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> If Cuban's idea is "we don't do insurance but you're free to pay with an HSA card or seek reimbursement from your insurance company" then this could be a huge

by mlthoughts2018 6y ago

> If Cuban's idea is "we don't do insurance but you're free to pay with an HSA card or seek reimbursement from your insurance company" then this could be a huge winner. This is the way it works for a lot of therapy and mental health services and it’s horrible. Prices are absolutely insane, practitioners are not accommodating to patient schedules, and patients have absolutely zero bargaining power. In some ways doing it through insurance is kind of like a union. You all agree to accept certain inefficiencies, bureaucracy, etc., (and associated cost) in order for better collective bargaining terms. Of course people with great jobs usually don’t care about unions. They don’t need the collective bargaining power and thus figure the bureaucracy cost is just a loss they don’t need. Same thing with very healthy people and insurance. If you’re healthy you just figure, give me cheap catastrophe insurance, what do I care? But if you’re in the depths of the medical industrial complex because you need frequent treatment for chronic conditions, you quickly learn that papering everything over with lots of bureaucracy to adhere it to better collective bargaining for patients is way better, and I’d rather take the nasty, churning quagmire of price inflating insurance than deal with spartan libertarian mini-insurance that essentially just results in rich-get-richer (i.e. genetically lucky healthy people just get to save money while everyone else suffers).

supertrope 6y ago
The supply and demand imbalance in clinical psychology and psychiatry is why they can choose to be out of network. Demand is not only wanting a good or service but being able to pay for it. Mentally ill people tend to have less or much less money. The long term trend is not good; why become a psychiatrist when you can earn more as almost any other specialist? (With exception of pediatry). Jails are collectively America's largest mental health service providers. If there was money in psych work you'd see even private equity pump it up like urgent care chains. Even with single payer or heavily regulated universal insurance schemes there's often a mental health services gap.
Analemma_ 6y ago
I'm sure individual experiences vary widely, but I know several people getting frequent treatment for chronic conditions, and none of them talk about how happy they are that an insurance company is collectively bargaining on their behalf. Most of them curse their insurance provider with every breath, and are firmly of the opinion that it would shoot them in the head if it thought it could get away with it.
- mlthoughts2018 6y ago
  They clearly haven’t tried navigating treatment options in markets without insurance. I’m glad they are privileged enough (from the insurance) to make those complaints.
com2kid 6y ago
> This is the way it works for a lot of therapy and mental health services and it’s horrible. Prices are absolutely insane, practitioners are not accommodating to patient schedules, and patients have absolutely zero bargaining power. I think that is more a supply/demand issue. I am not sure why people aren't rushing to become psychologists, it seems like it'd be a profitable field, but there is certainly a huge shortage, at least in major metro areas. I'd really like to read a proper analysis of the situation...
- mlthoughts2018 6y ago
  Is there any data to support this? I was talking to my therapist about it recently and she suggested the opposite. There’s a huge glut of therapists, they just only want to have clients who pay out of pocket because then they offload the work of any insurance reimbursement, paperwork or other overhead to the client. She also suggested therapists want good filters to avoid difficult clients, like low-income clients that have a hard time paying and have more difficult social or behavioral issues. As I understood it, she was saying basically this: 1. therapists typically just want to work freelance, make their own hours, and don’t mind having very few clients / taking extended breaks from working many hours. 2. therapists don’t want to deal with “challenging” clients (who generally are the most in need of therapy in the first place). “Ability to pay out of pocket” is a good filter to implicitly reject “undesirable” clients. 3. therapists want to externalize the labor burden of coordinating with insurance onto the patient 4. None of this has any connection to charging higher prices - that’s a separate supply & demand phenomenon based on the talent of the therapist, population & demographics of the area, and specializations that deal with issues more correlated with wealthy clients. My impression from all this has been a massive negative opinion of “working class” therapists and counselors, to the point where I believe they should be required to accept insurance and they should be required to manage the paperwork process of insurance claims as a regulated condition of practicing therapy - it’s a matter of public health that’s in all our collective best interest to enforce with regulation.
  - com2kid 6y ago
    > Is there any data to support this? I was talking to my therapist about it recently and she suggested the opposite. There’s a huge glut of therapists, they just only want to have clients who pay out of pocket because then they offload the work of any insurance reimbursement, paperwork or other overhead to the client. She also suggested therapists want good filters to avoid difficult clients, like low-income clients that have a hard time paying and have more difficult social or behavioral issues. Try to find a psychologist, not therapist (there are many paths to get qualifications to become a therapist, and not all of them are exactly HQ), in the pacific NW some time. The wait time is in months.

supertrope 6y ago

The supply and demand imbalance in clinical psychology and psychiatry is why they can choose to be out of network. Demand is not only wanting a good or service but being able to pay for it. Mentally ill people tend to have less or much less money. The long term trend is not good; why become a psychiatrist when you can earn more as almost any other specialist? (With exception of pediatry). Jails are collectively America's largest mental health service providers. If there was money in psych work you'd see even private equity pump it up like urgent care chains. Even with single payer or heavily regulated universal insurance schemes there's often a mental health services gap.

Analemma_ 6y ago

I'm sure individual experiences vary widely, but I know several people getting frequent treatment for chronic conditions, and none of them talk about how happy they are that an insurance company is collectively bargaining on their behalf. Most of them curse their insurance provider with every breath, and are firmly of the opinion that it would shoot them in the head if it thought it could get away with it.

mlthoughts2018 6y ago
They clearly haven’t tried navigating treatment options in markets without insurance. I’m glad they are privileged enough (from the insurance) to make those complaints.

com2kid 6y ago

> This is the way it works for a lot of therapy and mental health services and it’s horrible. Prices are absolutely insane, practitioners are not accommodating to patient schedules, and patients have absolutely zero bargaining power. I think that is more a supply/demand issue. I am not sure why people aren't rushing to become psychologists, it seems like it'd be a profitable field, but there is certainly a huge shortage, at least in major metro areas. I'd really like to read a proper analysis of the situation...

mlthoughts2018 6y ago
Is there any data to support this? I was talking to my therapist about it recently and she suggested the opposite. There’s a huge glut of therapists, they just only want to have clients who pay out of pocket because then they offload the work of any insurance reimbursement, paperwork or other overhead to the client. She also suggested therapists want good filters to avoid difficult clients, like low-income clients that have a hard time paying and have more difficult social or behavioral issues. As I understood it, she was saying basically this: 1. therapists typically just want to work freelance, make their own hours, and don’t mind having very few clients / taking extended breaks from working many hours. 2. therapists don’t want to deal with “challenging” clients (who generally are the most in need of therapy in the first place). “Ability to pay out of pocket” is a good filter to implicitly reject “undesirable” clients. 3. therapists want to externalize the labor burden of coordinating with insurance onto the patient 4. None of this has any connection to charging higher prices - that’s a separate supply & demand phenomenon based on the talent of the therapist, population & demographics of the area, and specializations that deal with issues more correlated with wealthy clients. My impression from all this has been a massive negative opinion of “working class” therapists and counselors, to the point where I believe they should be required to accept insurance and they should be required to manage the paperwork process of insurance claims as a regulated condition of practicing therapy - it’s a matter of public health that’s in all our collective best interest to enforce with regulation.
- com2kid 6y ago
  > Is there any data to support this? I was talking to my therapist about it recently and she suggested the opposite. There’s a huge glut of therapists, they just only want to have clients who pay out of pocket because then they offload the work of any insurance reimbursement, paperwork or other overhead to the client. She also suggested therapists want good filters to avoid difficult clients, like low-income clients that have a hard time paying and have more difficult social or behavioral issues. Try to find a psychologist, not therapist (there are many paths to get qualifications to become a therapist, and not all of them are exactly HQ), in the pacific NW some time. The wait time is in months.