@quixotic120
@lemmy.worlda virus perpetuates and replicates itself infecting other executables with its code, thus the name “virus”.
this is just shitty code that crashes hard. it’s not even particularly malicious, it doesn’t destroy anything
am a mental health provider, am listed in several insurance directories that I either no longer take or never took to begin with
It’s linked to another article but they describe why therapists stop taking insurance as a matter of complexity. This is true but another aspect is that some insurances simply pay significantly less than others. It’s a difficult thing to discuss because the low ones typically still pay like $60-80 an hour and on a surface level that sounds like a lot (because it is). But the reality is that doing therapy is complex. For one I typically lose about 30-50% of the good rates just to overhead (lower side is telehealth or home office, higher side is if you rent an office and can go even higher). More so if you’re actually planning for retirement and sick time, which a lot of therapists just ignore. Then you have to figure that we only get that rate for billable hours, which is 20-30 hours a week depending on how good you are. The rest of the time is admin bullshit, case collabs, screening new clients, etc all of which is unpaid.
So I can take the $70/hr insurance that barely covers my day to day, or I can limit myself to private pay and the ones that pay $100-140/hr. Even with the 100-140/hr ones I’m still probably making 60-70k on average because of stuff like no shows and cancellations (which is why more and more therapists are charging very high cancel fees)
But their main point of the complexity is a big one too. In my experience the insurances that pay low are the ones that are most likely to give me grief over payment. They’ll pay me very late (but if I submit billing 10 seconds late they’ll deny), they’ll clawback payments for the dumbest reasons and be the most aggressive about clawbacks (potentially meaning that I’ll suddenly get a note from them that I have to return $1000+ because they decided after paying me they shouldn’t have), and they’ll have the worst systems for submitting billing (requiring me to have hours of wasted time on hold with their shitty customer service)
It’s terrible that this person died and it’s worse that they spent almost $400/month for care that was never able to be delivered. It’s worse that this will probably result in no changes whatsoever. Even if harris’ Medicare for all prop passes it will take ages and the design is that there will still be a “two lane” system, where private supplementary insurance is still available for the rich. This will likely result in tons of providers that don’t bother taking Medicare because it’s more of a pain in the ass and pays less. So the government will finally give you insurance if you have none but it will be functionally useless like this article describes. End commercial insurance altogether
The important takeaway from this is that “supplements” have 0 oversight. The CBD, probiotics, vitamin d, etc that you buy could just be capsules of vegetable oil that does nothing at all. Or they could be asbestos and cyanide for all you know (that probably would lead to an investigation though). There’s also no safety regarding packing and handling, so it might literally be a guy with unwashed hands who just picked his butt loading your gelcaps in a dirty bathroom that someone just took a massive shit in. No one checks and verifies any of this and that’s why shills and hucksters jump onto this shit, it’s a completely unregulated market where can cut corners everywhere and say whatever you want as long as you include *not intended to treat any diseases and not evaluated by the fda
A $1200 thing you buy on instagram that sends “good waves” to your brain? Supplement. The cbd you buy at the gas station? Supplement. Doterra oils? Supplement. No regulation, no oversight, just robbing people based on their desperation to fix chronic pain and mental illness
It hasn’t seen a release yet, code is here:
https://github.com/arjpar/WebShield-staging/tree/ldev
I’m not endorsing it, never heard of it before this post, but this was literally the second line of the readme
“massaging tartrazine solution into hairless mouse skin over the course of a few minutes or using microneedling achieves “complete optical transparency in the red region of the visible spectrum”
I know it didn’t happen this way but I like to believe it was someone having their unwashed dorito fingers after lunch, decided to massage a mouse for several minutes, and figuring this out
I worked in training people to use AAC devices a relatively long time ago. Nowadays it’s generally handled with ipad/tablet apps. This is interesting because there is tactile feedback, which was true for most of the purpose built devices prior to cheap and very functional tablets all over the place
Before that though? It was crazy. The devices were cumbersome, really hard to use, and a pain to program. They were all over the place too; sometimes custom hardware, sometimes repurposed hardware, but even from the same company you’d see wildly different options.
A popular one was basically a windows ce computer (like a cash register) with a big lead acid battery like from a ups, all strapped into a metal box. This was popular because it was the most powerful and customizable but it was tremendously expensive (think like 10-12k) and super heavy. But these were meant to travel around with the learner and set up on a table, allowing for broad speech including building sentences
there were also some smaller more portable ones too. Still crazy expensive but less so (like 7k) and were palm pilots in big cases. Much lighter but far less powerful and more akin to what’s pictured here, a few pages of icons where the learner could indicate single words or short phrases but couldn’t build sentences. Eg the former could have icons for words and a board to allow the learner to construct the sentence “I want some pancakes please” then make it speak, whereas these would have a button for pancakes and when pressed would say “pancakes”. They were programmable though, you could use the former to just have an icon board and you could make the latter’s pancake button say a full sentence
There were also text to speech devices for learners that had more intellectual capability and could learn to type/read/write. These were just keyboards with a little screen, you’d type a sentence, and it would speak it back in a 1990s synth computer voice. Also expensive, comparable to the palm pilots but a bit less (like 5k iirc)
But the worst parts (aside from the obnoxious “medical device” pricing) were the software and support. The software was buggy garbage. These were always niche devices and the development teams were likely small and not very good. It was cumbersome and time consuming to program in the icon board, it would crash all the time, and the ui/ux was an absolute eyesore. Also the battery life was pretty terrible on most of them
The support was even worse. The device would break and they would repair it but this would often take weeks. We had several extras for commonly used devices to get around this but with some of the less used devices we didn’t. They would not forward you a loaner device or have any way of sending a replacement while you shipped the broken one back to be refurbished and resold or whatever. So the learner would essentially lose their primary (sometimes only if they didn’t know any asl) method of communication for weeks. We would go back to the books of paper icons but this is a different skill set and not every learner could quickly adjust to such a change. And this would often lead to regression in their ability to use the device
The iPad and android tablets were game changers. For $500 you had the device, and for another $2-300 you had better software that was still ugly and buggy but was regularly and easily updated (to update the other devices you’d often have to send them back as they usually had no connectivity to save battery life and limit the possibility of damage). I’m sure now, 10+ years later, the tablet software has evolved and isn’t just horrible ux and bugs (at least I hope so, looking at proloquo2go on the app store shows the same ugly ui but reviews are good so hopefully they fixed the workflows to program and improved stability). when they broke you could just pop over to the apple store and get it fixed, or for rural clients you could usually set up a repair and get a replacement device forwarded to you to limit downtime. Now when it broke it was maybe a few days to get a replacement up and running, and sometimes same day with the apple store.
I was so happy to see the old devices die
Then if you’ve met your deductible the big question is if you have a coinsurance after the deductible is met and an out of pocket maximum.
If your coinsurance is 60% or 80% or whatever, you won’t be responsible for the full bill but only that percentage of it.
If you have no coinsurance (a no charge after deductible plan) the service should be covered 100%
If you have coinsurance you should have an out of pocket max, which once hit should end the coinsurance and make services covered 100%. OOP max is typically quite a bit higher than deductible, sometimes 5-7x as much, but not always. It’s plan specific.
If your employer pays 50% that is an arrangement they have worked out and the specifics will be tied to your companies contract. This could mean they would pay 50% of any bill (unlikely as this is not a fixed cost they can plan for. Maybe if you’re like a ceo or some shit) or it could mean that up to your deductible they’ll pay 50%.
Also keep in mind even if you’re in a “covered 100%” scenario there are some instances in which you would still get billed:
Differential vs contracted rates - if the hospital charges $5000 for your procedure but your insurance only pays $4600 the hospital can sometimes bill you for the difference. This is not always the case; some contracts require the servicer (doctor) to accept the contracted rates and not charge more. Most common reason you’d get a bill in the above 100% scenarios and also the reason the math might not work out in coinsurance scenarios. Eg in the above surgery example your bill would probably be $1320. It should be 920 as that is 20% of the $4600 paid, or even $1000 as that is 20% of the 5k billed, but you pay the 920 as 20% of what your insurance paid plus the $400 difference, so $1320
Out of network providers - these can often have a separate deductible and sometimes in hospitals a provider can be out of network even though the hospital itself is in network
Non covered services - if the procedure involves a service that isn’t covered (uncommon)
Billing errors: if a bill looks wrong contest it and if your insurance isn’t reimbursing providers properly complain to them. Sometimes a medical office gets your info wrong and assumes your deductible or coinsurance is active when it shouldn’t be. Sometimes your insurance makes similar mistakes.
one of the most frustrating aspects of being a therapist in america in the past 10 years is the hand waving of the ethics involved in the financial renumeration of our relationship with those we serve
I would say a significant stressor for the overwhelming majority of the clients I have is financial woes. And because the system is backwards, those with high paying jobs well into their career tend to have the fancy PPO plans with no deductible where seeing me (or anyone) is only $10 despite the fact that they could much more easily afford a 5-10k deductible. Meanwhile the people who are making 20-50k a year on the other end of the spectrum almost always have those high deductible plans with sometimes massive deductibles and rarely have employer funded hsa.
I’m not an idiot, I run my own practice and I do the books for it. I can do the math to figure out how much take home pay someone has with those salaries. I can also conceptualize the cost of housing, food, phone, transportation, etc because I am also paying these things. So when I meet someone here and their appointments are $140 per meeting I am in a tough spot. I am asking them to take on a burden of $560 per month (assuming weekly sessions). That’s immense. And if the deductible is 5k, 7.5k, 10k, it will take ages to meet especially if they’re younger and not really making contact with many other medical providers.
I am contractually obligated to charge what your insurance pays me in these instances. If your insurance pays me $140 for the hour I have to charge you that until you hit the deductible. I could be dropped from the network if I modify this for you and get caught.
I can ask you to skip using your insurance and charge a lower out of pocket rate but this is complex. For one, many therapists can’t adjust their rate much lower. I have flexibility here because my practice is entirely telehealth so my overheads are much lower. But if you see them in an office? They are paying about 40-50% of that just in rent most places.
Additionally even with telehealth I have to be careful with adjusting rates. Insurance only pays me for specific timed and coded sessions. If you and I have a phone call for 25 minutes? Not covered. If you ask me to collaborate with your psychiatrist and I talk to them for 40 minutes? Not covered. The time I spend dealing with billing and this system, which works out to an average of 20-30 minutes per session? Not covered. So the 25% of my week doing billing shit and the overtime hours doing phone check ins, case collabs, etc. has to be covered by that.
This is why many therapists give fee schedules and charge you for all of these things. If you want paperwork from them it’s $1 a page, phone calls are $75/hr, etc. I can make it work without this because I’m not paying for office space but if I was I would need to do this to keep myself afloat.
This is also part of why many, many therapists simply don’t take insurance anymore. Just pay me the $140 directly. I can collect it via square or whatever and your billing is done. I no longer spend 5-10 hours a week on billing nonsense like fighting retracted payments, finding out why claims were denied, etc. You can submit receipts for out of network reimbursement and you deal with them.
I understand why my peers do what they do. But ethically it’s a mess. I signed up to help people and what I have become is a gigantic cash sink that puts a tremendous amount of pressure on the people I serve and is counterproductive to our work.
At the same time I deserve a fair salary for my work and this is the only way to get it. And if I protest the system by leaving it because it’s so broken then the end result is that there’s 1 less mental health provider who takes insurance. If I stop taking insurance altogether I alienate a ton of people with high need who can’t afford to pay out of pocket forever and/or don’t know how to navigate out of network reimbursement.
I cannot tell you how many times I do a screening call with someone and they say “this sounds like what I need”, they tentatively schedule, and then once I run their insurance and give them the actual numbers of what treatment will cost they simply ghost. It is a system that actively deters people from seeking assistance because it is so cost prohibitive
And the insurance lobby has its fingers so deep into the framework of america that this will simply never be fixed. It will only be changed. Look at Kamala Harris’ proposed Medicare for all: it still allows private plans. That will be a movement in the right direction because it will end the idea of someone being “uninsured”, which is great, but it will also create a two lane system in which many practitioners will do whatever they can to avoid taking basic Medicare patients in favor of the commercial plans. Commercial plans, at least in my area, simply pay more. Significantly more. Like $80/hr vs $140/hr. And in the end I will have the same problems because the unnecessarily complex private insurance system will still exist and be very powerful. I will just have one more insurer to add to the web of complexity. But no politician will ever remove the private health insurance industry. To do so would alleviate so much spending waste, so many wasted administrative dollars and man hours, but it would also result in layoffs of hundreds of thousands, if not millions, of americans whose jobs rely on processing the complex bullshit of this system