5 ms·

My question is why anyone but a few people would want to pay $140-$340/mo for a therapy-based approach not covered by insurance to a condition that is successfu

by devmor 2y ago

My question is why anyone but a few people would want to pay $140-$340/mo for a therapy-based approach not covered by insurance to a condition that is successfully treated in the vast majority of patients with medication that costs $10-20/mo with insurance? It is a very cool approach to a well documented and tested therapeutic practice, I just don't see the value proposition unless you're someone that specifically could not find any class of medication that worked for them.

throwway120385 2y ago
Medication has side effects, and it can be really difficult to access unless you can find a psychiatrist who is accepting of the idea that an adult has ADD/ADHD. I knew someone who tried to get it as an adult and she spent 3 years going between therapists and psychiatrists to build up enough history to be prescribed medication.
- kstrauser 2y ago
  I am eternally grateful that a friend turned me on to a local doctor who does video calls[0]. I'd struggled with getting in to see someone willing to take my complaints seriously[1], but a week after signing up for an online visit I had a prescription for something that's been life-changing. For me, personally, the whole effect of the meds are that I'm slightly more awake, as though I drank a cup of stout coffee, and I can more easily decide what to work on and then work on it. I'm fortunate to have had zero adverse reactions. [0]And then, knowing their clientele, texts and emails the heck out of me to remind me about upcoming appointments, which isn't strictly necessary but is understandable and appreciated. [1]One doc told me I had trouble focusing because of anxiety. "Do you know what you might be anxious about?" "Yeah, not being able to focus." That wasn't a productive visit.
- christalwang 2y ago
  Yeah, so many people have horror stories with medication, especially with the shortage going on right now and need immediate support. I've personally been impacted by the medication shortage, and many of our members.
  - mrandish 2y ago
    My N=1 experience has been remarkable success with medication. Of course, it does require some work and time to find the right med(s) and dosing. Also, the shortage was previously a problem in my very large HMO but early this year it started getting better and by about 5-6 months ago supply has returned to normal.
bbor 2y ago
I don't think medication "treats" ADHD in the sense of solving it completely. For one thing, we're living through an Adderal shortage, for another it doesn't last all day, and, most importantly, it isn't a cure-all, especially at the low dosages required for responsible long term use. As another commenter rightfully said, the downsides are also significant, especially in terms of exhaustion -- headaches are also a commonly reported one for methamphetamine. It's a lifesaver, but it's kinda like Ozempic: it enables you to follow through on your self-improvement goals, it doesn't do them for you. Also, some people don't have health insurance. We do exist, sadly -- 25 million of us, as of 2023: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240618.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/... Typically, a diagnosis/new psych appointment costs $250-350 OOP, and the monthly checkups cost anywhere from $100-200 (unless you can find someone willing to break the rules for you and prescribe without 30d checkins). The baffling coupon system does mean that the refills themselves are cheap, somehow, but I've paid $60 before just because the coupon wasn't working and I couldn't be bothered to go home and figure it out and go without meds for X days. Of course that all becomes easier if you're willing to stick with non-controlled substances, but still
- deleted 2y ago
  [deleted]
- Dilettante_ 2y ago
  >non-controlled substances Could you elaborate? The ones I know of are St. John's Wort(though that's more for depressive symptoms) and Phenylpiracetam.
  - hypatiadotca 2y ago
    Guanfacine and clonidine are two non-controlled meds approved for ADHD. They are second line treatments; all the first line treatments are stimulants, because they have the best evidence behind them.
    - astrange 2y ago
      The stimulants also have fewer and simpler side effects. But they don't work 24/7, At least not if you want to sleep.
aidenn0 2y ago
I'm not a Shimmer user, but a few things: 1. Insurance doesn't always cover ADHD medication, and when it does it can be a pain; every time my employer switched insurers I had to change my medication because the new insurer wouldn't cover the same thing the previous insurer covered. I've never had insurance cover my psychiatrist either, which amortizes out to about $100/mo. 2. Stimulant medication improves symptoms for over 80% of people with ADHD but "normalizes" about 1/3. So If you are in the 2/3 people that still have some ADHD symptoms on medication, then you're still going to have to cultivate healthy coping mechanisms. 3. Sometimes you go on a trip and forget to bring your medication, or you forget to bring the monthly prescription into the pharmacy on time (no refills on Schedule II substances), or your pharm is out of your meds. Now you are temporarily unmedicated and still need to function.
- kstrauser 2y ago
  Regarding #1: my insurance pays for 100% of my meds. It seems like the extended release versions are the hardest to get covered, but people who can get by with the plain old all-at-one formulations may have a much easier time with that. Also, insurance doesn't pay for my doctor directly, but their website has a place for me to submit out of network claims. I do that with my doctor's receipts and insurance cuts me a reimbursement check for a large portion of the bill. It's a pain in the neck in the sense that getting all the insurance stuff straight is extra hard when you're in need of being treated for ADHD in the first place. It does give me something to hyperfocus on every couple of months.
  - aidenn0 2y ago
    Extended release was hard with some, but I had one insurer that would only pay for 1 pill per day, so I had to use ER with them.
    - kstrauser 2y ago
      I have heard ahem that you could get 30 pills that were each an entire day's dose, cut them in half, and take them as 60 separate doses. For example, you and the doc think you should take 10mg in the morning and 10mg at lunch, so get a prescription for 30 20mg pills and buy a pill chopper. Purely rumor, I'm sure.
n8cpdx 2y ago
I’m skeptical of the pricing, but I could see it having value for working professionals or students who are at risk of failing out and don’t have good support on campus. I personally have ADHD, and I’m medicated. The medication makes it possible to focus on tasks, not guaranteed. I still have to engage cognitive skills and essentially implement a system similar to this, just without a coach. Specifically: break down tasks, use a Pomodoro timer, walk and make tea between focus sessions, put the phone away, use environmental cues like specific work music, etc. Sleep and exercise are also incredibly important for success with ADHD, and the stimulant medications can interfere with both, so I could see coaching being useful there as well, not sure if the service offers help there.
- christalwang 2y ago
  Love what you said about sleep and exercise. In the Shimmer app, we call this "Lifestyle Medicine" but it's basically the foundational pieces of your life that keeps your body running as it should. And this should 100% be considered before more complex treatments. For us we include sleep, exercise, and food/nutrition. That's awesome that you have a whole bunch of skills that you've found that works for you! For some people, this takes months to figure out the right mix since what works for someone may not work for others. And also, HOW you do something is almost more important than WHAT skill you're using. I would also add that in coaching, in addition to skills, the coach is supporting in long-term thinking, goal setting, so that there's a direction forward as well, which is really important. I like the quote "medication is like glasses, it helps you see more clearer but it doesn't teach you how to read". I think about this quote a lot because for me, the value of coaching has been to help me set a new direction in life, be reflective in what I want, then work to build an ADHD-friendly life around me that helps me go in that direction. Totally hear you on pricing. We're working on a few routes around reimbursement, partnerships with schools/workplaces, etc. Right now we are HSA/FSA eligible and also many of our members get it paid for through their work's L&D budget or disability/DEI budgets. Of course, that's a bit harder because it requires them to disclose. We also do a whole ton of scholarships for anyone with a financial need!
- NegativeK 2y ago
  I don't want to respond to the top comment so it doesn't look attackish, but expecting the medication to completely cure the symptoms for everyone is laughably wrong. I've got decades of learned behaviors to deal with. And while my doctor was correct in that a medication that works will be like night and day (I'd rephrase it as life changing), I still struggle more than I like.
deleted 2y ago
[deleted]
christalwang 2y ago
Coaching is different from talk therapy in that it's focused on more action-oriented, future-oriented concerns. For example, in therapy, you'll talk about WHY / WHERE a specific thought process came from, vs. in therapy you'll talk about how you can design your life in a way that minimizes impact of this thought process. Things like calendar design, routine design, how you do to do lists, skills you may need to learn, the list goes on. These are things that ADHD coaches are trained on and things that therapists likely won't support with. Also, coaching is about accountability so things like check-ins throughout the week and nudge/reminders are a key part of ADHD coaching but not therapy. Also many of our clients have done (or are currently doing) therapy and come to Shimmer because their therapist suggested it. And on your point of medication, many people do not want to take medication (cultural or other reasons), or cannot take medication (e.g. side effects or can't mix with their other meds).
givinguflac 2y ago
I totally agree with you, and find the price a big turn off. I pay $30 a month for my meds, this I’m sure would help but no way could I justify the expense.
magnetowasright 2y ago
I agree with you. I want to note that ADHD 'coaches' are not trained or licensed or regulated (they're not healthcare professionals at all) so they aren't at all appropriate to be practicing anything 'therapy-based' like you describe it. I'm medicated and I still need therapy and support from disability support workers. Therapy should just be practiced by people qualified, trained, registered, and regulated. Support workers are such a better value prop than these ADHD 'coaching' scams. It's also amazing how high efficacy ADHD meds have. There's loads of reasons why they don't work for people but they're so effective! Every time I see that stupid 'prescription' video game I get frustrated that it exists and it marketed particularly towards kids who I assume aren't getting the most effective medical care (meds and therapy) because people are still fearmongering over meds (and therapy lol). Also the whole war on drugs thing. Inhumane and not necessary. Just let people who want to be be medicated! Still need therapy tho. The meds don't suddenly cure everything

by devmor 2y ago

throwway120385 2y ago

Medication has side effects, and it can be really difficult to access unless you can find a psychiatrist who is accepting of the idea that an adult has ADD/ADHD. I knew someone who tried to get it as an adult and she spent 3 years going between therapists and psychiatrists to build up enough history to be prescribed medication.

kstrauser 2y ago
I am eternally grateful that a friend turned me on to a local doctor who does video calls[0]. I'd struggled with getting in to see someone willing to take my complaints seriously[1], but a week after signing up for an online visit I had a prescription for something that's been life-changing. For me, personally, the whole effect of the meds are that I'm slightly more awake, as though I drank a cup of stout coffee, and I can more easily decide what to work on and then work on it. I'm fortunate to have had zero adverse reactions. [0]And then, knowing their clientele, texts and emails the heck out of me to remind me about upcoming appointments, which isn't strictly necessary but is understandable and appreciated. [1]One doc told me I had trouble focusing because of anxiety. "Do you know what you might be anxious about?" "Yeah, not being able to focus." That wasn't a productive visit.
christalwang 2y ago
Yeah, so many people have horror stories with medication, especially with the shortage going on right now and need immediate support. I've personally been impacted by the medication shortage, and many of our members.
- mrandish 2y ago
  My N=1 experience has been remarkable success with medication. Of course, it does require some work and time to find the right med(s) and dosing. Also, the shortage was previously a problem in my very large HMO but early this year it started getting better and by about 5-6 months ago supply has returned to normal.

bbor 2y ago

I don't think medication "treats" ADHD in the sense of solving it completely. For one thing, we're living through an Adderal shortage, for another it doesn't last all day, and, most importantly, it isn't a cure-all, especially at the low dosages required for responsible long term use. As another commenter rightfully said, the downsides are also significant, especially in terms of exhaustion -- headaches are also a commonly reported one for methamphetamine. It's a lifesaver, but it's kinda like Ozempic: it enables you to follow through on your self-improvement goals, it doesn't do them for you. Also, some people don't have health insurance. We do exist, sadly -- 25 million of us, as of 2023: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240618.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/... Typically, a diagnosis/new psych appointment costs $250-350 OOP, and the monthly checkups cost anywhere from $100-200 (unless you can find someone willing to break the rules for you and prescribe without 30d checkins). The baffling coupon system does mean that the refills themselves are cheap, somehow, but I've paid $60 before just because the coupon wasn't working and I couldn't be bothered to go home and figure it out and go without meds for X days. Of course that all becomes easier if you're willing to stick with non-controlled substances, but still

deleted 2y ago
[deleted]
Dilettante_ 2y ago
>non-controlled substances Could you elaborate? The ones I know of are St. John's Wort(though that's more for depressive symptoms) and Phenylpiracetam.
- hypatiadotca 2y ago
  Guanfacine and clonidine are two non-controlled meds approved for ADHD. They are second line treatments; all the first line treatments are stimulants, because they have the best evidence behind them.
  - astrange 2y ago
    The stimulants also have fewer and simpler side effects. But they don't work 24/7, At least not if you want to sleep.

aidenn0 2y ago

I'm not a Shimmer user, but a few things: 1. Insurance doesn't always cover ADHD medication, and when it does it can be a pain; every time my employer switched insurers I had to change my medication because the new insurer wouldn't cover the same thing the previous insurer covered. I've never had insurance cover my psychiatrist either, which amortizes out to about $100/mo. 2. Stimulant medication improves symptoms for over 80% of people with ADHD but "normalizes" about 1/3. So If you are in the 2/3 people that still have some ADHD symptoms on medication, then you're still going to have to cultivate healthy coping mechanisms. 3. Sometimes you go on a trip and forget to bring your medication, or you forget to bring the monthly prescription into the pharmacy on time (no refills on Schedule II substances), or your pharm is out of your meds. Now you are temporarily unmedicated and still need to function.

kstrauser 2y ago
Regarding #1: my insurance pays for 100% of my meds. It seems like the extended release versions are the hardest to get covered, but people who can get by with the plain old all-at-one formulations may have a much easier time with that. Also, insurance doesn't pay for my doctor directly, but their website has a place for me to submit out of network claims. I do that with my doctor's receipts and insurance cuts me a reimbursement check for a large portion of the bill. It's a pain in the neck in the sense that getting all the insurance stuff straight is extra hard when you're in need of being treated for ADHD in the first place. It does give me something to hyperfocus on every couple of months.
- aidenn0 2y ago
  Extended release was hard with some, but I had one insurer that would only pay for 1 pill per day, so I had to use ER with them.
  - kstrauser 2y ago
    I have heard ahem that you could get 30 pills that were each an entire day's dose, cut them in half, and take them as 60 separate doses. For example, you and the doc think you should take 10mg in the morning and 10mg at lunch, so get a prescription for 30 20mg pills and buy a pill chopper. Purely rumor, I'm sure.

n8cpdx 2y ago

I’m skeptical of the pricing, but I could see it having value for working professionals or students who are at risk of failing out and don’t have good support on campus. I personally have ADHD, and I’m medicated. The medication makes it possible to focus on tasks, not guaranteed. I still have to engage cognitive skills and essentially implement a system similar to this, just without a coach. Specifically: break down tasks, use a Pomodoro timer, walk and make tea between focus sessions, put the phone away, use environmental cues like specific work music, etc. Sleep and exercise are also incredibly important for success with ADHD, and the stimulant medications can interfere with both, so I could see coaching being useful there as well, not sure if the service offers help there.

christalwang 2y ago
Love what you said about sleep and exercise. In the Shimmer app, we call this "Lifestyle Medicine" but it's basically the foundational pieces of your life that keeps your body running as it should. And this should 100% be considered before more complex treatments. For us we include sleep, exercise, and food/nutrition. That's awesome that you have a whole bunch of skills that you've found that works for you! For some people, this takes months to figure out the right mix since what works for someone may not work for others. And also, HOW you do something is almost more important than WHAT skill you're using. I would also add that in coaching, in addition to skills, the coach is supporting in long-term thinking, goal setting, so that there's a direction forward as well, which is really important. I like the quote "medication is like glasses, it helps you see more clearer but it doesn't teach you how to read". I think about this quote a lot because for me, the value of coaching has been to help me set a new direction in life, be reflective in what I want, then work to build an ADHD-friendly life around me that helps me go in that direction. Totally hear you on pricing. We're working on a few routes around reimbursement, partnerships with schools/workplaces, etc. Right now we are HSA/FSA eligible and also many of our members get it paid for through their work's L&D budget or disability/DEI budgets. Of course, that's a bit harder because it requires them to disclose. We also do a whole ton of scholarships for anyone with a financial need!
NegativeK 2y ago
I don't want to respond to the top comment so it doesn't look attackish, but expecting the medication to completely cure the symptoms for everyone is laughably wrong. I've got decades of learned behaviors to deal with. And while my doctor was correct in that a medication that works will be like night and day (I'd rephrase it as life changing), I still struggle more than I like.

deleted 2y ago

[deleted]

christalwang 2y ago

Coaching is different from talk therapy in that it's focused on more action-oriented, future-oriented concerns. For example, in therapy, you'll talk about WHY / WHERE a specific thought process came from, vs. in therapy you'll talk about how you can design your life in a way that minimizes impact of this thought process. Things like calendar design, routine design, how you do to do lists, skills you may need to learn, the list goes on. These are things that ADHD coaches are trained on and things that therapists likely won't support with. Also, coaching is about accountability so things like check-ins throughout the week and nudge/reminders are a key part of ADHD coaching but not therapy. Also many of our clients have done (or are currently doing) therapy and come to Shimmer because their therapist suggested it. And on your point of medication, many people do not want to take medication (cultural or other reasons), or cannot take medication (e.g. side effects or can't mix with their other meds).

givinguflac 2y ago

I totally agree with you, and find the price a big turn off. I pay $30 a month for my meds, this I’m sure would help but no way could I justify the expense.

magnetowasright 2y ago

I agree with you. I want to note that ADHD 'coaches' are not trained or licensed or regulated (they're not healthcare professionals at all) so they aren't at all appropriate to be practicing anything 'therapy-based' like you describe it. I'm medicated and I still need therapy and support from disability support workers. Therapy should just be practiced by people qualified, trained, registered, and regulated. Support workers are such a better value prop than these ADHD 'coaching' scams. It's also amazing how high efficacy ADHD meds have. There's loads of reasons why they don't work for people but they're so effective! Every time I see that stupid 'prescription' video game I get frustrated that it exists and it marketed particularly towards kids who I assume aren't getting the most effective medical care (meds and therapy) because people are still fearmongering over meds (and therapy lol). Also the whole war on drugs thing. Inhumane and not necessary. Just let people who want to be be medicated! Still need therapy tho. The meds don't suddenly cure everything