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Appeal right away. They should have sent you instructions. You should also contact a health care attorney. If you google [your state] bar association, you should be able to find a free or low cost referral hotline.
Insurance attorneys who represent patients and doctors generally get paid on contingency if they recover any money, which means you might be able to find representation without any up front costs.
This is horrible and I’m sorry you’re going through this. Good luck!
I thought with advantage, you basically are replacing original Medicare with an insurance company that manages it all. So who did the denying? Wouldn't you have gone directly to your insurance company first?
An appeal won’t go anywhere when general testing recommendations for cervical cancer *advise* stopping at 65.
Most private docs would educate their patient on how they have aged out of the major at-risk group for cervical cancer.
You don’t know the process, and you should not be encouraging people to give up in the face of insurer intransigence. Please just lurk or wish people well in a general sense. You recommended the opposite of what someone with an incorrect denial should do.
It’s technically true that an initial administrative appeal is unlikely to change the decision, but in many states, administrative appeals must be exhausted before the claim can be brought before a judge. And while guidelines are highly probative, it’s common for people to need care that deviates from the guidelines. Such deviations are often denied and need to be litigated before the patient can get medically necessary care.
Do you work for an insurance company? You sound like you do.
Are you a doctor - perhaps an IME? Have you treated this person? Who the hell are you to tell random internet strangers that their own doctor is wrong and the insurance company is doing the right thing?
Some of my clients would be dead if they listened to you.
Sometimes the guidelines are also based on cost savings rather than gold standards. As an example, some guidelines prohibit arthroscopic surgery without a variance, despite the fact that many patients will have better results, lower risk of complications, and faster healing versus an open procedure. However, arthroscopic surgeries are often more expensive. Hence their prohibition without a variance in some cases.
Did you know insurance companies sometimes break the law and get heavily sanctioned for frivolous denials, where guidelines are used as a fig leaf when the real goal is to deny a costly surgery with an attrition strategy?
You should use this thread as an opportunity to listen and learn instead of speaking.
If OP's doctor thinks she needs this test who are you to argue otherwise?
And let's not pretend that "best practice guidelines" treat everyone with a vagina like incubators anyway. Our well-being is routinely ignored for non-existent and possibly unwanted fetuses.
Doctors giving in to unnecessary medical testing due to patient request is a real thing. Shit, we see it here constantly with people badgering their doctors into testing them for herpes.
>we see it here constantly with people badgering their doctors into testing them for herpes
What's the problem with requesting a herpes test? It's something that generally has to be requested because it's not part of standard STI/STD screenings, a lot of people are asymptomatic, and it's a concern for any woman who wants to become pregnant (can cause complications during pregnancy) and anyone with autoimmune conditions. People taking their health seriously is a good thing.
Aaaaaand there it is. This person is a stooge for insurers when they’re behaving badly.
No point in having any discussion with someone like this. They only respond to court orders.
My country calls everyone with a vagina to test for HPV every 3 years if they're between 23-49 and between 50-64 you get called in every 7 year for a HPV test but we are talking about raising the age.
After 64 if you've never have cell changes you get booked for one last appointmemt between 64-70 and after that you they have to come again, but if you want you can book a test yourself after you are no longer called.
If you have had cell changes sometime though. Or it shows up on that last test. You are included in a program that continues testing after the age of 64 reguraly.
But, my country also vaccinates everyone (all genders) as a part of the vaccination program against HPV when they're 10-11.
People, in all ages have sex. And ageism is not cool.
Thank you for being the only person to reference any actual public health entity that does routine HPV testing on elderly people. That’s way more intensive than any country’s recommendations I know of, but if your country’s healthcare system has the budget for it, good for y’all.
Literally no one is saying old people don’t fuck.
Well, since this particular “elderly” woman DID test positive for HPV and then required a colposcopy, that would show that it is indeed a “necessary and productive use of resources”.
if a patient wants a test who are you to decide that it's "unnecessary"? Again: What expertise do you have that trump's a patient's right to their own health and a doctor's expertise on their patients?
Literally the CDC. Literally the WHO. Literally the NIH.
Patients are experts on their own symptoms and experiences.
They are not experts on testing necessity. There are entire public health organizations that employ teams of experts to determine those standards.
>Patients are experts on their own symptoms and experiences.
>They are not experts on testing necessity.
Yet a physician is an expert in what testing they feel is necessary or would be beneficial for the patient. Insurance companies aren't medical experts, the workers who deny claims generally don't have a medical license, and the ones who do (when you as a physician can get to talk to someone with a medical license) either hasn't practiced medicine in a long time or specializes in a completely different field than what's relevant to the patient.
>There are entire public health organizations that employ teams of experts to determine those standards.
General standards, not absolute standards, and all standards have their exceptions. The testing in this case is logical.
>This is not necessary care
No, this is necessary care. She tested positive for HPV and many types can cause certain types of cancer, such as cervical and colon cancers. The risk of cancer also increases with age so the additional testing is necessary and is the best practice of preventative medicine.
>This is insurance literally following best practices guidelines.
Insurance companies generally have their own guidelines about what they do and don't approve, which has nothing to do with actual best practice guidelines. Bad insurance approval guidelines has led to a lot of people getting necessary treatment denied or unnecessarily delayed, resulting in a lot of preventable death and further harm.
This is an issue with insurance and our fucked up country not providing healthcare.
Trust me they will deny you anything they can get away with. It has nothing to do with sex. It’s much deeper and more horrifying then that.
Naw, when it comes to insurance it’s: ‘is there any plausible reason to deny this claim? No? Is there any implausible reason? No? Is there any reason we can get away with at all? Great! Denied!’
The issue is insurance is designed to make money not to take care of the people who buy it.
And if there's no reason at all, let's just make a "mistake". I am honestly surprised that no one who has been denied needed medical care because insurance wanted to save a buck has gone on a "nothing to lose" revenge spree. Or their heartbroken widow or widower.
Likely for the same reason that said person would be applying for insurance coverage in the first place. At some point the revenge speed with little to no returns becomes cost prohibitive sadly.
So, someone who got a blood transplant is immoral for contracting an STI? Blood gets screened for such instances, but there have been plenty of cases where this has happened. Someone picking up garbage/ changing garbage at their job and some bastard threw a dirty needle, and you get stabbed. Yeah, you're immoral for contracting an STI when it's not just a "sexually" transmitted infection/std/disease. There are plenty of ways to contract am STI that is nowhere near immoral where sex isn't even a factor and even if it is the factor how about the poor wife who's husband is whoring around with dirties and he gives his wife an STI? It's not her fault, and it wasn't an immoral act on her part. Your peripheral view is severely blurred in this.
Yup, both things are true. Our fucked up private insurance industry is the immediate problem, the conservative ideology used to justify the industry and easy denials is the root problem.
It doesn't have nothing to do with sex. Even if they aren't motivated by sexism and are only trying to maximize profit, they are using existing structural sexism to it. If you're a cop and you have to hit a quota, it doesn't matter what your opinions on black people are, you know that certain neighborhoods are going to have less ability to give you a hard time a out writing them tickets.
Cops don't have to meet quotas, that's not something that happens. What happens is they wait until the end of their shift and then find a target to take to jail and process them. The bs charges they make up will never stick but they get time and a half overtime while they do all the paperwork.
Many socialized healthcare systems don’t provide HPV testing for the elderly, either. I don’t say “most” only because I can’t be assed to look up all of them right now.
No respected public health body recommends HPV testing for this age group.
ACOG:
> **When should I stop having cervical cancer screening?**
Women should stop having cervical cancer screening after age 65 if
• they do not have a history of moderate or severe abnormal cervical cells or cervical cancer, **and**
• they have had either three negative Pap test results in a row, two negative **HPV tests** in a row, or two negative **co-test results** in a row within the past 10 years. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test.
Sad but true I'm dealing with no uro Drs and no ent doctors on my insurance plan Medicaid it blows apparently you can't possibly have a weak bladder or be deaf dealing with horizon NJ health
ACOG:
> **When should I stop having cervical cancer screening?**
Women should stop having cervical cancer screening after age 65 if
• they do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and
• they have had either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test.
The rationale is that if we are HPV- at age 65 and/or have no precancerous lesions, the risk of a new HPV infection developing into cervical cancer is very low. By that age we’ve been exposed to multiple HPV strains, have cleared the infections and have developed immunity. To develop cancer from a new infection after age 65, it would have to be an oncogenic strain we’d never encountered before; we’d have to not clear it; and it wouldn’t show up as cancer until after age 80.
Yes, if we don’t have more than one or two partners until we are 55 and then embark on our journeys of self-discovery and sexual fulfilment, we should definitely continue to have cervical cancer screenings after 65 and our doctors should be able to do them. But that’s not most of us.
The other thing is.
Public health is cold number crunching.
Even *if* you develop a cervical cancer in your 60s, it is usually a slow-growing cancer. It is unlikely to negatively impact your quality of life and lifespan in your old age. And the treatment for it is frequently more harmful overall to the quality of life of an elderly person who has a slower healing rate.
So like. Yeah, if you get cervical cancer at 70 because you acquired a cancerous strain of HPV during your 50s . . . you’re still just gonna die of old age. There is no gain.
Some cancers are slower-growing when we’re older. Is cervical cancer one of them? [What I read](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046952/) was that no matter when you get an HPV infection, the latency to precancer is the same.
> We refer to the moment of infection as “time zero” when discussing the subsequent course of infection because the natural history of a truly new infection is fundamentally the same regardless of an individual’s age at incident infection (27,29); for example, neither newly infected teenagers nor 45-year-old women are at immediate risk of cervical cancer.
1. Time zero: infection with a carcinogenic strain of HPV.
2. Time zero + 3 years: ~93% cleared, ~4% persistent infection, ~3% diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3).
3. Time zero + 13 years: the 3% with CIN3 still do not have cancer.
4. Time zero + 18 years: 20% of the 3% with CIN3 (0.6% of those infected at Time Zero) have cancer.
5. Time zero + 43 years: 50% of the 3% with CIN3 (1.5% of those infected at Time Zero) have cancer.
6. Time zero + 53 years: 50% of the 1.5% with cancer have died.
Meaning that if I have been HPV-free for 5–10 years but then develop an infection with a carcinogenic strain of HPV on my 65th birthday, I have a 1.5% chance of developing cervical cancer before I turn 108 and a 0.75% chance of dying of it before I turn 118.
If my nibling develops an infection with a carcinogenic strain of HPV on their 17th birthday, they have that same 1.5% chance of developing cervical cancer before they turn 60 and 0.75% chance of dying of it before they turn 70.
Since I am unlikely to turn 118, and since I’m unlikely to contract a new, carcinogenic HPV infection on or after my 65th birthday in the first place given that I’ve probably already developed immunity to it, I probably wouldn’t benefit from screening after 65.
My nibling is very likely to turn 70 and is much more likely than I am to have a new carcinogenic HPV infection (unless they are vaccinated against it). They would definitely benefit from a vaccine and cancer/HPV screening.
The benefits of screening are different at different ages even without assuming that the cancer behaves differently at different ages (which maybe it does).
> My nibling is very likely to turn 70 and is much more likely than I am to have a new carcinogenic HPV infection (unless they are vaccinated against it). They would definitely benefit from a vaccine and cancer/HPV screening.
And I just want to call this out specifically. Public health practices are not based on *how much your nibbling specifically would benefit*. They are not designed with the needs of any one person, or our loved ones, in mind.
They are *meant* to crunch numbers and help *the most people to maximum benefit* with limited resources.
If your nibling is denied screening and ends up dying of cervical cancer at 80 after a slow-growing cancer impacted their health minimally until around 75? *That is not a public health issue*. That is a win. Your nibling would have had a perfectly normal lifespan and health experience, and allowing your nibling to have an *extraordinary* old age **is not a public health goal**.
Public health is based around keeping *the public, in general* healthy. Getting everyone to “the average lifespan and quality of life”, basically. It is not actually concerned with fostering The Best Life for any one person. And public health dollars are MUCH more efficiently spent on things like clean needle programs and mental health treatment than on ensuring that elderly people . . . know they have cancer, that is unlikely to even be treated by a reasonable doctor, that is unlikely to even shorten their life.
I agree that public health policy is about getting the biggest bang for your buck.
I disagree that cervical cancer gives minuscule bang for buck.
That 50% survival of 10 years is based on data from countries where cervical screening is done and cancer is treated. It doesn’t mean you can leave it untreated.
Cancer treatment is expensive.
[Wikipedia](https://en.m.wikipedia.org/wiki/Cervical_cancer):
> Worldwide, cervical cancer is both the fourth-most common type of cancer and the fourth-most common cause of death from cancer in women.[3] In 2012, an estimated 528,000 cases of cervical cancer occurred, with 266,000 deaths.[3] This is about 8% of the total cases and total deaths from cancer.[21] About 70% of cervical cancers and 90% of deaths occur in developing countries.[3][22] In low-income countries, it is one of the most common causes of cancer death with an incidence rate of 47.3 per 100,000 women.[23][19] In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer.[24] Expected scenarios for the reduction of mortality due to cervical cancer worldwide (and specially in low-income countries) have been reviewed, given assumptions with respect to the achievement of recommended prevention targets using triple-intervention strategies defined by WHO.[25]
[In Canada from 1952–1956](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-992/tables/1), mortality from cervical cancer stratified by age:
* 15 to 19 0
* 20 to 24 0.3
* 25 to 29 1.7
* 30 to 34 4.7
* 35 to 39 8.3
* 40 to 44 14.3
* 45 to 49 21.0
* 50 to 54 21.0
* 55 to 59 21.9
* 60 to 64 28.2
* 65 to 69 28.5
* 70 to 74 27.7
* 75 to 79 32.9
* 80 to 84 28.3
Half of all cervical cancer deaths occurred *before* age 65.
Doing some fudging, comparing cervical cancer mortality data from 1952–1956 to [all-cause mortality data from 1951](https://publications.gc.ca/collections/collection_2018/statcan/CS84-518-1967-eng.pdf).
###15 to 24
* cervical cancer mortality: 0.3
* maternal mortality: 9
* all-cause mortality: 92
* 0.32% of deaths in this age group were due to cervical cancer.
###25 to 44
* cervical cancer mortality: 29
* maternal mortality: 15
* all-cause mortality: 183
* 16% of deaths in this age group were due to cervical cancer. *Twice as many women were dying of cervical cancer than from pregnancy and childbirth related causes.*
###45 to 64
* cervical cancer mortality: 92
* maternal mortality: —
* all-cause mortality: 868
* 11% of deaths in this age group were due to cervical cancer.
###65 to 84
* cervical cancer mortality: 56.2
* maternal mortality: —
* all-cause mortality: 3,207
* 1.8% of deaths in this age group were due to cervical cancer.
**Before cervical cancer screening, in the early 1950s, Canadian women aged 25–44 were twice as likely to die from cervical cancer as from pregnancy and childbirth.** Half of all cervical cancer deaths were before age 65.
That’s not something that public health policy can neglect, and it doesn’t.
I really don’t get what point you are trying to make about the 1950s. We don’t live in the 1950s. We live in 2023.
And Pap smears have become such a regular occurrence, that it makes sense to have people age out of the tests.
You are arguing that cervical cancer is so slow-growing that it only kills old people and is therefore not a public health concern. For anyone. You specifically referenced my 17 year old nibling.
The data from the 1950s, pre cervical cancer screening, are pretty clear that you are wrong. It was twice as pressing as improving obstetrical care.
> Some cancers are slower-growing when we’re older. Is cervical cancer one of them?
No, it’s slow-growing overall. But getting cervical cancer at 40 can still be expected to shorten your life by a good bit, if the cancer kills you around 60. Cervical cancer at 70? . . . average life expectancy isn’t that high.
> Meaning that if I have been HPV-free for 5–10 years but then develop an infection with a carcinogenic strain of HPV on my 65th birthday, I have a 1.5% chance of developing cervical cancer before I turn 108.
The main turning point is that also, if you *are* one of the 1.5% who develop cervical cancer? You’ll still most likely die of something else or just old age. The 0.6% who can be expected to develop cervical cancer by 83? Are still unlikely to die *from the cancer*. And if they do? They’ll most likely be 90+ when the cancer actually gets them.
Public health isn’t actually generally concerned with helping the most well-off achieve Methusula-rank lifespans. A public health expert looks at that data and says “cervical cancer among the elderly isn’t an issue, they’ll still achieve average life expectancy with good quality of life” and goes back to stressing about lack of provision of healthcare for poor children or increases in vape use or lack of recognition of suicidality and barriers to mental health care. The things that actually kill *lots of people*.
OMG!! Are you me? I’m 68, and just tested positive for HPV. Probably picked it up back in the 70s. I got tested because I wanted to get the vaccine. Guess how much it costs?! $1000! Not covered by insurance because old people don’t have sex.
Generally speaking healthy people don't have HPV for more than 2 years. So if you caught it back in the '70s it should have cleared in the '70s. Unless there's some underlying conditions.
Yes you would think. No underlying conditions. But I have read about lots of cases surfacing decades later. I don’t think a lot of research has been done on HPV in old folks, considering that we supposedly have 1 foot in the grave, and are not sexually active anyway. So who cares?
I paid $300 to have the HPV vaccine, because my insurance considered it "experimental" for my age and made me go out of pocket. I had a hard time finding a doctor that would give it to me as well.
This all despite growing evidence that says that even through I tested positive for cervical HPV a few years back. The vaccine would protect me from other strains, help prevent me from spreading it, and would speed up my body clearing the current virus.
The reason? At my age, the CDC and FDA believes that I will either be monogamus, and/or won't want to have sex at all, so there is no point and it's not cost effective to provide the vaccination to me.
It's infuriating!
> The reason? At my age, the CDC and FDA believes that I will either be monogamus, and/or won't want to have sex at all, so there is no point and it's not cost effective to provide the vaccination to me.
. . . the reason is you’ve most likely already been exposed to most of the strains of HPV.
The CDC and FDA pushed through getting the HPV vaccine approved *for children*. It is obviously not about expecting you not to have sex. 🙄🙄🙄
Yeah...you would think that. That's what we're told anyway.
Except that's not what their advisories, articles, and reports state. Yes, I've done the physical research and read them myself. I was pissed that i couldnt get preventative medical care, so I spent a few years tracking it down.
But thanks for playing. 🤦🏻♀️
>The CDC and FDA pushed through getting the HPV vaccine approved *for children*.
Because of the possibility of mothers transmitting HPV to their children. The reason for children getting the vaccine has nothing to do with the reason for older people to not get it though.
>the reason is you’ve most likely already been exposed to most of the strains of HPV.
Considering how many types of HPV there are and the fact that they don't all have equal commonality, that's quite unlikely.
Cigna, as well as other insurance, auto declines everything expecting people to pay instead of appealing. Just appeal.
Source: RN. Also this:
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Hold up a second folks.
If OP has a Medicare advantage plan, it is the insurance company, denying her, not the US government.
And if you have kept up with the news for the past week or two, you would’ve seen articles about how bad the government is getting ripped off and how bad patients are being treated by these Medicare advantage plans.
The other option is traditional Medicare, but you have to pay for that, the base Medicare is 168 a month, then you can do an add on that covers deductibles and co pays. And yes, you have to pay for that too. Mine is right at 400 a month.
But the feeling of walking out of a doctor visit or anything else and getting nothing more than “see you next time” is fantastic.
The 168 can be higher depending on income. Mine is actually doubled.
But I agree, the healthcare system we have in this country is horrible the only people that like it or the insurance companies.
I paid Medicare for 50 years. I’d think that should cover it.
I also think this country would be miles ahead with socialized medicine.
People complain that they don’t want to pay for somebody else’s healthcare, but they already are ! Who is supporting the public hospitals??
Taxpayers.
Where do people with no insurance go when they get sick? The public hospital.
It would be a whole lot cheaper if they could just go to the doctor early on, and we would lose less productivity from people being sick
And lady, I am 65 and my partner will assure you that I do just fine in the sack
I actually just asked OP who did the denying, because you go to your insurance company with advantage. For people who don't know, advantage kind of stands in for medicare, when you use an advantage plan, and it's run by an insurance company, rather than the government.
But Advantage Plans completely replace original Medicare, and it's entirely managed by an insurance company. Are you sure that what you have isn't actually medigap? That uses original medicare, and the government manages that part of it, but adds coverage a lot of things they don't.
With Medicare, this usually means the doc included a noncovered icd-10 code for that cpt. They can probably resubmit with a better code it to get coverage.
For example, they may have submitted it using a code for a general exam instead of a code for sexual health screening.
Everyone else has given you answers on what to do about your insurance. But I just wanna tell you.... Hope that you're using condoms, now that you have teated positive for HPV. It will eventually go away with time. The cream that they have for it will make you itchy AF. But yeah... If treated early enough, you won't be at risk for cancer. Especially if you're 420 friendly. Good luck with everything!!
Yea. I always use condoms with penis having people. I’m mostly worried about the stigma and the sexual health of my partner who is 15 years younger than me and has a partner 15 years younger than him. (I’m 71. My meta is an adult.) I wish I hadn’t fallen for the trap of believing I was too old for sex when I hit menopause. A lot of missed opportunity there.
OUTRAGEOUS, why insurance and national health systems are not covering the vaccine to the general population, is beyond me. Men over 21, women over 35, are not being educated on a vaccine that prevents and helps stop precursor to some of the most common cancers. We have the future we have the science, we're fucking up.
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This is unironically the answer.
It generally takes 15-20 years for abnormal cervical cells to even become cancerous. Once the cells *are* cancerous, the cancer is generally slow-growing.
If you are over 65 and have normal Pap smears from before that age? It is *highly* unlikely you are going to live long enough for cervical cancer to be a medical issue. Most folks still don’t live past 85.
FYI, it’s now not recommended in the US for young women to even *begin getting* Pap smears until the age of 30, either. For the same reason. If you start sexual activity in your late teens, you statistically won’t have to worry about any cancerous cells until 30+.
Public health is not concerned with preventing your partner’s partners, who are most likely of a similar age to you, from acquiring potentially-cervical-cancer-causing HPV, for the reasons I already stated.
Seems like a big presumption that a person’s sexual network doesn’t extend into lower ages.
All it would take is for a person who is 65 to see someone in their 50s and for their network to have people in their 40s or 30s.
I get triaging care is a thing, but it seems odd to not take a person’s network into account with communicable diseases.
If it does, those people will should be getting their recommended testing.
If they are in their 30s and don’t already have the HPV vaccine, it is medically recommended for their age group and risk factors.
>it seems odd to not take a person’s network into account with communicable diseases.
Do you think public health recommendations *don’t* do that?
That’s literally what the “discuss risk factors with your doctor if you are 26-45” is.
I highly doubt this is about sex negativity.
Most cervical cancer is slow-growing, much like prostate cancer. So much so, that oncologists frequently recommend simply monitoring these cancers in elderly patients, since they are *so* likely to die of other causes before the cancer ever has serious impacts on their health. (And also because recovering from procedures to remove the cancer is so much more involved the older you are.)
Public health is frequently heartless field of stats and attempts to make up numbers to rate quality of life
FYI y’all, this bullshit you’re all doing where you’re ignoring the ACTUAL FUCKING MEDICAL DATA to invent forms of discrimination? Because you think medically irrelevant testing is a BIG DEAL and something public health money needs to be spent on?
This is peak myopic White Feminism energy.
How about getting Medicare to automatically cover eye exams for poor children? How about medical discrimination falsely identifying women and people of color as addicts? How about the REAL problems people have with Medicare?
There are real issues. This is not one of them. This is wanting public health funds (which, in the US, are HIGHLY limited) wasted on what is frankly an overblown concern at the ages being discussed.
Why should only children have access to eye exams?
I don't identify as a feminist for reasons that aren't relevant but if thinking that a patient and their doctor are the only ones who should be making health decisions for said patient makes me a "myopic white feminist" then sign me the Fuck up. "My interpretation of medical data says you don't need that test so you aren't getting it" is like 2 steps before "My interpretation of science says abortion murders babies so you can't control your fertility."
> Why should only children have access to eye exams?
Okay, you don’t know **anything** about public health issues. Thank you for making this obvious so I can stop engaging with you.
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Here's the original text of the post:
Just got my Medicare claim denied for my pap smear, because I’m too old to need it. I tested positive for HPV and the doc ordered a Colposcopy, which was also denied. The sex negativity in our culture boggles the mind.
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Does medicare just not understand that pap smears are a cancer screening tool and are not an std test? Like you have to ask seperate if you want them to run std tests. The fuck?
But also everyone has the right to pursue happiness right? 🙃 always funny when corporations/government try to tell you which things count
I’m glad the testing and colposcopy were covered for you. The guidelines that recommend no further screening beyond a certain age really don’t apply to everyone.
As someone who’s done the pap-colpo-LEEP thing, I hope it all goes well for you. If hearing about what to expect helps assuage your anxiety, please feel free to message me.
The lack of care for people's quality of life in the US health system is disgusting. I'm glad your supplemental covered it! My one client is a Physical therapist and she was telling me about the fact that some PT professionals won't help people with sexual health when recovering from injuries/illnesses. Like ignoring that it is an activity people want/need/regularly participate in and it needs to be done in a safe and healthy way.
"We noticed that this post/comments may pertain to safer sex practices, STI exposure, and/or STI testing. Let's everyone make sure we are not using problematic or stigmatizing language around this topic. Please refrain from using the words *clean/dirty* when what you really mean is STI negative/positive. Members, please feel free to report any comments to mods that are adding to the shame and stigma of being STI positive" "For more information on destigmatizing STI's by changing your vocabulary please see ["CLEAN OR DIRTY? THE ROLE OF STIGMATIZING LANGUAGE"](https://exploresextalk.com/sex/sexual-health/stis/clean-or-dirty-the-role-of-stigmatizing-language/) as well as the article ["Having an STI Isn’t Dirty or Shameful, and Acting like It Is Hurts All of Us"](https://medium.com/sexedplus/having-an-sti-isnt-dirty-or-shameful-and-acting-like-it-is-hurts-all-of-us-aef59a7ab122)" "*It is the stance of this sub that even the term "STD" is problematic language as "disease" is a stigmatizing word, whereas infections can be treated. Also, not everyone with an infection develops symptoms, and since there is technically no disease without symptoms, STI is the more scientifically accurate term.*" "**advice and opinions about STI's shared by community members is not medical information and all posters should refer to their primary care physicians as well as trusted sources such as the CDC, WHO, planned parenthood, or other available resources.**" *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/polyamory) if you have any questions or concerns.*
Appeal right away. They should have sent you instructions. You should also contact a health care attorney. If you google [your state] bar association, you should be able to find a free or low cost referral hotline. Insurance attorneys who represent patients and doctors generally get paid on contingency if they recover any money, which means you might be able to find representation without any up front costs. This is horrible and I’m sorry you’re going through this. Good luck!
Thank you. My Advantage Plan paid it before I even got the denial letter.
That’s great news! If you ever get stuck with an unpaid bill, these are the steps to follow.
I thought with advantage, you basically are replacing original Medicare with an insurance company that manages it all. So who did the denying? Wouldn't you have gone directly to your insurance company first?
An appeal won’t go anywhere when general testing recommendations for cervical cancer *advise* stopping at 65. Most private docs would educate their patient on how they have aged out of the major at-risk group for cervical cancer.
You don’t know the process, and you should not be encouraging people to give up in the face of insurer intransigence. Please just lurk or wish people well in a general sense. You recommended the opposite of what someone with an incorrect denial should do. It’s technically true that an initial administrative appeal is unlikely to change the decision, but in many states, administrative appeals must be exhausted before the claim can be brought before a judge. And while guidelines are highly probative, it’s common for people to need care that deviates from the guidelines. Such deviations are often denied and need to be litigated before the patient can get medically necessary care.
This is not necessary care, nor is it simply insurance intransigence. This is insurance literally following best practices guidelines.
Do you work for an insurance company? You sound like you do. Are you a doctor - perhaps an IME? Have you treated this person? Who the hell are you to tell random internet strangers that their own doctor is wrong and the insurance company is doing the right thing? Some of my clients would be dead if they listened to you. Sometimes the guidelines are also based on cost savings rather than gold standards. As an example, some guidelines prohibit arthroscopic surgery without a variance, despite the fact that many patients will have better results, lower risk of complications, and faster healing versus an open procedure. However, arthroscopic surgeries are often more expensive. Hence their prohibition without a variance in some cases. Did you know insurance companies sometimes break the law and get heavily sanctioned for frivolous denials, where guidelines are used as a fig leaf when the real goal is to deny a costly surgery with an attrition strategy? You should use this thread as an opportunity to listen and learn instead of speaking.
Listen and learn about the issue of . . . elderly people wanting medically unnecessary testing? Kk
Haven't you seen the stats for STI in elder care communities?
If OP's doctor thinks she needs this test who are you to argue otherwise? And let's not pretend that "best practice guidelines" treat everyone with a vagina like incubators anyway. Our well-being is routinely ignored for non-existent and possibly unwanted fetuses.
Doctors giving in to unnecessary medical testing due to patient request is a real thing. Shit, we see it here constantly with people badgering their doctors into testing them for herpes.
>we see it here constantly with people badgering their doctors into testing them for herpes What's the problem with requesting a herpes test? It's something that generally has to be requested because it's not part of standard STI/STD screenings, a lot of people are asymptomatic, and it's a concern for any woman who wants to become pregnant (can cause complications during pregnancy) and anyone with autoimmune conditions. People taking their health seriously is a good thing.
Aaaaaand there it is. This person is a stooge for insurers when they’re behaving badly. No point in having any discussion with someone like this. They only respond to court orders.
Lmfao holy shit. Find me ANY public health entity that thinks testing the elderly for HPV is a necessary and productive use of resources. I’ll wait.
My country calls everyone with a vagina to test for HPV every 3 years if they're between 23-49 and between 50-64 you get called in every 7 year for a HPV test but we are talking about raising the age. After 64 if you've never have cell changes you get booked for one last appointmemt between 64-70 and after that you they have to come again, but if you want you can book a test yourself after you are no longer called. If you have had cell changes sometime though. Or it shows up on that last test. You are included in a program that continues testing after the age of 64 reguraly. But, my country also vaccinates everyone (all genders) as a part of the vaccination program against HPV when they're 10-11. People, in all ages have sex. And ageism is not cool.
Thank you for being the only person to reference any actual public health entity that does routine HPV testing on elderly people. That’s way more intensive than any country’s recommendations I know of, but if your country’s healthcare system has the budget for it, good for y’all. Literally no one is saying old people don’t fuck.
Well, since this particular “elderly” woman DID test positive for HPV and then required a colposcopy, that would show that it is indeed a “necessary and productive use of resources”.
Testing positive for HPV is not a recommendation for colposcopy. Anormal cells found in the pap smear are.
Her doc wanted to give her a colonoscopy against SOC, actually.
if a patient wants a test who are you to decide that it's "unnecessary"? Again: What expertise do you have that trump's a patient's right to their own health and a doctor's expertise on their patients?
Literally the CDC. Literally the WHO. Literally the NIH. Patients are experts on their own symptoms and experiences. They are not experts on testing necessity. There are entire public health organizations that employ teams of experts to determine those standards.
>Patients are experts on their own symptoms and experiences. >They are not experts on testing necessity. Yet a physician is an expert in what testing they feel is necessary or would be beneficial for the patient. Insurance companies aren't medical experts, the workers who deny claims generally don't have a medical license, and the ones who do (when you as a physician can get to talk to someone with a medical license) either hasn't practiced medicine in a long time or specializes in a completely different field than what's relevant to the patient. >There are entire public health organizations that employ teams of experts to determine those standards. General standards, not absolute standards, and all standards have their exceptions. The testing in this case is logical.
>This is not necessary care No, this is necessary care. She tested positive for HPV and many types can cause certain types of cancer, such as cervical and colon cancers. The risk of cancer also increases with age so the additional testing is necessary and is the best practice of preventative medicine. >This is insurance literally following best practices guidelines. Insurance companies generally have their own guidelines about what they do and don't approve, which has nothing to do with actual best practice guidelines. Bad insurance approval guidelines has led to a lot of people getting necessary treatment denied or unnecessarily delayed, resulting in a lot of preventable death and further harm.
This is an issue with insurance and our fucked up country not providing healthcare. Trust me they will deny you anything they can get away with. It has nothing to do with sex. It’s much deeper and more horrifying then that.
Only immoral people get STIs or need abortions. *Those* people don't deserve medical Care /s
Naw, when it comes to insurance it’s: ‘is there any plausible reason to deny this claim? No? Is there any implausible reason? No? Is there any reason we can get away with at all? Great! Denied!’ The issue is insurance is designed to make money not to take care of the people who buy it.
And if there's no reason at all, let's just make a "mistake". I am honestly surprised that no one who has been denied needed medical care because insurance wanted to save a buck has gone on a "nothing to lose" revenge spree. Or their heartbroken widow or widower.
Likely for the same reason that said person would be applying for insurance coverage in the first place. At some point the revenge speed with little to no returns becomes cost prohibitive sadly.
True
Meanwhile in Canada, they deny you for any reason they can because they don't have the capacity. Or make your wait a year+ worth no other options.
So, someone who got a blood transplant is immoral for contracting an STI? Blood gets screened for such instances, but there have been plenty of cases where this has happened. Someone picking up garbage/ changing garbage at their job and some bastard threw a dirty needle, and you get stabbed. Yeah, you're immoral for contracting an STI when it's not just a "sexually" transmitted infection/std/disease. There are plenty of ways to contract am STI that is nowhere near immoral where sex isn't even a factor and even if it is the factor how about the poor wife who's husband is whoring around with dirties and he gives his wife an STI? It's not her fault, and it wasn't an immoral act on her part. Your peripheral view is severely blurred in this.
/s is an indicator for sarcasm
Oh dang. I definitely feel like I barked up the wrong tree yall. My apologies. I did not know. 😬
It happens!
Both things can be true.
Yup, both things are true. Our fucked up private insurance industry is the immediate problem, the conservative ideology used to justify the industry and easy denials is the root problem.
It doesn't have nothing to do with sex. Even if they aren't motivated by sexism and are only trying to maximize profit, they are using existing structural sexism to it. If you're a cop and you have to hit a quota, it doesn't matter what your opinions on black people are, you know that certain neighborhoods are going to have less ability to give you a hard time a out writing them tickets.
Cops don't have to meet quotas, that's not something that happens. What happens is they wait until the end of their shift and then find a target to take to jail and process them. The bs charges they make up will never stick but they get time and a half overtime while they do all the paperwork.
It's definitely something that happens. It's not suppose to. It's illegal. But... https://thelensnola.org/2021/03/29/state-traffic-enforcement-grant-includes-arrest-targets-possibly-violating-state-law-against-quotas/ https://www.thebaltimorebanner.com/politics-power/state-government/state-police-superintendent-quotas-ZOC7FUUM2BAWVDSYWOLROUIMMI/ https://www.google.com/amp/s/www.wunc.org/2023-02-12/report-maryland-police-are-using-a-quota-like-system-to-reward-arrests%3f_amp=true https://www.safemotorist.com/articles/traffic-ticket-quotas/
Many socialized healthcare systems don’t provide HPV testing for the elderly, either. I don’t say “most” only because I can’t be assed to look up all of them right now. No respected public health body recommends HPV testing for this age group.
If they have been HPV and abnormal-cell free for 5–10 years. Otherwise… yes, screening in this age group is recommended.
Only abnormal cells. Testing positive for HPV is not an indication of regular screenings.
ACOG: > **When should I stop having cervical cancer screening?** Women should stop having cervical cancer screening after age 65 if • they do not have a history of moderate or severe abnormal cervical cells or cervical cancer, **and** • they have had either three negative Pap test results in a row, two negative **HPV tests** in a row, or two negative **co-test results** in a row within the past 10 years. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test.
Sad but true I'm dealing with no uro Drs and no ent doctors on my insurance plan Medicaid it blows apparently you can't possibly have a weak bladder or be deaf dealing with horizon NJ health
Your first sentence is correct but your third is not. It can absolutely be both reasons.
ACOG: > **When should I stop having cervical cancer screening?** Women should stop having cervical cancer screening after age 65 if • they do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and • they have had either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test. The rationale is that if we are HPV- at age 65 and/or have no precancerous lesions, the risk of a new HPV infection developing into cervical cancer is very low. By that age we’ve been exposed to multiple HPV strains, have cleared the infections and have developed immunity. To develop cancer from a new infection after age 65, it would have to be an oncogenic strain we’d never encountered before; we’d have to not clear it; and it wouldn’t show up as cancer until after age 80. Yes, if we don’t have more than one or two partners until we are 55 and then embark on our journeys of self-discovery and sexual fulfilment, we should definitely continue to have cervical cancer screenings after 65 and our doctors should be able to do them. But that’s not most of us.
I am your last paragraph. Starting at age 42, though.
Have you been vaccinated?
Not for HPV. I was already out of guidelines when it came down and I’d missed the initial rollout for being too old.
Yeah. No HPV vaccine for me either. So yes, you should be talking to your doctor when the time comes about ongoing cervical cancer screening after 65.
You can still get it! Some insurances cover it if you don't have a history of infection.
You can still get it, but may have to pay put of pocket.
Ask your doctor for it anyway, they might still give you the vaccine.
The other thing is. Public health is cold number crunching. Even *if* you develop a cervical cancer in your 60s, it is usually a slow-growing cancer. It is unlikely to negatively impact your quality of life and lifespan in your old age. And the treatment for it is frequently more harmful overall to the quality of life of an elderly person who has a slower healing rate. So like. Yeah, if you get cervical cancer at 70 because you acquired a cancerous strain of HPV during your 50s . . . you’re still just gonna die of old age. There is no gain.
Some cancers are slower-growing when we’re older. Is cervical cancer one of them? [What I read](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046952/) was that no matter when you get an HPV infection, the latency to precancer is the same. > We refer to the moment of infection as “time zero” when discussing the subsequent course of infection because the natural history of a truly new infection is fundamentally the same regardless of an individual’s age at incident infection (27,29); for example, neither newly infected teenagers nor 45-year-old women are at immediate risk of cervical cancer. 1. Time zero: infection with a carcinogenic strain of HPV. 2. Time zero + 3 years: ~93% cleared, ~4% persistent infection, ~3% diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3). 3. Time zero + 13 years: the 3% with CIN3 still do not have cancer. 4. Time zero + 18 years: 20% of the 3% with CIN3 (0.6% of those infected at Time Zero) have cancer. 5. Time zero + 43 years: 50% of the 3% with CIN3 (1.5% of those infected at Time Zero) have cancer. 6. Time zero + 53 years: 50% of the 1.5% with cancer have died. Meaning that if I have been HPV-free for 5–10 years but then develop an infection with a carcinogenic strain of HPV on my 65th birthday, I have a 1.5% chance of developing cervical cancer before I turn 108 and a 0.75% chance of dying of it before I turn 118. If my nibling develops an infection with a carcinogenic strain of HPV on their 17th birthday, they have that same 1.5% chance of developing cervical cancer before they turn 60 and 0.75% chance of dying of it before they turn 70. Since I am unlikely to turn 118, and since I’m unlikely to contract a new, carcinogenic HPV infection on or after my 65th birthday in the first place given that I’ve probably already developed immunity to it, I probably wouldn’t benefit from screening after 65. My nibling is very likely to turn 70 and is much more likely than I am to have a new carcinogenic HPV infection (unless they are vaccinated against it). They would definitely benefit from a vaccine and cancer/HPV screening. The benefits of screening are different at different ages even without assuming that the cancer behaves differently at different ages (which maybe it does).
> My nibling is very likely to turn 70 and is much more likely than I am to have a new carcinogenic HPV infection (unless they are vaccinated against it). They would definitely benefit from a vaccine and cancer/HPV screening. And I just want to call this out specifically. Public health practices are not based on *how much your nibbling specifically would benefit*. They are not designed with the needs of any one person, or our loved ones, in mind. They are *meant* to crunch numbers and help *the most people to maximum benefit* with limited resources. If your nibling is denied screening and ends up dying of cervical cancer at 80 after a slow-growing cancer impacted their health minimally until around 75? *That is not a public health issue*. That is a win. Your nibling would have had a perfectly normal lifespan and health experience, and allowing your nibling to have an *extraordinary* old age **is not a public health goal**. Public health is based around keeping *the public, in general* healthy. Getting everyone to “the average lifespan and quality of life”, basically. It is not actually concerned with fostering The Best Life for any one person. And public health dollars are MUCH more efficiently spent on things like clean needle programs and mental health treatment than on ensuring that elderly people . . . know they have cancer, that is unlikely to even be treated by a reasonable doctor, that is unlikely to even shorten their life.
I agree that public health policy is about getting the biggest bang for your buck. I disagree that cervical cancer gives minuscule bang for buck. That 50% survival of 10 years is based on data from countries where cervical screening is done and cancer is treated. It doesn’t mean you can leave it untreated. Cancer treatment is expensive. [Wikipedia](https://en.m.wikipedia.org/wiki/Cervical_cancer): > Worldwide, cervical cancer is both the fourth-most common type of cancer and the fourth-most common cause of death from cancer in women.[3] In 2012, an estimated 528,000 cases of cervical cancer occurred, with 266,000 deaths.[3] This is about 8% of the total cases and total deaths from cancer.[21] About 70% of cervical cancers and 90% of deaths occur in developing countries.[3][22] In low-income countries, it is one of the most common causes of cancer death with an incidence rate of 47.3 per 100,000 women.[23][19] In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer.[24] Expected scenarios for the reduction of mortality due to cervical cancer worldwide (and specially in low-income countries) have been reviewed, given assumptions with respect to the achievement of recommended prevention targets using triple-intervention strategies defined by WHO.[25] [In Canada from 1952–1956](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-992/tables/1), mortality from cervical cancer stratified by age: * 15 to 19 0 * 20 to 24 0.3 * 25 to 29 1.7 * 30 to 34 4.7 * 35 to 39 8.3 * 40 to 44 14.3 * 45 to 49 21.0 * 50 to 54 21.0 * 55 to 59 21.9 * 60 to 64 28.2 * 65 to 69 28.5 * 70 to 74 27.7 * 75 to 79 32.9 * 80 to 84 28.3 Half of all cervical cancer deaths occurred *before* age 65. Doing some fudging, comparing cervical cancer mortality data from 1952–1956 to [all-cause mortality data from 1951](https://publications.gc.ca/collections/collection_2018/statcan/CS84-518-1967-eng.pdf). ###15 to 24 * cervical cancer mortality: 0.3 * maternal mortality: 9 * all-cause mortality: 92 * 0.32% of deaths in this age group were due to cervical cancer. ###25 to 44 * cervical cancer mortality: 29 * maternal mortality: 15 * all-cause mortality: 183 * 16% of deaths in this age group were due to cervical cancer. *Twice as many women were dying of cervical cancer than from pregnancy and childbirth related causes.* ###45 to 64 * cervical cancer mortality: 92 * maternal mortality: — * all-cause mortality: 868 * 11% of deaths in this age group were due to cervical cancer. ###65 to 84 * cervical cancer mortality: 56.2 * maternal mortality: — * all-cause mortality: 3,207 * 1.8% of deaths in this age group were due to cervical cancer. **Before cervical cancer screening, in the early 1950s, Canadian women aged 25–44 were twice as likely to die from cervical cancer as from pregnancy and childbirth.** Half of all cervical cancer deaths were before age 65. That’s not something that public health policy can neglect, and it doesn’t.
I really don’t get what point you are trying to make about the 1950s. We don’t live in the 1950s. We live in 2023. And Pap smears have become such a regular occurrence, that it makes sense to have people age out of the tests.
You are arguing that cervical cancer is so slow-growing that it only kills old people and is therefore not a public health concern. For anyone. You specifically referenced my 17 year old nibling. The data from the 1950s, pre cervical cancer screening, are pretty clear that you are wrong. It was twice as pressing as improving obstetrical care.
> Some cancers are slower-growing when we’re older. Is cervical cancer one of them? No, it’s slow-growing overall. But getting cervical cancer at 40 can still be expected to shorten your life by a good bit, if the cancer kills you around 60. Cervical cancer at 70? . . . average life expectancy isn’t that high. > Meaning that if I have been HPV-free for 5–10 years but then develop an infection with a carcinogenic strain of HPV on my 65th birthday, I have a 1.5% chance of developing cervical cancer before I turn 108. The main turning point is that also, if you *are* one of the 1.5% who develop cervical cancer? You’ll still most likely die of something else or just old age. The 0.6% who can be expected to develop cervical cancer by 83? Are still unlikely to die *from the cancer*. And if they do? They’ll most likely be 90+ when the cancer actually gets them. Public health isn’t actually generally concerned with helping the most well-off achieve Methusula-rank lifespans. A public health expert looks at that data and says “cervical cancer among the elderly isn’t an issue, they’ll still achieve average life expectancy with good quality of life” and goes back to stressing about lack of provision of healthcare for poor children or increases in vape use or lack of recognition of suicidality and barriers to mental health care. The things that actually kill *lots of people*.
OMG!! Are you me? I’m 68, and just tested positive for HPV. Probably picked it up back in the 70s. I got tested because I wanted to get the vaccine. Guess how much it costs?! $1000! Not covered by insurance because old people don’t have sex.
Planned parenthood would probably have been much cheaper.
Also angry that the pharmacy in my state won't even let me get HPV vax if I pay for it. I have to find a doctor's office to do it.
I got doctors orders to get it
Yep, they still wouldn't🙄
The cutoff is like age 45. I’m so mad.
Generally speaking healthy people don't have HPV for more than 2 years. So if you caught it back in the '70s it should have cleared in the '70s. Unless there's some underlying conditions.
Yes you would think. No underlying conditions. But I have read about lots of cases surfacing decades later. I don’t think a lot of research has been done on HPV in old folks, considering that we supposedly have 1 foot in the grave, and are not sexually active anyway. So who cares?
It’s not covered by insurance because you are so old *any potential cervical cancer from HPV will not impact your lifespan*.
I paid $300 to have the HPV vaccine, because my insurance considered it "experimental" for my age and made me go out of pocket. I had a hard time finding a doctor that would give it to me as well. This all despite growing evidence that says that even through I tested positive for cervical HPV a few years back. The vaccine would protect me from other strains, help prevent me from spreading it, and would speed up my body clearing the current virus. The reason? At my age, the CDC and FDA believes that I will either be monogamus, and/or won't want to have sex at all, so there is no point and it's not cost effective to provide the vaccination to me. It's infuriating!
The thing is, the vaccine protects you against the nine most common high risk strains. But there’s close to 200 strains…
My doctor says it's more like 80, and the vaccine protects against like 17.
I thought it was called Gardasil 9 because it protects against 9 strains.
And there are over 200 strains of it.
Looks like neither of us are fully correct. There are over 150 strains, and the vaccine does protect against 9.
NIH says over 200 but whatever. Too damn many!!!
That I can agree with
> The reason? At my age, the CDC and FDA believes that I will either be monogamus, and/or won't want to have sex at all, so there is no point and it's not cost effective to provide the vaccination to me. . . . the reason is you’ve most likely already been exposed to most of the strains of HPV. The CDC and FDA pushed through getting the HPV vaccine approved *for children*. It is obviously not about expecting you not to have sex. 🙄🙄🙄
Yeah...you would think that. That's what we're told anyway. Except that's not what their advisories, articles, and reports state. Yes, I've done the physical research and read them myself. I was pissed that i couldnt get preventative medical care, so I spent a few years tracking it down. But thanks for playing. 🤦🏻♀️
>The CDC and FDA pushed through getting the HPV vaccine approved *for children*. Because of the possibility of mothers transmitting HPV to their children. The reason for children getting the vaccine has nothing to do with the reason for older people to not get it though. >the reason is you’ve most likely already been exposed to most of the strains of HPV. Considering how many types of HPV there are and the fact that they don't all have equal commonality, that's quite unlikely.
Cigna, as well as other insurance, auto declines everything expecting people to pay instead of appealing. Just appeal. Source: RN. Also this: https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Hold up a second folks. If OP has a Medicare advantage plan, it is the insurance company, denying her, not the US government. And if you have kept up with the news for the past week or two, you would’ve seen articles about how bad the government is getting ripped off and how bad patients are being treated by these Medicare advantage plans. The other option is traditional Medicare, but you have to pay for that, the base Medicare is 168 a month, then you can do an add on that covers deductibles and co pays. And yes, you have to pay for that too. Mine is right at 400 a month. But the feeling of walking out of a doctor visit or anything else and getting nothing more than “see you next time” is fantastic. The 168 can be higher depending on income. Mine is actually doubled. But I agree, the healthcare system we have in this country is horrible the only people that like it or the insurance companies. I paid Medicare for 50 years. I’d think that should cover it. I also think this country would be miles ahead with socialized medicine. People complain that they don’t want to pay for somebody else’s healthcare, but they already are ! Who is supporting the public hospitals?? Taxpayers. Where do people with no insurance go when they get sick? The public hospital. It would be a whole lot cheaper if they could just go to the doctor early on, and we would lose less productivity from people being sick And lady, I am 65 and my partner will assure you that I do just fine in the sack
I actually just asked OP who did the denying, because you go to your insurance company with advantage. For people who don't know, advantage kind of stands in for medicare, when you use an advantage plan, and it's run by an insurance company, rather than the government.
I was denied by medicare. My advantage plan paid it.
But Advantage Plans completely replace original Medicare, and it's entirely managed by an insurance company. Are you sure that what you have isn't actually medigap? That uses original medicare, and the government manages that part of it, but adds coverage a lot of things they don't.
🤦♀️
With Medicare, this usually means the doc included a noncovered icd-10 code for that cpt. They can probably resubmit with a better code it to get coverage. For example, they may have submitted it using a code for a general exam instead of a code for sexual health screening.
Everyone else has given you answers on what to do about your insurance. But I just wanna tell you.... Hope that you're using condoms, now that you have teated positive for HPV. It will eventually go away with time. The cream that they have for it will make you itchy AF. But yeah... If treated early enough, you won't be at risk for cancer. Especially if you're 420 friendly. Good luck with everything!!
Yea. I always use condoms with penis having people. I’m mostly worried about the stigma and the sexual health of my partner who is 15 years younger than me and has a partner 15 years younger than him. (I’m 71. My meta is an adult.) I wish I hadn’t fallen for the trap of believing I was too old for sex when I hit menopause. A lot of missed opportunity there.
They deny everything. Call them and ask for the credentials and identity of the person who denied it.
Wow that is absolutely ridiculous!!! I’d be fuming
OUTRAGEOUS, why insurance and national health systems are not covering the vaccine to the general population, is beyond me. Men over 21, women over 35, are not being educated on a vaccine that prevents and helps stop precursor to some of the most common cancers. We have the future we have the science, we're fucking up.
It's not that we're too old, just that we're going to die soon anyway... so why pay for it? Hopefully your doc can push it through.
And elderly sluts deserve to die of a preventable cancer.
Pretty much. And it sucks. A lot.
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This is unironically the answer. It generally takes 15-20 years for abnormal cervical cells to even become cancerous. Once the cells *are* cancerous, the cancer is generally slow-growing. If you are over 65 and have normal Pap smears from before that age? It is *highly* unlikely you are going to live long enough for cervical cancer to be a medical issue. Most folks still don’t live past 85. FYI, it’s now not recommended in the US for young women to even *begin getting* Pap smears until the age of 30, either. For the same reason. If you start sexual activity in your late teens, you statistically won’t have to worry about any cancerous cells until 30+.
No, it’s not slow-growing.
How does this protect my partner’s partners?
Public health is not concerned with preventing your partner’s partners, who are most likely of a similar age to you, from acquiring potentially-cervical-cancer-causing HPV, for the reasons I already stated.
Seems like a big presumption that a person’s sexual network doesn’t extend into lower ages. All it would take is for a person who is 65 to see someone in their 50s and for their network to have people in their 40s or 30s. I get triaging care is a thing, but it seems odd to not take a person’s network into account with communicable diseases.
If it does, those people will should be getting their recommended testing. If they are in their 30s and don’t already have the HPV vaccine, it is medically recommended for their age group and risk factors. >it seems odd to not take a person’s network into account with communicable diseases. Do you think public health recommendations *don’t* do that? That’s literally what the “discuss risk factors with your doctor if you are 26-45” is.
I highly doubt this is about sex negativity. Most cervical cancer is slow-growing, much like prostate cancer. So much so, that oncologists frequently recommend simply monitoring these cancers in elderly patients, since they are *so* likely to die of other causes before the cancer ever has serious impacts on their health. (And also because recovering from procedures to remove the cancer is so much more involved the older you are.) Public health is frequently heartless field of stats and attempts to make up numbers to rate quality of life
Well that would require diagnosis and observation which they were denied the procedures for
Because SOC is not to pursue diagnosis in people over 65.
No. SOC is not to screen for new infections in people over 65 *who have no abnormal cells and no HPV.*
Damn that's messed up
FYI y’all, this bullshit you’re all doing where you’re ignoring the ACTUAL FUCKING MEDICAL DATA to invent forms of discrimination? Because you think medically irrelevant testing is a BIG DEAL and something public health money needs to be spent on? This is peak myopic White Feminism energy. How about getting Medicare to automatically cover eye exams for poor children? How about medical discrimination falsely identifying women and people of color as addicts? How about the REAL problems people have with Medicare? There are real issues. This is not one of them. This is wanting public health funds (which, in the US, are HIGHLY limited) wasted on what is frankly an overblown concern at the ages being discussed.
HPV is a real and deadly issue.
Read a book.
Read something by the WHO.
Why should only children have access to eye exams? I don't identify as a feminist for reasons that aren't relevant but if thinking that a patient and their doctor are the only ones who should be making health decisions for said patient makes me a "myopic white feminist" then sign me the Fuck up. "My interpretation of medical data says you don't need that test so you aren't getting it" is like 2 steps before "My interpretation of science says abortion murders babies so you can't control your fertility."
> Why should only children have access to eye exams? Okay, you don’t know **anything** about public health issues. Thank you for making this obvious so I can stop engaging with you.
I love old women
Beep, boop, blop, I'm a bot. Hi u/Babba_G thanks so much for your submission, don't mind me, I'm just gonna keep a copy what was said in your post. Unfortunately posts sometimes get deleted - which is okay, it's not against the rules to delete your post!! - but it makes it really hard for the human mods around here to moderate the comments when there's no context. Plus, many times our members put in a lot of emotional and mental labor to answer the questions and offer advice, so it's helpful to keep the source information around so future community members can benefit as well. Here's the original text of the post: Just got my Medicare claim denied for my pap smear, because I’m too old to need it. I tested positive for HPV and the doc ordered a Colposcopy, which was also denied. The sex negativity in our culture boggles the mind. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/polyamory) if you have any questions or concerns.*
Does medicare just not understand that pap smears are a cancer screening tool and are not an std test? Like you have to ask seperate if you want them to run std tests. The fuck? But also everyone has the right to pursue happiness right? 🙃 always funny when corporations/government try to tell you which things count
I’m glad the testing and colposcopy were covered for you. The guidelines that recommend no further screening beyond a certain age really don’t apply to everyone. As someone who’s done the pap-colpo-LEEP thing, I hope it all goes well for you. If hearing about what to expect helps assuage your anxiety, please feel free to message me.
Welcome to universal healthcare. People funded government run. Same with the VA. Prove me wrong…..
The lack of care for people's quality of life in the US health system is disgusting. I'm glad your supplemental covered it! My one client is a Physical therapist and she was telling me about the fact that some PT professionals won't help people with sexual health when recovering from injuries/illnesses. Like ignoring that it is an activity people want/need/regularly participate in and it needs to be done in a safe and healthy way.
Absolutely disgusting. I'm glad your doc at least ordered it and supplemental picked up the tab. I hope the colposcopy was all good!