But there’s no money in being healthy!
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Reminds me of reading in a great book about a family with an unusually high number of schizophrenic children that no company was willing to do research on their DNA in search of a cure because they didn’t see enough potential profit in doing so. 
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It’s not just health insurers. Hospitals contract with GPOs (Group Purchasing Organizations) to purchase everything from defibrillators to office chairs. GPOs claim to save the hospitals money by aggregating the purchasing power of many hospitals, but this is where the perverse incentives hit. First, they don’t charge the hospitals for this service, they charge the suppliers. Second, they charge a percentage of the total spend from each manufacturer, then pass a percentage of that fee on to the hospital as a “rebate.” Many hospitals fund their entire purchasing department off of those rebates, which make the people in that department dependent on the GPO for their own salary.
Naturally, GPOs have zero interest in actually saving hospitals money. They want to increase the hospital’s equipment spending in order to increase their own revenue. If it sounds like what they do comes straight out of the organized crime playbook, you’re correct. It took an act of Congress to make the GPO business model legal.
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But but, someone told me that the Feds spent $3,000 on a wrench!
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WTAF--
Meanwhile, reality has some facts (TW: upsetting pictures):
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Applied behavioral analysis is “conversion “therapy”.”
It doesn’t actually help autistic kids. It leaves a lot of these kids with ptsd, and with a fear of saying no.
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Agree about ABA (although I feel I must point out that not all ABA is what we would classically call ABA, but is called that, ironically, so that insurance will cover it.) The article headline is misleading, they are cutting a wide range of therapies on the basis that it has not been shown to improve them enough to stop needing therapy. IOW, because it does not cure autism. Which is a very no shit kind of thing. PT/OT/ST and etc. do not cure autism, but can make it easier to live with. I hate insurance companies!
(By way of background, I have 2 SILs who have their doctorates in education and SLP. The education doctor hates ABA, the SLP doctor loves it. At a family dinner, they started trying to figure out why their experiences were so different. It was because the “ABA” was completely different. I told SLP SIL “I want your ABA in my area!” I found that equally frustrating and enlightening.)
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This is a thing I’ve seen in discussions on the topic, is that someone will be praising ABA, and then a (usually) autistic person will talk about how harmful ABA is, and they’ll be shouted down.
Typically, if the ABA proponent actually listens to the autist and goes and reads the things they are pointed to, they come back horrified. “That’s not what we do!”.
The thing is, if you go and look at what ABA is defined as, at the theoretical foundations of it, of the standards promoted by the ABA professional organisation, there is a way to describe what those horrified people are doing: not ABA. As soon as you start thinking of the person you’re treating as a person, and being concerned about their internal state, it’s not ABA any more.
So a lot of people practicing “ABA” are actually implementing some sort of occupational therapy or behavioural therapy or even cognitive therapy and, as you say, calling it ABA so that Insurance will fund it.
The trouble is that when everything is called ABA, then the Association for Behavior Analysis becomes the arbiter of what those people are doing. And if it doesn’t work, then it must be because they are doing ABA wrong (which, you know, they are, but that’s a good thing), and the pressure is on to “fix” that by “correcting” it. That is, by removing all elements of empathy and stripping back everything which isn’t Skinnerian reinforcement.
And I suspect that’s what’s behind the Insurance industry’s pushback on ABA: there are too many people doing “ABA” who actually aren’t, and the industry has lost faith in the AssBA to bring it back to the much vaunted “clinically proven” standards. (Spoiler: they are only “clinically proven” in papers that only cite other ABA practitioners and researchers: it’s a massive research echo chamber.) The irony is that it’s the “proper” ABA which doesn’t do what it promises. (It promises to make your autistic child less autistic and able to obey orders and generally act more like a normal person… parents typically don’t want a child who is traumatised, fearful, more full of the need to self-sooth, with less ability to do so because self-soothing has become a source of anxiety in its own right, and more tendancy to explode in hurtful behaviour as a result).
But the AssBA doesn’t want to entirely crack down on all the !ABA practitioners, because otherwise how could it claim to speak on behalf of all those many many ABA practitioners?
ABA delenda est. All those other things, the things that work, by all means keep them. Just stop calling them something they’re not and thereby giving a horrible thing undeserved credibility.
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I have frequently described ABA as treating pain by making kids afraid to cry. Makes those around them feel better, so success! But the problem i have with calling essentially everything ABA is unless you know the folks doing it, you have no idea what you are sending kids into. Leslea’s ABA experience (SLP SIL) is so markedly different from Jen’s (Ed.D. SIL) and mine that it made me question whether i had any idea what was happening, but it just made the situation more confusing.
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And insurance companies manage to fuck up shit even more. If it wasn’t for them and the stranglehold they have on funding therapies, the people doing !ABA could start calling it something else that distinguishes those therapies from abuse. Making it easier on parents. Easier on researchers studying the effectiveness of different therapies in good faith, and easier to educate people that true ABA, by the standards of the Association for Behavior Analysis, is abuse
US health insurance companies poison our society’s ability to care for people in so many ways.
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I was finalizing my ACA coverage and this notice popped up. Looks like some people are gong to have an even rougher go of it.
Important update for DACA recipients & consumers with certain other immigration statuses
Due to a recent court ruling, don’t select “Yes” to the application question that asks if you have eligible immigration status if you:
Live in one of these states: Alabama, Arkansas, Florida, Indiana, Iowa, Kansas, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, and Texas
Get a list of immigration statuses no longer eligible for Marketplace coverage in these states.
DACA recipients and consumers with certain other immigration statuses who don’t live in one of those states aren’t affected.
This is a preliminary court decision and final decisions could affect your eligibility for coverage. Check for updates before January 15 when Marketplace Open Enrollment ends.
I thought Dreamers were legal.
Judge Daniel Traynor of the U.S. District Court in North Dakota issued the order Monday from Bismarck, dealing a setback to a Biden administration rule that was estimated to allow 147,000 immigrants to enroll for coverage. Traynor’s ruling came in a lawsuit filed over the policy and will remain in effect until the matter can go to trial.
The ruling applies to immigrants in 19 states where Republican attorneys general sued to avoid having to comply with the new policy. They cited concern over immigrants possibly qualifying for public subsidies available to many people insured under the ACA.
The GOP state officials argued that the rule created earlier this year by the U.S. Centers for Medicare and Medicaid Services would be a strong incentive for immigrants to remain in the U.S. illegally and could creating costs for states. They argued that both the Affordable Care Act and a 1996 law prohibit U.S. government benefits flowing to immigrants living in the U.S. illegally.
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Whoops.
I hope whomever found it provided the info to the attorneys suing over the use of AI to deny claims before reporting it to anyone else. Even if the attorneys didn’t have a chance to download everything, that could provide some interesting directions for discovery demands
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mysharona1987
A doctor’s angry letter to United Healthcare after they denied covering his patient’s nausea medication needed after his chemo.
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Every moment i spend arguing with insurance companies is a moment i am not providing patient care. Not only is that how i make my living, but we are all chronically overbooked and taking time away from that means kids are not being seen. So i can tell a HS dropout that just because they don’t understand that big word does not mean it is not a very bad thing. We are seeing the truth of “one death is a tragedy, one million merely a statistic.” This is a huge chunk of why there is a primary care crisis, and it is getting worse.
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I am incredulous that people get billed for a rape kit! Even moreso that an insurance claim on it would be denied, bit seriously! Is there any other crime where the victim gets billed for the investigation?
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So my wife had some routine blood work done a couple months ago, it’s covered by our insurance.
We got a bill today for 200 bucks because the bill wasn’t submitted in a timely fashion.
Wtf?
We’re not the ones submitting the bill.
The bill says to call the lab to dispute. When she calls a recording says press one of you’re over 50.
Huh? Okay, she’s presses one.
Then she gets a recording that she won a prize. She hangs up and tries again for a live person. She gets one, they kept saying she won some sort of free monitoring device.
She couldn’t get anyone on the line to discuss the bill.
Tomorrow she’s calling Blue Cross but I suspect it’s going to be a run around.
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For anyone unfamiliar with the story behind the polio vaccine, this is a really nice summary, and told in an entertaining fashion as well.
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