siderea: (Default)
[personal profile] siderea
I am nominally on vacation this week, in that I told all my patients that I'm taking the week off and not meeting with them. I am, nevertheless, still doing a lot of work-related things, including trying to write a Siderea Post to get out for December. We'll see how that goes. I've been struggling with exhaustion and low mood and poor concentration, which has made writing challenging. I'm definitely experiencing some burnout, in large part, I think, because I didn't take adequate time off this year. I'm going to try to do better about taking breaks in the coming year.

Also, I've had a critical weakness in my self-care game, which I am now realizing I need to get serious about. I saw a new PCP in November who quite reasonably asked me what I did for fun, and I was like, "Oh, hmmm, fun... I remember doing that..." The problem is that while I am not incapable of experiencing enjoyment, I've lost either the capacity or opportunity to enjoy most things I used to do for pleasure. Like, you know, ensemble voice and woodwind music-making and going out for fine dining and shows. Obvious stuff like that, but also unobvious stuff that is apparently an effect of being a therapist. Like I'd noticed many years ago that being a therapist really seemed to diminish my pleasure in movies and fiction; I once said in a movie review, "this is like my job, only boring". I'm not incapable of enjoying books and movies, but the odds that I will enjoy any particular one have gone way, way down, and the odds that it will bore me or stress me out have gone way, way up.

More recently, I've discovered that I am radically less able to emotionally tolerate reading non-fiction therapy-related things that discuss bad things happening to people, which, like, is all the non-fiction therapy-related things I want to read. I've got a book on my nightstand by a really interesting author about a topic I am very interested in, but it has to do with child abuse (comparatively mild child abuse even!) and I am coping with the case studies so badly – my mood has taken a nosedive after every chunk I read – that I've realized I need to at the very least not read it on vacation. So apparently I can't be doing that for fun, like I used to (don't judge) anymore either.

I came to realize more consciously that I've been in a state of not being able to do any of the things that seemed like they would be enjoyable and not able to enjoy any of the things I was able to do. Well... maybe not any.

Realizing I needed to do something to approximate recreation I pulled my harp out of the closet, and I've started practicing daily. And, yes, it is turning out that playing harp is better than not playing harp. I'm four days in, and am making an intention of doing it every day. Unfortunately, I can't do it much, because I have lost a lot of hand strength and stamina, and if I overshoot, I'll fall back into repetitive strain hell, so my practice sessions are necessarily pretty short. But the only way past that is through it, so onward.

My todo list never seems to get any shorter, for at least two really irritating reasons. First of all, every single thing on it takes longer and is more involved than even my cynical/paranoid estimates allowed for.

For instance, one of the banks where I have bank accounts was bought by another bank. They sent me a little torrent of mail about the change over, telling me to watch my mail for the new ATM card I would be receiving. Of course the ATM card never shows up so eventually I look through the mail to see what I'm supposed to do, and there's a phone number you are to call if you don't get a card; I call it, and it is a recording saying that if you didn't get a card in the mail, to present in person at a branch during normal banking hours. Swell. So I eventually managed to take some time during the business day away from my job to spend an hour in a branch to get an ATM card. As a side note, while I'm there, they of course look up to see if I were issued a card in the first place, and it turns out: nope. There is no card number to cancel because, despite the half dozen or more mailer saying I was going to be shipped one, they never issued me one. (The teller has the temerity to then say, "Well, did you even have an ATM card with the old bank?" I just took out my wallet and plucked out my old ATM card and put it on the counter.)

Everything has been like that lately.

The other thing is that the government keeps throwing rocks at my head. Some of this is federal law changes that pertain to health care practitioners – I'll tell you about the No Surprises Act in a moment – and some of it is things like the fact that yesterday, I checked my mail and discovered I have a summons to jury duty. Le sigh.

The entire profession of psychotherapy just woke up to the fact that there's something called the No Surprises Act that goes into effect Jan 1, 2022. Americans, you will be seeing a lot of press about how wonderful it is and how it will protect you, the consumer. Some of it is even true. Some of it, not so much.

The best, most charitable spin I can put on it is that it is a well-meaning law that maybe works great for medical care in hospitals, which is what everyone seems to always imagine when it comes to health care, and they just failed to think about what it would look like to apply to psychotherapy.

But I'm not feeling really charitable.

The law is supposed to prevent patients from getting stuck with large bills "by surprise", after having received medical care.

But the law only applies in the case of patients who don't use their insurance. It actually specifies that these protections are only for people who are uninsured or otherwise self-pay. If you use your insurance to pay for medical services – or try to – then these protections don't pertain to you.

Well, just one little problem with that. At least in psychotherapy. I can't say how this works in the rest of medicine, but in psychotherapy, surprise bills are basically something that only can happen to patients who use insurance.

Psychotherapy is, to my knowledge, the only branch of medicine in the US for which there is a very large self-pay market. Those of use who don't take insurance, we don't issue surprise bills. In fact, many of us don't bill at all. I, personally, have never billed a patient, at all, ever. I don't need to, because like many other psychotherapists who are strictly self-pay (also called private pay), I run my practice as pay-as-you-go. I tell my patients on intake that I do not allow patients to carry unpaid balances except by advance arrangement, entirely so that they don't abruptly get socked with a huge bill later on. And unlike in the rest of medicine, I, the actual healthcare provider herself, as is typical for private pay private practice psychotherapists, discuss my fees and the cost of receiving treatment from me directly and forthrightly with my patients. Frequently, even. I do not ever want my patient to get surprised by our financial dealings, except maybe happily, so I not only am super transparent and clear about fees and costs, I work overtime to keep the channel of communication open about money, so that if a patient has a financial problem, I know about it so I can lower my rates.

No, surprise bills in psychotherapy are almost entirely the product of a patient trying to use their insurance to pay for psychotherapy and it not working. Surprise bills come from insurance companies misleading their insureds about therapy being covered, and the insured booking appointments with a therapist under the impression the insurance is going to pay for it, only, oopsie doodle, the insurance company decides eventually that nope, they don't feel like doing that, so now you're on the hook for months of weekly therapy sessions. "Oh, did we list that therapist as being in-network for your plan on our website? Our bad! So sad. It was an honest mistake, you know how hard it is to keep track of which therapists are actually taking our insurance product. But, I'm sure you understand, we're not going to pay for all the therapy you had over the last three months while we came to this conclusion."

Hey did I ever tell you about how BCBS of MA, back when I worked for a clinic, refused to pay for the therapy of a patient of mine for months because apparently – as best our billing specialist could figure out – the patient had a first name like "Mary Ann" but somewhere in their system someone had once entered it as "Ann Mary" so even though we had all the right insurance ID numbers for that patient, and the name in our computer matched the name printed on the patient's insurance card, the insurance company kept insisting they had no idea who this patient was and clearly their medical bills were none of their problem? Yeah.

Yeah, in psychotherapy, surprise bills are a product of the insurance industry and, with the exception of the odd private pay psychotherapist who doesn't run on a pay-as-you-go model (WHY?) don't happen to self-pay patients.

So the patients who need this protection don't get it, and those of us whose patients don't need it get to do additional, Kafka-esque paperwork that doesn't even make sense in the case of psychotherapy. I get to spend my vacation making up a new form and making versions for every patient on my caseload. And my patients get more mystifying, confusing paperwork, which even if they wish to opt out of receiving, they can't.

Also, apparently there's something in there about having to have an arbitration services in case a patient objects to one of the bills I don't send them? Good times.

Meanwhile, coming soon to media near you: painting healthcare providers who complain about any of this as rascals who have been caught ripping off their patients.

So there's that.

The pandemic continues apace. I have a lot I feel I should apprise you of, but also I am so very tired of having to cover it, and would really like to share my thoughts on other things, instead. This is one of the great bummers of global catastrophes: the emergent need to focus on survival really sucks up all the oxygen in the room. Sometimes literally.

Anyhoo, I should get back to doing that. It's not like I don't have a lot to say about the pandemic.

(no subject)

Date: 2021-12-31 03:20 am (UTC)
gingicat: (Default)
From: [personal profile] gingicat
Yeah, this is why the specialist in neurodiverse couples doesn't take insurance, which is also why I max out my FSA.

(no subject)

Date: 2021-12-31 04:16 am (UTC)
dianec42: Joshua tree against a blue sky (Default)
From: [personal profile] dianec42
Ugh, that's a lot. Thanks for the precis on the No Surprises Act. Stupid healthcare-industrial complex.

(no subject)

Date: 2021-12-31 04:46 am (UTC)
cellio: (Default)
From: [personal profile] cellio

That's a lot of blah-or-worse to be dealing with. I'm sorry.

You mentioned being limited in how much harp-playing you can do for now while you rebuild strength/stamina. You also mentioned previously enjoying woodwind ensembles. Does playing woodwinds by yourself do anything for you, and does it involve different strains than the harp? Can you get more music fix after you have to stop with the harp for the day by switching to a woodwind? Or are woodwinds only interesting with others?

Wow, that No Surprises act sure sounds messed up. Insurance companies are generally the cause of surprises, and yet (a) they are never held culpable and (b) this excludes them? Um, what?

On "cause of", in addition to what you said, they sometimes deny things they really do cover per their policies, and then spend months or longer arguing about it, cynical-me says in hopes the patient will just give up. A family member received a $20,000 (!) bill for a routine colonoscopy covered as preventative care (and insisted on by the PCP; family member was averse). A friend has been arguing with his insurance company for nine months now about necessary followup care for an approved surgical procedure; I think that one's close to six figures. In both cases the insurance company is clearly wrong according to all medical professionals involved (and what the patients can discern from the written policies), and yet it's the patients, not the insurance company, who have to deal with the people who quite reasonably want to be paid by somebody. It sure looks like both patients and providers are already being messed with by insurance companies, and this law doesn't help that at all. Sigh...

(no subject)

Date: 2021-12-31 07:19 am (UTC)
alexxkay: (Default)
From: [personal profile] alexxkay
I observe that a lot of law is pretty clearly written initially by progressives, but amended (either before or after the initial passage into law) into nothingness or actual evil by others. I cite a piece of disability law I ran up against: a definition of "disabled" that was essentially "you are unable to do the work that you were trained to do -- or any other work" (emphasis added). That added phrase so completely negates the point of the earlier one that I cannot help but believe they were written by two very different people.

(no subject)

Date: 2022-01-01 05:51 am (UTC)
brainwane: My smiling face, including a small gold bindi (Default)
From: [personal profile] brainwane
Also, siderea, piggybacking on the music-related question, may we offer suggestions or recommendations for books or films that may be enjoyable - perhaps ones in which people treat each other well, or in which characters feature very lightly if at all?

book & film recs

Date: 2022-01-04 08:58 pm (UTC)
brainwane: My smiling face, including a small gold bindi (Default)
From: [personal profile] brainwane
A few books or films that might suit your current needs:

the art documentary Rivers & Tides featuring Andy Goldsworthy, which is (as I recall) slow and gentle and doesn't have many interpersonal scenes

R.K. Narayan's funny and idiosyncratic My Dateless Diary travelogue of visiting the mid-20th-century US -- he runs across a few troubled people but overall it's light

Within the optimistic scifi anthology "Consolation Songs", the stories "Storm Story" by Llinos Cathryn Thomas and "This Is New Gehesran Calling" by Rebecca Fraimow, all sweet stories about people coming together in tough circumstances

Within the anthology It Gets Even Better: Stories of Queer Possibility, the story "Sea Glass at Dawn" by Leora Spitzer, a warm and loving story of dragons helping a human figure out how to control a new talent for fire

Road Fever: A High-Speed Travelogue by Tim Cahill, a fun memoir in which the suspense is "will these two guys break the Guinness world record for driving the length of the Americas?"
Edited (weird wording) Date: 2022-01-04 09:43 pm (UTC)

(no subject)

Date: 2021-12-31 10:10 am (UTC)
From: [personal profile] ewt
That is a lot!

I am glad the harp playing is helping some so far.

(no subject)

Date: 2021-12-31 10:44 am (UTC)
From: [personal profile] ewt
Additionally:

The pandemic continues apace. I have a lot I feel I should apprise you of, but also I am so very tired of having to cover it, and would really like to share my thoughts on other things, instead.

For what it's worth I also miss your other writing.

For me right now the challenges of the pandemic are mostly around figuring out how to navigate this major change long-term, and that is only partly about the pandemic (supply chain stuff, including in utilities; climate stuff; politics... it is all intertwined). I have a privileged starting point in many ways, such that a few minor investments have made a big difference to my quality of life. My "lockdown lifestyle" was/is medium-term sustainable, to the point that our household reverts to that when risks are higher (and well before wider restrictions come in). I'm expecting further supply chain nonsense here in the coming months as import and export laws begin to be enforced differently, but I am about as well prepared for those as I can be. Longer term I will probably need to make some tradeoffs if I want to do any choral singing again, but longer term I expect bigger problems.

(no subject)

Date: 2021-12-31 12:41 pm (UTC)
cvirtue: CV in front of museum (Default)
From: [personal profile] cvirtue
I have some areas I can't read, as well, and it frustrates the hell out of me.

I'm supposed to be in control of my brain (let's all chuckle at my hopeless naivete) but can't think this one out of my head.

(no subject)

Date: 2021-12-31 05:11 pm (UTC)
elusis: (Default)
From: [personal profile] elusis
I have sources for model forms.

Also it seems to be delayed now? I don't know - I've got six tabs open to read but that's what AAMFT CAMFT and Simple Practice are saying? I think.

Vacation!

(no subject)

Date: 2022-01-01 07:08 am (UTC)
elusis: (Default)
From: [personal profile] elusis
This article suggests it: https://www.natlawreview.com/article/surprises-continue-biden-administration-delays-implementation-certain-provisions-no

"This requirement was set to take effect on January 1, 2022, but the Department noted that compliance is likely not possible by that time; therefore, the Departments intend to undertake notice and comment rulemaking in the future to implement this provision and in the meantime, will defer enforcement."

But AAMFT and CAMFT think not? They provide sample docs anyway.

https://blog.aamft.org/2021/12/no-surprises-act-new-billing-disclosures-going-into-effect-in-2022.html

https://www.camft.org/Resources/Legal-Articles/Chronological-Article-List/the-no-surprises-act-what-mfts-need-to-know

https://www.simplepractice.com/blog/no-surprises-act-good-faith-estimates/

(no subject)

Date: 2022-01-01 06:54 pm (UTC)
j_quadrifrons: Crop of a picture of Tenpou from Saiyuki Gaiden, lounging (Default)
From: [personal profile] j_quadrifrons
There are definitely several pieces of the act which aren't being enforced, but I think most of it is the price transparency stuff.

(no subject)

Date: 2022-01-01 01:53 am (UTC)
j_quadrifrons: Crop of a picture of Tenpou from Saiyuki Gaiden, lounging (Default)
From: [personal profile] j_quadrifrons
FWIW the No Surprises Act does offer one benefit to patients covered by insurance: it eliminates the "out of network anesthesiologist at an in network hospital" problem. Which is the most notorious "surprise billing" scenario but, I suspect, not the most common. (It does this at the cost of asking insurers to perform on a monthly basis calculations that will take longer than the projected life span of the universe to complete, but that's not all that outrageous for regulations honestly.)

Also, I Am Not A Lawyer and my only interaction with the regulation has been via a large insurance provider, but my understanding is that arbitration only applies to balance billing, which shouldn't be an issue if you don't take insurance?

(no subject)

Date: 2022-01-01 06:25 am (UTC)
From: [personal profile] londo
Deepest sympathies and solidarity over here re: the need to avoid RSI hell.

(no subject)

Date: 2022-01-01 05:50 pm (UTC)
From: [personal profile] to_do_list
I have a belated "squee" at the fact that you play harp (I have been curious if you do, given your avatar, ever since I discovered your writing)
and wanted to send you best wishes on finding it joyful/fun/pleasant, despite the hurdles

(no subject)

Date: 2022-01-03 06:52 pm (UTC)
matildalucet: (Default)
From: [personal profile] matildalucet
My trumpeting lip sends your harping hands love and encouragement. Some is better than none, it appears, except when it isn't. Starting again is probably better than giving up entirely, or so I tell myself when it has been a few days.

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