ragebutt
@ragebutt@lemmy.dbzer0.com
- Comment on Anon considers LASIK 1 day ago:
Warby Parker, Zenni optical, eyebuydirect, etc are finally breaking the luxottica monopoly. 5-6 years ago my glasses were easily 2-3x that
Very jealous of the ICLs. I need the toric kind (or to also get lasik or also continue wearing glasses/contacts) and the last quote I got was 5-7k per eye. It should be covered by insurance, ridiculous
- Comment on Anon considers LASIK 1 day ago:
Does Europe have options that break the luxottica stranglehold?
I have some major qualms with zenni optical, warby Parker, etc but the fact of the matter is that luxottica/essilor had a stranglehold on many independent opticians, places like Walmart and target, chain stores like LensCrafters, etc and drove prices up substantially. Those other places have issues but they bring costs down substantially
My newest glasses I got last week. -15, -15.25, astigmatism both eyes, prism. Warby Parker frames were $99 and 1.74 index lenses brought to 230, with insurance it was $130 because they pay for frames. Zenni would’ve been even cheaper because they have frames super cheap and the 1.74 index for like $75 but warby Parker has actual stores near me where I can get an exam and also get the glasses adjusted if necessary.
Whereas a few years ago I was in the same boat as you. My script was closer to -13.75 then but the local optician only had luxottica brands: Gucci, Ray ban, etc. a few no name ones that still cost like $150 instead of $250-300. High index lenses were like $3-400. Insurance would bring the $6-800 glasses down to 4-600
Someday I’ll get implantable contact lenses. They recently approved the ones that correct astigmatism in the USA and can correct up to -20. No insurance coverage though. “Cosmetic”. $5-7000 per eye. Sigh
- Comment on Anon considers LASIK 1 day ago:
Thank you for making me feel more confident
- Comment on Anon considers LASIK 1 day ago:
Spoken like someone who has normie glasses
Talk to me when your prescription is -13 or worse, your glasses always have to be special ordered with the most expensive high index lenses, your glasses are physically heavy, and they distort your face so the area around your eyes looks far away.
You go to warby Parker and get the $99 frames but it’s still somehow $230. Even a place like Zenni is $75 for 1.74 lenses (not including frames).
Also you have to be cautious about what frames you pick because the larger your lenses are the thicker they’ll be. You one of those zoomers that wants cute big grandma glasses? Bad plan
- Comment on Would Trump/MAGA recognize my relationship as opposite-sex or think same-sex ? 1 day ago:
Well they’re not good, they’re still enabling the government to remove your rights and the rights of others plus they tend to have a lot of other hot takes and behavior that are objectively shitty.
Speaking broadly they seem to be people that are bigoted and reassess their bigotry when it becomes humanized. They only changed this opinion because it impacts someone they care about directly, basically. In some cases they still hold the shitty opinion and view their loved one as the exception (the “real trans” vs “fake trans” thing)
The other piece that can be a real mindfuck is that they can often go to a “we just don’t talk about it” thing, where they do silently think the absolute worst of you but at least aren’t assholes about it. This is at least not detrimental to you directly but can lead to ugly behavior and systemic oppression
Approach with caution, basically, and don’t be shocked if someone who initially seems very sweet and courteous says some utterly disgusting shit if the conversation turns ugly if you bring up “sensitive topics”
- Comment on Would Trump/MAGA recognize my relationship as opposite-sex or think same-sex ? 1 day ago:
Everyone is going on about how maga is inherently anti trans but the situation is more nuanced
If you’re terminally online then yes, maga is 100% anti trans all the time but irl that is not always the case
I provide gender affirming care and work with families where someone is trans and their families are MAGA people, respect pronouns and names, give rides home from surgery, call partners boyfriend/girlfriend as appropriate, and will even at times get mad at others for not respecting their child’s identity
This is not a super common thing, to be clear, but it’s also not shockingly rare. Maybe 20-25% of my clients? It also gets into the whole “humanizing” factor. These people are so insulated from minority groups thanks to continued segregation that they can easily demonize them but lgbt minorities can pop up in their families much easier. That’s why they fucking hate acceptance movements; you can’t white flight from your queer kid but you can bully them into a loveless marriage that ends in divorce or suicide. But when they finally do integrate they generally recognize that while there are aspects of a culture they still despise the people within it are still just people, especially if those people are the people they’ve known and loved their whole life
It’s cognitive dissonance at its finest though and creates tons of friction. Client is obviously very upset that family is voting to end their rights and family usually does mental gymnastics to not see it that way. Also majority of instances, overwhelmingly so, are trans men. This is all based on my anecdote so take it with a grain of salt but imo trans women are most often used for propaganda and portrayed as monsters so trans men sometimes fly under the radar via erasure. though to be absolutely clear key word is sometimes, trans men absolutely get a ton of shit flung at them too. This probably plays into the fact that trans women outnumber trans men by a significant margin and more importantly/likely systems of misogyny, people hate women.
That said I would generally assume the worst, especially if you encounter a group of Trump people, or if you are in a place where you are doing discourse online
- Comment on glupi jebeni bot 1 week ago:
“Optimizing for things people love” aka talking to you like an hr team building seminar
It’s frustrating, or maybe it’s a good thing given the tendency for some people to form weird pseudo social relationships with LLMs, to see the evolution of chatgpts language processing
Public chatgpt only had the 3.5, 4, and 4o model but you can play with earlier models like 2 and 3 on huggingface. These were far weirder, often robotic and stilted but sometimes mirroring more natural colloquial English more based on the input
Rather than make something that is authentic and more natural to interact with they instead go for the ultra sanitized HR corporate speak bullshit. Completely bland and inoffensive with constant encouragement and reinforcement to drive engagement that feels so inauthentic (unless you are desperate for connection with anything, I guess). It’s mirrored in other models to some degree, deepseek, llama, etc (I don’t know about grok, fuck going on twitter).
3-5 years until it’s ruined by advertising, tops. If that
- Comment on grandma's house recently got a roomba 1 week ago:
Except grandpas house and no young master to serve, only angry grandpa who doesn’t want her
- Comment on Yes 1 week ago:
I remember reading a conspiracy theory that this key was purposely put in by a liberal employee who believed everything should be free and that’s why the first 5 digits are FCKGW - fuck George w - and that it was the volume license for Lockheed Martin or something
It’s not true but interestingly this key was leaked before windows xp even came out, like a month before, and it’s suspected to be a VLK from dell
Nowadays they’d probably say leftist
- Comment on This section of Jim Carrey's Wikipedia Article 1 week ago:
I misread the headline as “this section of jimmy carters Wikipedia article” and was so confused
- Comment on [deleted] 2 weeks ago:
Depends on the person, resilience factors, support, access, what the addiction is, etc
- Comment on [deleted] 3 weeks ago:
A sleep test if you have the resources (health insurance and such). Most common cause for apnea is obesity but there are other potential factors like issues with tonsils, sinuses, septum, turbinates, and/or adenoids that wouldn’t require a cpap but other things like surgical correction
Additionally lifestyle changes can make a huge impact especially if it is related to obesity
Nowadays you often can do sleep tests for things like apneas at home, you usually dont have to go to sleep centers. It can be worth it to make your dad aware of this. Ive had older clients who were very avoidant of sleep studies before they found this out because before a few years ago it was far more common that sleep studies were a much bigger pain in the ass. Youd have to go to the sleep center and sleep there, hooked up to a bunch of machines, uncomfortable bed, not necessarily on your sleep schedule. Now thats really just reserved for certain sleep issues like narcolepsy and severe insomnia
if you can’t get a sleep test and cpap the old school way to manage apneas was to sew a pocket to the back of a tshirt that held a tennis ball, which would force you to sleep on your side. Not ideal but better than dealing with the health impact of an apnea. Not to inspire fear but apneas are terrible for your health. They cause you to wake up briefly and return to sleep.
This happens fast enough for you to not remember and as a result the “cycle” of sleep is interrupted. If the apnea is severe this can happen many times per hour or even per minute, causing you to never get restorative sleep. You “sleep” all night but feel exhausted all the time because you never enter the deeper cycles. Luckily it’s not an immediate danger at all but after years or decades the effects compound just like having a consistent extreme lack of sleep would
- Comment on Life is Strange road-trip 3 weeks ago:
Cooool
I recently played through 2 and true colors. I have the lost records game too. I haven’t gotten dual exposure yet because I know if I’m patient enough it will be free
- Comment on Nintendo reserves the right to brick your console following "unauthorised use", in bid to prevent piracy 3 weeks ago:
Hard to say. Consoles have certainly gotten more sercure and people finding vulnerabilities are far less likely to just give them out for free these days
But there is incentive to hack any console and nintendo has historically attracted the biggest dorks. Additionally they also seem to historically make pretty huge blunders, though the switch exploit was nvidias fault tbf
- Comment on Google shares slump as Apple exec calls AI the new search 4 weeks ago:
AI absolutely is the new search but only because the major search engines normal people use have completely destroyed their core products functionality for advertising revenue
AI will likely follow suit. In 5-10 years chatgpt or bard or whatever will give you a completely and obviously biased response promoting a product or service with a sponsored interstitial that is labeled as sponsored before you get the answer to make it seem like the obviously biased answer isn’t a gamed response
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 4 weeks ago:
Hint books were an experience back then. I remember the hint book for myst had this whole narrative about some other person who got trapped in the book, which was supposed to be like the player. It was this whole story of how they solved all the various puzzles. I remember it being quite long but I was also like 9 so maybe it was just like 10 pages
- Comment on If it's good enough to keep your house warm, it's good enough to keep your insides warm 4 weeks ago:
More like the focus group thought the masks were “super gay fauci shit” so home depot went with “guy wearing $2 safety glasses that don’t even have a dust seal”
- Comment on Someone give me money so I can find out 4 weeks ago:
I’ve never had a gold leaf thing, aside from a shot of goldschlager, but I have wondered this
Maybe the next time I make a dessert I’ll pick up some flavorless, odorless gold to really take my treat to the next level. What a stupid trend
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 4 weeks ago:
All those old games were so punishingly hard
You’d play leisure suit Larry or whatever and get 3/4 of the way through and get stuck. Then you’d check a walkthrough and realize you didn’t check the trash can on the first screen of the game for a key item and now you’re fucked and literally have to start over from the beginning
Or you’d get to a death condition and get a screen that just mocks you: remember to save early and save often!
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 4 weeks ago:
Yeah, basically every game that runs on scummvm is a good candidate here: leisure suit Larry, kings quest, police quest, the dig, sam and max, Indiana jones and the fate of Atlantis, all the sierra and lucasarts ones
Myst series is another good one. Journeyman project trilogy. These all ruled when I was like 12 years old
I miss when games were confusing and aimless by default. I know there are still games like this but I feel like the default now is a game that’s like “oh hey, go down this hallway full of locked doors! Except one door is unlocked, that’s a secret area, good for you! But otherwise go down the hallway to the next hallway!”
- Comment on Peepee poopoo 4 weeks ago:
I used to send out my reminders by hand and made it very clear, pretty much what you wrote
I don’t know why you would emulate a script
- Comment on [deleted] 4 weeks ago:
Do you mean for their medical records? Like I would write their medical records into an encrypted file that they hold the key for?
This is an interesting idea but it would be reliant on the client self funding services. I also don’t know if it would be legal because I am not a lawyer and generally the government wants access to your data
The other aspect that I absolutely glossed over here which was probably a bad idea is that payers retain the right to your records for auditing purposes to ensure their funds are not being wasted (which is a whole textbook of issues).
The vast majority of time this transmits data that is typical for medical services and is somewhat minimal - time and date of service, CPT code(s) (aka what kind of service was rendered, diagnosis code(s) relevant to service, who the service was for, charge rate for the service (how much money I bill). The stuff you see on an explanation of benefits. Insurers don’t typically see actual progress notes.
However, they reserve the right to do so in a few instances: if you file a grievance against the clinician, if they feel the clinician is doing something wrong, or if they simply decide to do a random audit (this is astoundingly rare with commercial insurers but happens much more routinely with government funded plans like Medicare and Medicaid).
In the first instance it’s generally a good thing; the insurer is acting as an advocate for you because the clinician did you harm in some way. In this instance the insurer is actually one of the best people you can have on your team. They don’t actually care about you but they are aligned with your mission; if they can prove clinician malfeasance they can usually recoup tens of thousands of dollars of insurance payments going back years.
The second two are where things are muddier. When that insurance ceo got got a light was shone upon the ugliness of these systems for a brief moment but now no one cares again. Audits are increasingly being triggered by automation: if you are an outlier in terms of utilization then you run the risk of getting your therapist’s practice raided by Optum. Insurance regulations are contractual, not legal, and are often conflicting and obscenely complex. They are written in such a way that it is essentially guaranteed that if complex cases are audited they will find issue with dozens of notes. And the law is on the side of the insurance: they can go back years and rescind payments
So what can end up happening is that you come to therapy from a hospitalization. You aren’t doing well. You see me twice a week because of this for 4 months. You do better. We see each other for another 6 months weekly. You regress, and we go back to twice weekly for 4.5 months. You have optum insurance (a subsidiary of United, but they aren’t the only ones who do this), and their internal systems flag you for high utilization of services
They contact me and tell me that is anomalous and as a result they will be doing an audit of records. They don’t just audit you though, they audit anyone I work with who has optum for the last 3 years. Any note that has even a minor issue: did I not make use of an intervention clear enough? Did I forget to change the session times to actual times from the default 5-6pm? Did we have a session where you were doing poorly and it was more just me listening to you vent and process? All those are retroactively rejected. Now my practice suddenly owes optum thousands of dollars, sometimes tens of thousands. I’ve had colleagues with group practices where this ends up being a 20-30k bill due in 15 days or their contract is voided and all their optum clients are fucked.
The problem is self funding services is a mixed bag. With overheads even as a telehealth only practice the minimum I can charge for a livable wage of about 50-60k a year is a sliding scale of $45-60 and frankly that only works because I have about 50% of a caseload that’s commercial insurance clients that pay double that. Even with that 45-60 is a huge ask for a weekly or biweekly service, 90-240 a month is a tremendous expense for most people. Therapy should cost nothing, or maybe like $10 a session at most, but if I charge that I will starve. I don’t know a resolution here.
- Comment on [deleted] 4 weeks ago:
This is funny but in serious mode many of my clients have pretty bad religious trauma and the protections for lawyers and priests and stuff fall apart if they were used fraudulently so even if I just got it and never said anything to my clients it probably wouldnt actually work
This is a bullshit law. You should be able to speak to therapists and medical staff freely
- Comment on [deleted] 4 weeks ago:
I’m sorry, but I don’t think the answer is to be dishonest to you about the reality of the situation
I do believe our government has failed us here and that therapy should be protected communication the same as speaking to a lawyer, for what it’s worth
- Comment on [deleted] 5 weeks ago:
It is legally impossible to have a truly private conversation with a therapist, any therapist should explain this to you. The only relationships where records cannot be subpoenaed are conversations with a lawyer and confessionals with clergy. This is bullshit but it is where the law stands
Any therapist who practices ethically should make this very clear to you prior to engaging in treatment
Any therapist who has their records subpoenaed should question the subpoena and only release records if absolutely and truly necessary.
We have not really had situations where a therapists records are being subpoenaed to justify disappearing an individual and the therapist simply acquiesces in the modern context. If so, I’d love for you to point me to a case where such a thing happens. 95% of subpoenas for therapist records are for custody battles, divorce proceedings, and disability claims. The remainder (which is probably a smaller number) is generally related to criminal cases where a defendants competence is trying to be determined. In these cases the records are often being subpoenaed by the defense to establish a lack of competency.
I will openly concede we appear to be heading towards times that may very well test the moral code of the therapist community in regards to this issue. To further complicate things unlike during WW2 there are now many paths to circumvent a clinicians resistance. If I for example flat out refuse to release a transgender clients records, or alter them, the government will likely go after the vendor of the software I have used to store my records for the past 6 years. I am all but sure they will acquiesce. The overwhelming majority of clinicians are in the same position as me. Many are not independent and don’t even have autonomy over their records; a subpoena may come and they never see it. The agency simply releases them because it is run by executives that do not want to interrupt revenues. It is a scary time
- Comment on [deleted] 5 weeks ago:
I am a therapist, at least in America you should know that your therapy records are not fully confidential and are subject to subpoena. They are confidential in the way that if a cop asks for them I will tell them to fuck off, or if a random person does the same thing applies.
But you should be fully aware that psychiatric and medical records do not have the same rights that you would have with a lawyer or a clergy member during confessional. If I see you, my records are eventually subpoenaed, and I refuse to release them I can be held in contempt and potentially jailed. I can also be compelled to testify but this is extremely uncommon, basically unheard of.
This is absolute bullshit and a good therapist should do two things: they should make this clear to you and they should document in a way that skirts the line between “enough to pass an insurance audit” and “as vague as humanly possible”. There are many ways to go about this.
Additionally if records are subpoenaed I can push back against the subpoena. However, this can be difficult and very expensive. In my experience subpoenas will essentially request everything. “Records including patient notes, assessments, treatment plans, billing information, medical imaging, etc etc etc for the entire duration of treatment”. Stuff that doesn’t even make sense for my scope of practice. This makes sense for them; might as well grab everything you can and avoid potentially missing some juicy detail.
Pushing back is tough though. In some instances I don’t have to; the client is aware of the subpoena and is fine with me releasing records. In instances where I can’t I need to retain counsel. My malpractice insurance provides counsel for this but they tend to provide super cheap lawyers from lawyer mills who are just making sure I’m not fucking up anything that would get myself sued. If I tell them I want to push back and avoid releasing they generally heavily discourage this and if really pressed will flat out refuse.
My only option at this point is to fire them and retain counsel at my own expense. Lawyers are goddamn thieves so this can easily cost 2-5,000 assuming it doesn’t end up in some huge battle where I need to retain counsel for weeks. Like many outpatient therapists I’m self employed so I have to just eat that cost (I think technically I can bill the client for it but that’s kind of fucked up so I’ve never looked into it). If they’re not independent like me and work for a larger agency they don’t have to eat the cost but they also usually don’t have the option to do this; most agencies are run by capitalistic cowards who will bend at the knee to avoid conflict and do not have any interest in principles or ethics
On the electronic medical record(EMR) front documentation management systems are fairly secure, or at least as secure as healthcare management systems can be. Psychiatric management systems are a double edged sword; we tend to have smaller boutique solutions tailored to meet our needs. Hospital networks and large medical agencies will generally have something by Epic or Oracle health.
These companies don’t bother with software packages for small practices like mine though, which make up the bulk of outpatient psychological care in America. They want the huge medical networks that will pay contracts of 150k/month. That makes them huge targets though. My software solution is niche and mostly unknown so hackers targeting it is far less likely. On the other hand the resources involved in securing it are far less.
A growing concern with all software solutions is integration of LLM nonsense to streamline writing progress notes. Generally they want us billing as much as possible so this is being pushed hard to raise utilization rates. Some software guarantees the models are sanitized and that once deployed data fed into the model isn’t used for refinement or reinforcement learning but not all guarantee this. This is concerning from a privacy standpoint. Some more intrusive versions record and process the audio of the entire session and spit out a progress note, which is real gross
As for a cellphone being present, I don’t know how to get around that. Normally I would say I don’t think there’s much risk from a cellphone simply being present in the office but I stopped bringing mine in because i noticed the voice assistant would be accidentally invoked at times. I bring it in now because I have a cellphone that no longer runs a voice assistant. This is gonna be a tall order though. Everyone in the world has a phone on them all the time and they very rarely degoogle or disable siri
I don’t tell you this to discourage you from therapy. I tell you this to encourage you to make an educated decision when you select a practitioner. If confidentiality and privacy are meaningful issues to you (and they should be) when you do your consult or first visit ask about how the therapist handles subpoenas, ask about how they handle documentation knowing subpoenas are a risk, ask if they use AI summarization tools.
- Comment on What if 5 weeks ago:
reminiscent of one of the greatest I think you should leave sketches
also garfeild
- Comment on Why does it seem like everyone is so good looking and beautiful nowadays? 5 weeks ago:
come to my house, i look like shit
- Comment on Annon has not been seen again 5 weeks ago:
- Comment on 4chan Is Dead. Its Toxic Legacy Is Everywhere 1 month ago:
There’s a supposed message from one of the admins promising it will return
If it does come back it will likely take ages given much of the 20 year old hacked together source leaked. If they simply relaunched as is it would likely go down again in minutes
