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

Bleed in my ass

those bass drum hertas tho

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

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

your scenario is either worded incorrectly or very atypical (which is very possible, there are a lot of different insurance plans in the us

typically high deductible plans work in a way of “meet your deductible and then we cover x% after that”

eg I am a therapist, I bill your insurance $100 for an hour session. You have a $1000 deductible with 80% coinsurance.

Our first 10 sessions will cost you $100 out of pocket, which goes to me directly. I submit billing for these sessions but get no reimbursement from the insurer because you have already paid the full amount. However, my submission of billing indicates to the insurer that you paid $100 for a medical service on whatever date for whatever diagnosis.

After the $1000 deductible is met your insurance splits the bill with you 80/20. Now you pay me $20 per meeting and when I submit the billing the insurance (hopefully) pays the other $80 to give me the $100 per meeting I am owed.

This of course assumes no other medical spending goes on for the duration, otherwise you would hit your deductible faster. If you saw me 3x and then had a surgery that cost $5,000, you’d pay $700 for the surgery to settle your deductible plus an additional $860 (20% of the remaining $4300) and then sessions would be $20 under the 20% coinsurance.

You should also have an out of pocket max, this is kind of similar to a deductible but it is different. This is a tally of your total spending and once you hit it your coinsurance usually drops and you pay nothing.

Also important point is that deductibles reset every plan year. This should have been made abundantly clear to you but I still encounter many who do not know this

Additionally your insurance may have certain services covered that don’t cost you anything or where the deductible doesn’t apply (eg you’d only pay 20% even if it’s the first appointment of the year). Typically this is preventative care, things like physicals and vaccinations

That is the most typical. But like I said it there are many plans and variations. It’s possible you have a plan that prior to meeting the deductible you pay 50% of billing and then have a 0% coinsurance. This would be really great insurance.

It’s also possible that you have a benefits package from your employer that is basically paying 50% of your deductible in a roundabout way. this is far more commonly done by the employer funding an hsa/fsa account which would be a payment card that you use on medical spending and not the insurer. However, I have encountered plans where the hsa and insurance were rolled together and joint companies, where the hsa would pay all or part of billing prior to deductible on the patients behalf

Using the same examples above you’d pay me $50 until you met your deductible, then nothing once the deductible is met. If you had a $1000 deductible, saw me twice, then had the 5k surgery you’d pay me $100 and $900 for the surgery. If you have one of the situations where the employer is covering 50% of the deductible it would be the same but the surgery would be $400 because ultimately you’re only paying $500 of the $1000 deductible and your employer is covering the other half. This is not a situation I’ve ever encountered

Another important point is that deductible status is dependent on your providers doing timely billing and your insurance processing said billing in a timely manner as well. This does not always happen. As a result you may meet your deductible but my billing verification shows that is not the case. The examples I used above were clean and easy but it’s never that simple. Most people have a deductible around $2500 (and many 2-4x this) and see several different healthcare services.

I submit my billing at the end of each day but some places are sloppy and will take weeks to submit. This can lead to situations where you are charged money because I was under the impression you had a deductible but you should not have been. Eventually the insurer will pay me once things sort out. If I am good at record keeping (I am great at it for this reason) I will catch the double payment and send you a refund. This is why it is important for you to keep track of deductibles and medical spending. Not all offices are managed well. I’ve personally had money stolen from me (because this is literally fraud, to not refund the double payment) and I don’t believe it was ever intentional, just offices with shitty management. Let your providers know if you’ve met your deductible. I will always hold off on charging you if you tell me this, submit billing, and see what the insurance reimburses. If they reimburse me in full then you were right. If they don’t I send you a bill and if that is incorrect you need to call your insurance to complain

You should be able to track deductible and out of pocket spending on your insurances consumer portal (eg go to Aetna.com or whatever and click “for subscribers” and make an account, if you haven’t already). This should also give you an explanation of plan details.

Most importantly you should be able to call the office of the place (or billing dept if it’s a larger health network) doing the procedure to have their office manager check what you will be expected to pay for the procedure both at time of service and expected cost total. This takes only a minute but be forewarned it is essentially an estimate and not a guarantee. Billing can change last minute depending on how the procedure goes (eg added complexity allowing them to add another cpt code for something)

There’s a lot more to it than this unfortunately. Some plans have tiered deductibles, sometimes a staff member in a hospital isn’t personally enrolled and then are considered “out of network”, which is a whole other thing, sometimes you are still responsible for a certain services that the provider requires but the insurance refuses to pay. That last point especially: every time you establish with a medical office or get a procedure you sign something that says you are financially responsible for services not covered by insurance (I guarantee this, every time). So if you get bloodwork with like 30 tests and 2 aren’t covered even if you’ve met your out of pocket max and have the best insurance in the world you’re getting a bill (and potentially a hefty one, some blood tests are extremely expensive)

Sorry this is very long and complex but that is kind of how insurance is? To boil it down to a “eli5” 2-3 sentence explanation would either require your specific plan information in much more detail or to overgeneralize and potentially mislead you.

I mean like running their hypothetical control software/framework within a docker on a local server. Is that illogical? I do the same for the software that runs my ip cameras with my home server, instead of them needing to connect to some external server.

You’re ultimately right though, when it comes to docker I am at the proficiency level of “can deploy other people’s images” and not so much on the “have bothered to make my own”

A school district spends $180,000 (hyperbole, I don’t know actual numbers) of taxpayer money deploying this system between the actual hardware costs, maintenance costs to install the hardware, it costs to implement it into their network, and probably an ongoing contact with this dummy’s company. Maybe only for support but with the way things are now I’m sure they built this app to phone home to their servers (introducing a huge potential security risk over simply running it locally on the schools existing network infrastructure in a docker or something), calling it “cloud based”, and charging the district 1k/month to run the devices the district now owns and should be able to operate without the company. The company then talks about how they’ll back up records and safeguard data so you don’t have to worry about that (that it dept you pay is pointless!)

Three months after deployment it turns out the sensors can be tripped by many things not related to vaping, maybe increases in heat, mouthwash breath, etc. the false positives are due to a hardware flaw and cannot be fixed with a patch. Feel free to upgrade to sensor version 2.0, now with improved accuracy! (read: the problem still exists but isn’t as bad). Only another 40k to buy the new hardware, rip out the old hardware (which is now worthless), install the new stuff, and configure the software for everything (again, maintenance and IT costs)

9 months after deployment the company is doing poorly because their product is stupid and only a few idiots actually bought it (way to go idiot). There’s concerns because they sent a new Eula that outlines data sharing policies. They are potentially finding ways to harvest the data they agreed to safely store to try and create a new revenue stream to right their sinking ship. District counsel says fighting the Eula change will be expensive and there’s not much precedent for it, plus they state they will anonymize data before sharing so it’s not a ferpa violation, technically. It feels scummy but you can’t do anything about it. You also don’t really trust them to only sell anonymized data but you can’t prove they aren’t crossing that line so whatever, I guess

15 months after deployment they get hacked because they’ve run out of vc cash, never could get an actual profit stream going (turns out they’re spending 750,000/yr on salaries for 5 people and they’re all kitted out with sick work computers for what is basically coding a web app, but I digress). security of their servers was one of the budgetary constraints they chose to make to right the ship (but had to keep the $1800 office chairs and the 15-20k/mo rent loft they use as an office in a hcol area). The contract says this may happen and they’re not responsible unless there’s gross negligence on their part, which you can’t prove, and that they do some bare minimum reactionary shit after the fact to mitigate damage. So they’re legally blameless and now you get to notify your community their children’s data was leaked to god knows who, whoops

22 months after the fact they go out of business officially. You get a form email about the company’s journey and the difficult decision they had to make to stop fucking around on a dumb project that sucks because no dumbass vc will give them fun bucks anymore to keep playing tech bro billionaire. All the sensors stop working because they require a connection to the servers, which they shut off immediately without a sunset period. You’re reminded every day when you log in to the schools admin panel and get 350 “sensor not connected” error messages and your students bitch about the “sensor not connected: server not available” error pop up showing up on their classroom console. It takes IT a few days to remove their shit from the network and that costs you even more money in wasting your IT staff time when they should be fixing the broken computers in the computer lab or whatever.

Now your school has a bunch of weird boxes on the wall. Sometimes people ask you about them and you go “oh those don’t do anything” and remember that they cost taxpayers in your community tens, if not hundreds, of thousands of dollars and wasted hundreds of hours of your supports staffs time that they could’ve been using to improve the school

But then you scroll on instagram and see there’s this new thing that will detect when kids are bullying each other. You just have to put a camera in each classroom. It’s okay, it won’t record. It will just use the power of AI and machine learning. You’re sold right there and the cycle starts again

it was so good. I saw Ben folds, bright eyes, Tom petty, common, blackalicious, beck, Radiohead, Dresden dolls, clap your hands say yeah, bela fleck, and sonic youth. Maybe others but that’s what I remover looking over the schedule and lineup. The first night we showed up late and mainly just watched the comedy tent which was patton Oswalt and some others, demitri martin was there. I had planned it out and it went fairly well, thankfully I had been once before so I had some familiarity with the grounds. I was also in my early 20s which helped me with the whole “just keep going” and I slept till noon basically everyday which also helped. At some point I had a mild fight with my friends that I came with because they just wanted to spend some time camping and that felt like such a waste so I broke away and watched several acts alone

I remember being really frustrated because I also wanted to see medeski, Martin, and wood, cypress hill, and golden but they played at they same time as beck, all overlapping each other to some degree, and all on stages that took a bit to get to. It was rough but I chose to get a good spot for beck and plant there for Radiohead after

Now that I’m almost 40 though? no thanks. My max festival is 1 day and realistically I’m not going unless prices start coming down. 2024 bonnaroo lineup was decent but not amazing and was like 400-500 for the 4 day pass, minimum (although iirc resale eventually saw the price fall down a decent bit. Hope a lot of scalpers ate shit lmao). not even gonna start about the $1800 “vip packages”

The lineup was pretty solid, especially if you look at the full lineup, but that price is a bit much for a single day festival.

We just keep getting fucked. I paid 160 for bonnaroo 2006 tickets because I got the first wave, I think the final wave was 190. That’s with fees and all. Adjusted for inflation thats $250-290. But that was a 4 day festival with Radiohead headlining, beck, tom petty, god tons of sick bands. It was imo the peak of bonnaroo

Now this is $300 for a single day? It’s more after inflation for 1/4 the festival? I get that there’s savings in running a festival for multiple days so it’s not like cutting a 3 day to a 1 day means costs are cut by 2/3rd, but from my perspective as a consumer it looks like I am paying ~300% more than I did 18 years ago even after adjusting for inflation because I just don’t get nearly as much value for my dollars.

I remember that bonnaroo and being like “Jesus this is so much money” and here we are with a show that’s 53% more expensive in raw dollar amount and 1/4 the length. Sigh.

Was worth it though, that Radiohead set was insane. They played for over 2 hours. Also a few months later I got tickets for daft punks alive 2007 tour - $50 plus fees (which were like $14). At the time I thought it was the most absurd shit, so expensive. I almost didn’t go. I’m glad I did because it was the most insane concert I’ve ever seen in my life. But it’s funny because nowadays finding a major act that puts out tickets for $65 with fees is actually fairly tough.

I mean the internet has become a piecemeal existence where you’re expected to add on things like it’s McDonald’s so I guess this is just the next step in the trend

I miss 1997 when the internet and all the information on it was free (save purchasing a computer and the monthly fee for an isp, if you want to be pedantic I guess)

lmao really? so you’re still a non subscribing pleb that gets the “please support our cause and subscribe” stuff but you literally only no longer get targeted ads? Shameless

am I reading this right that you would pay and still get advertisements, just not targeted ones?

Also nontraditional warfare that has technically been seen but not really (at least in an officially acknowledged way, maybe something like stuxnet?) like offensive cyber warfare. If things truly came to trading blows russia does have very talented cyber espionage folks and the us has shown many times that it has pretty shocking vulnerabilities on many critical points of cyber infrastructure. these probably haven’t been attacked because it would be a literal act of war to go after the power grid, weapons systems, water delivery systems, etc but if the gloves come off then you better believe these systems start getting attacked by state sponsored actors who will never come anywhere near american land

Women are not allowed in this world anymore because they don’t want their husbands and children in this country

what the hell, hitler sounding autocorrect

I am a therapist. I take insurance but it’s a goddamn nightmare

You either join a group practice (goodbye at least 40% of earnings) or you try to go it alone

If you go it alone: hello navigating the maze of bureaucracy that is insurance credentialing and billing. Good luck! No real guidance here. There are some “tutorials” online but they’re super generalized because everything is very different on a regional level. Aetna in Atlanta is entirely different from Aetna in New Jersey. Then you can also play the game of “guess how much money I will make?” Because none of them tell you until you’re about to sign the contract (and some don’t tell you until after!). Or you can pay someone to do all this for you for like $1000. Also it takes months. Then you have to figure it all out again to figure out how to bill. Then you have to figure it all out again to figure out how to bill electronically because you bill on paper the first few times to get payments and then use the payment numbers to set up accounts to actually bill the normal way. Or again you can pay someone to bill for you for like 5-10% of your earnings.

And all of this is while you’re a 1099 worker so no health insurance, paid time off, retirement, etc

Alternatively you can in some places join a hospital system. These will sometimes pay you a salary and benefits but will usually pay a shit salary, crappy benefits, and give you a nightmare quota and ask you to supervise interns. Or work someplace like an IOP and run groups but again you’ll make like 40-50k tops with crappy benefits (and the student loan debt of someone with a masters degree). Plus a lot of those places will still keep you as a 1099, at least around here.

So then the community mental health/medicaid agencies cry about why they can’t keep staff and the mental health crisis facing low ses communities (hint: it’s because you pay $30/hr as contract workers to people with 100k+ student loan debt)

Then people run from those places to group practices and stay there for a bit but eventually bail because they take 40% of earnings

Then they go independent and panel with insurers and it’s okay but also a fucking headache. They work 25 hours a week seeing clients and 15 hours a week unpaid doing paperwork to bill for said clients. All well and good except what the article wrote is all true, eventually you get a clawback where an insurance company is like “you wrote 90847 and you meant 90837, you could just correct and resubmit but we won’t allow that. You did it 15 times so we are demanding you return $8,000 thanks” also your quarterly tax payment is due tomorrow. Oh and your insurance billing has to be submitted timely but Aetna is 3 months late in paying you and owes you 6k. It will come, eventually, probably

Also all that admin stuff they refuse to pay you to do? They pay grow and headway and alma and all those other vc backed tech bro companies that started during Covid to “revolutionize mental health” lmao. They pay them $30-40 a session to do it. Shoulda made a website milking off other therapists with a sob story about how you were depressed and had trouble finding a therapist bro, you could’ve been a multimillionaire instead of some dipshit making 65k with no retirement savings

Put a rubber band between screwdriver and screw, otherwise the other things already stated like CA glue, filing a flathead groove, or drilling the cap off

in the future use the appropriate sized driver and retire drivers when they become stripped

More like sponsored ”Product” for the first 8 results

I read it wrong at first and thought it was an actual irl theme park based on mars attacks, which would be a strange ip to choose for such an endeavor but I would still welcome it

This exists, kind of

There’s bonded connections in several senses

Bonded ports but this doesn’t increase throughput in the way you’re thinking. eg if I bond 2 1 gigabit Ethernet ports I can’t connect at 2 gigabits, I can connect 2 users at up to one gigabit each (or several users totaling 2 gigabits but no 1 user at more than 1 gigabit)

bonding routers can take two internet connections and combine them, which is closer to what you are probably imagining. They combine throughput, eg a 100mbit connection and a 100mbit connection become a 200mbit connection although realistically it’s not that perfect and you have to get the right services for it, not just any connection will work, it’s a rabbit hole and generally much slower and worse latency than if you just got a traditional connection. Think people using starlink and 5g internet in rural settings

There’s also something called speedify, which is software that claims to do the above in software alone, bonds two connections to combine throughput. Never tried it, reviews are mixed. Some say it works, some say it’s spotty, some say you only get the speed of the one connection, etc.