small print.
They’ll find a way to still charge you.I don’t know what’s covered under US “healthcare”, and I think it also depends on your age. Probably should talk to your doctor and ask them. Maybe a bunch of blood tests, dental work, cancer screenings, prostate check, colonoscopy, and upper endoscopy.
I work in American healthcare. Your doctor is actually one of the worst people to ask about coverage.
Unfortunately, the only solid way to be 100% sure of coverage is to call your insurance company and make them guarantee your planned procedures in writing. Every doctors office has a department to deal with insurance—after you talk to the insurance company you will want to talk to the insurance department at the doctors office and give them the written statement from the insurance company.
After your procedures, your bill will be processed by a medical coder at the doctors office, and a clearing house coder who gets things ready for your insurance company, before it potentially gets double checked again by coders who actually work for the insurance company. Those people will not have any clue about the arrangement made prior to your procedure, and this is the series of steps where something might happen that would cause your insurance company to not pay.
If you did your due diligence and got everything in writing beforehand, then the insurance company will kick the bill back to the doctor, at which point it will be reviewed by a payment specialist who will be able to see and use the written commitment to force the insurance company to process the bill.
This whole process takes anywhere from weeks to months, so you may not know there is a problem until a while after your appointment.
Welcome to American healthcare. Good luck getting whatever you can.
Unfortunately, dental is typically separate from health care in the US. (It’s stupid).
This isn’t always the case, technically. Dental can be considered for normal health insurance if it’s directly impacting your health (like an emergency surgery). That being said, your insurance may fight the shit out of this and will still most likely require you to list your dental insurance as the primary for billing.
Vasectomy if you don’t plan on having kids. Also consider mental healthcare. Everybody could use a little bit now and then.
Vasectomy is probably free anyway.
Or crazy cheap (like copay), since it prevents lots of expenses for the insurance company.
Yes! Mental healthcare!!
OP editing their post cuz they got put off by 2 whole downvotes is a sign that, yes, it’s time to consider mental health
Do you have any persistent pain or discomfort when doing things? Get that checked out.
Another +1 for colonoscopy.
Also if there’s a family history of anything nasty, see if there’s a test for it my maybe? (E.g. heart attacks, get blood work done for cholesterol).
Get a full physical including blood work.
Fun fact: for people over 45, colonoscopy screening for cancer is always free. If your insurance tries to make you pay for it, report them to your state insurance commissioner or the Center for Consumer Information and Insurance Oversight. ACA made a lot of preventative medicine & screenings free.
in my experience the first one was free. the followup a few months later wasn’t.
Yeah, it’s the screening that’s free. If that turns something up, then it transitions to “care.”
I’ve had the same experience with “wellness” check-ups: if I mention some complaint to the doc during the visit, it suddenly becomes “visit with complaint” and costs me $120.
This is great, except in my case, where I have regional insurance that no one takes where I live. Everyone is out of network.
This is the perfect opportunity to recreationally infect yourself with rare short term diseases. Try breaking your arm or nose you have a story. Self harm has never been so cheap.
Seriously though get checked for prostate cancer. Seriously, especially if you’re over 25 it’s very possible and catching it early will be a massive difference.
Same for everyone reading this. I doubt it’s that expensive so please look into it and get checked if affordable where you are.
I was actually told by my doctor that unless you have a history of colon or prostate cancers in the family, advisory boards are pushing testing to past 40.
Idk. When I worked oncology all our prostate patients were very young men way before 40.
But thats anecdotal. I don’t have any numbers. But whats the worst thing that can happen when you get a prostate check? That they don’t find anything?
I mean the downsides are basically cost, another stick/blood draw, potential for false positive and further anxiety/testing. No weigh-in on whether or not any individual should at any specific time, but even less-invasive screenings are not zero risk.
Excerpt from the US Preventative Task Force about prostate cancer screening:
“An elevated PSA level may be caused by prostate cancer but can also be caused by other conditions, including an enlarged prostate (benign prostatic hyperplasia) and inflammation of the prostate (prostatitis). Some men without prostate cancer may therefore have positive screening results (ie, “false-positive” results). Men with a positive PSA test result may undergo a transrectal ultrasound-guided core-needle biopsy of the prostate to diagnose prostate cancer.”
Yeah, as an early 30s AMAB having to go in for annual checkups for insurance, two different doctors told me there really isn’t shit to do for someone my age
I would talk to your doctor about it for your case specifically rather than advocating broadly for prostate cancer screenings.
Huh, I’m always happy to proven wrong. thank you for bringing this up.
Is this still relevant however with blood testing becoming more prevelant? The main reasons listed are due to harms caused by probing both physical and psychological along with false positives which out-weigh the positives of a 0.128% life saving outcome. It’s been 6, nearly 7 years now and prostate testing is both more accurate and non-invasive
Either way, this body is currently in the final research plan stage of updating the recommendation.
https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/prostate-cancer-screening-adults
I’d agree we should stand by the current assessment though until it changes. Thank you for the correctionThere are primarily 2 stool tests available today, one has significant false positives, the other doesn’t.
I forget the names, or I’d send you a link. It’s been about a year since I looked it up. I know my insurance uses the more accurate one, fortunately.
I have no clue, it’s just something I’ve read about a little. It’s definitely not my area of expertise, so take this with a grain of salt.
From what I understand, prostate cancer is usually very slow, and it’s possible to have a little spot of it for years that doesn’t affect you. For some people, the right answer to finding a prostate tumor is to just monitor it, but obviously, people freak out when they have cancer, and want treatment. Cancer treatments are all no joke, so it seems that you could sacrifice a lot to treat something that would have just chilled there not hurting you.
I have no clue about the blood tests. If it’s like a “yes or no” for prostate cancer, it might have that same disadvantage. If it tells the Dr something more like type of prostate cancer or growth, it’s a different story.
Not sure if your link is the same as I’ve read, but yes, the thing with prostate cancer is that treatment doesn’t seem to change the outcome.
This is most likely because it usually doesn’t develop until mid-50’s or later, and grows so slowly that it doesn’t have time to kill you.
I think the concern would be it occurring in younger ages, or it growing faster than typical.
So test and monitor is likely a good thing, treatment shouldn’t be a given, unless there are clear signs.
Checking for prostate cancer is super easy now and doesn’t even require a finger in your bum. It’s a simple blood test that is far more accurate than the traditional manual method. I get one done every time I have a physical since they just add it on to the other stuff they check my blood for.
-doesn’t even require a finger in your bum
Then what the heck am I paying these deductibles for?? >:(
PSA sucks, it has both low sensitivity and low specificity.
Find a excuse to get physical therapy.
My ‘bone spurs’
Talk to your primary doctor if they can get you a referral for an MRI. Insurance loves to try and deny MRIs, so I think a referral is probably required due to how expensive they are. IMO, they should be included in annual physicals since it’s one of the only (if not the only) ways to detect brain tumors early, which is critical given how difficult it is to treat brain tumors and the earlier the better.
Medical authorities usually don’t advocate for getting imagery like that as a screening tool without any relevant risk factors or symptoms. Everyone has stuff that is unique and weird about their bodies but completely benign, and chances are, it turns up in an MRI or CT. This can end up leading to unnecessary invasive procedures to remove or biopsy something. The odds (in the literal sense) are that not-called for screening leads to either worse outcomes or the same outcomes as people who didn’t get the screenings.
I didn’t look up a source for MRI specifically, cause that’s pretty broad, but here’s a report that does a good job explaining it for prostate cancer screenings. The logic is the same.
I mean, sure, but if it detects something and there’s no reason to suspect it’s necessarily cancerous, then I’d hope doctors would recommend just keeping an eye on it and possibly scheduling periodic checkups to ensure it doesn’t continue growing. No competent doctor is going to recommend invasive surgery right off the bat.
My wife is there.
She’s gotten two knee replacements this year and is scheduled for a hip replacement before the end of the year. And last night I reminded her she’s been meaning to go to a dermatologist.
Ooh! Dermatologist! That’s a good one!
Here I am with acceptably functional knees and hips. I just can’t win!
Yes but how’s your skin
Well. It covers my body.
You should get a full dermatologist check. Especially if you have ever been sunburned.
Get any suspicious or annoying moles removed and biopsied.
I have 4 friends (granted 50+ years old) who have had skin cancers removed in the last year. Many, many stitches on faces, arms, and necks
Tape worm weight loss, or if you are already at a healthy weight start roids for a couple months
Can I keep abusing stimulants while I do those?
…the stimulants should be helping with that though already.
Oh they are. I’m down 15 pounds since the end of last year.
Ah you’re doing alright dude! Keep at it, you’ll lose that other 25 no problem! Losing it too fast can be unhealthy too and all, and idk if science agrees but I find if I lose weight at a moderate pace in a healthy way it doesn’t come back as easy.
😂
Teeth. Teeth right the fuck now. And if somehow there is nothing wrong with them see if your insurance will cover a flouride coat to keep them that way.
Oh and literally every cancer screening possible. Get your butt checked, your nuts checked, some dermatologists will literally check every inch of your skin. Tell your doctor about every bad habit you have and see what else they’re willing to look for.
Damn, teeth are included in health insurance in the US?
Nope, same with eyes. Dental and eye health are separate insurance in the good ol US
Teeth are not covered by insurance in the U.S. (I know. We all know)
For those not in the US: it may be covered, but normally it’s a separate insurance plan and not covered by your regular health insurance.
It also varies what type of “dental” care. Some mouth/gum surgeries may be covered by the health plan. I think most dental plans cover checkups. All this varies wildly with your employer and insurance election, though.
Was just going to point this out too. It’s so stupid.
I’ve also done the math on dental insurance vs out of pocket and a few times, out of pocket was significantly cheaper than the service + insurance.
I’ve done the same math recently and decided it would be cheaper just to pay myself and keep a bit of savings around for anything extra. I could not find a plan that would pay out more than $2k in a year, and that’s not even a month of rent some places.
It was a very sad day when I learned that my dental insurance is a reverse deductible. Like you said, they only pay out $2k a year then it’s all out of pocket. Actually so stupid.
Yes here in America we operate healthcare with the knowledge that your teeth and eyes are not a part of your body.
I’d say colonoscopy, esp if you’re over 45, but those are required by law to have no out-of-pocket costs, regardless.
Go to all the specialists! And if therapy is covered, indulge in that, too.
Therapy is covered, thank you for reminding me
Some kind of general fitness testing?
You know, involving heart, lung capacity, performance?
This is interesting, although my results will be awful, thanks to long COVID, recovering from surgery, and vaping weed.
Having the data could still be helpful for tracking your progress towards recovering from some of those things in the long term. 🤷
Outs there anything you can get done to address the long Covid symptoms?
Gender reassignment surgery?
If you’re on any expensive meds, now’d be a good time to get them refilled. …and ‘my backpack got stolen!’ them and get them refilled again if that’s covered.
If you’ve got anything you think needs to be addressed with any urgency at all, skip the normal process and go to the ER to complain about your symptoms, especially if you’ve got ANY pain in your abdomen or tenderness in your lower back (which could mean kidney stones).
Infact, even if you don’t have pain, go in and tell them you feel nauseous after eating anything greasy or fatty, and you’ll get a free ultrasound of your gallbladder to see if there’s any stones in there. …don’t actually accept surgery to remove it unless there are stones that look like they’re for sure going to be problematic, cuz you WILL have symptoms once it’s gone (eating will make you feel like shit… your body should adjust eventually, but that’s not a guarantee, and it can take anywhere from a few months to years).
So, if they offer a scan or any diagnostic, do it. If they offer surgery, have a long think about whether it’s actually worth doing.
Not only refill your meds, but there are places where you can get 90 day prescriptions filled, so you can go into the new year with several months of pills already ready.
The ER idea is brilliant, especially because I just moved here and don’t have a PCP yet. Even better, I can hit up urgent care every day!
Yeah your biggest obstacle right now is going to be “our next available appointment is in 4 months”, so ER is the way passed that. It’s not super ethical, but neither is the way our healthcare system operates, so do what you gotta do.
When it comes to the American insurance industry, I think I am fresh out of “ethics.”
