quixotic120

@quixotic120@lemmy.world

• ⁨Comment⁩ on ⁨Frostpunk creators cancel "Project 8" and lay off staff amid concerns that "narrative-driven, story-rich games" don't sell⁩ ⁨⁨11⁩ ⁨hours⁩ ago⁩:

  You are the stupidest moron I’ve ever encountered on the internet

• ⁨Comment⁩ on ⁨Four pianos. Four.⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  Unless you’re going to refurbish them solely to use as decorative pieces those pianos are guaranteed trash

• ⁨Comment⁩ on ⁨Frostpunk creators cancel "Project 8" and lay off staff amid concerns that "narrative-driven, story-rich games" don't sell⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  You keep going on about the original post. I was replying to you dude, who said everything is mobile games and live services. I never said all games are movie games? I just said you are wrong and not all games, AAA or otherwise, are mobile games and live services. And you are still wrong, and that’s still true

• ⁨Comment⁩ on ⁨Frostpunk creators cancel "Project 8" and lay off staff amid concerns that "narrative-driven, story-rich games" don't sell⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  Only some of those are movie games, sure. I was more responding to your “everything is mobile games and live services”, which is just untrue

  The only one I haven’t played yet is wukong. Also I agree the spiderman games are totally awesome. I strongly disagree about fromsoft games though, sekiro alone is amazing

• ⁨Comment⁩ on ⁨Frostpunk creators cancel "Project 8" and lay off staff amid concerns that "narrative-driven, story-rich games" don't sell⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  Every yakuza game, baldurs gate, every fromsoft game, the insomniac games like spiderman, Sony stuff in general like horizon, god of war, last of us, etc, black myth wukong, the endless remake games (some of which are very solid) like ff7, silent hill 2, persona 3 reload, etc, rockstar games even (rdr2 was 2018 and gta6 is supposed to come out this year, maybe). The sea of jrpgs like shin megami tensei v vengeance, trails through daybreak, granblue fantasy, unicorn overlord, etc. And that’s literally off the top of my head

  Mobile games and live services dominate for sure bc they shit money and are easy to develop but decent games still exist (though tbf a lot of them are starting to pull serious bullshit too. Love yakuza but sega locking new game+ behind a $15 dlc. First yakuza game I didnt do a new game+ run on and the lamest one to platinum because you don’t have to beat the hardest boss or run it on legendary)

• ⁨Comment⁩ on ⁨Well, I guess that settles it⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  I refuse to calm down and I demand help

• ⁨Comment⁩ on ⁨Well, I guess that settles it⁩ ⁨⁨1⁩ ⁨day⁩ ago⁩:

  uh, dunno if people have noticed but the Mediterranean is kind of goin through some shit right now. Also Italy has a pretty notable history of bombings and assassinations

  But also what the other person said, dude is american. I’m so sick of my family members talking like sopranos characters because our grandparents were actual Italians. Plus they 100% definitely didn’t say gabbagool and proshoot before like 2003

• ⁨Comment⁩ on ⁨Stop taking physical media fans for granted⁩ ⁨⁨1⁩ ⁨week⁩ ago⁩:

  I’m all for buying physical media as it’s the last bastion of freedom in terms of media ownership (sometimes at least, I’m pretty sure stuff like ps5 games need to contact sony servers to boot so in a decade or two they might all be worthless). I post a lot about media piracy and I do a lot of it but I buy a lot of physical media too, I have a lot of blu rays, I have like 1200 records, I have a ton of books and manga, I have a lot of games (although the aforementioned point makes this one the least likely nowadays)

  But I don’t care for special editions. Frankly I don’t care for most editions. I’ve often found that piracy can get me the superior version of the release. That’s what I will get. If it’s the physical release then I will buy it. But if the bluray is just an upscale and I can get a pirated remux that’s the raw 2k non upscaled I will go with that. If I can get a pirated version that’s the physical release remuxed with the Dolby vision/hdr10+ layer from a web release for much better image quality I will go with that because apparently they can’t be bothered to release that on physical. If I can get an anime that uses superior video from an Italian bluray release, superior audio from the Japanese bluray, and fan subs that have vastly improved sync and translation (and sometimes even animation, background signs, and the songs with karaoke styling) then I will go with that. Groups that release an oop release with better color grading because you decided your movie needed to be regraded in that weird blue and orange tone that all movies are graded in now. Etc

  When your product pales in comparison to what piracy groups provide don’t be shocked when I am not swayed by stickers and a goofy box that fucks up the aesthetic of my shelf of discs. Take pride in your work and master your film with the same quality that some group releasing for e-cred does and I’ll give you my money (assuming your movie isn’t shit and is priced reasonably, $30-60+ for a bluray is insane)

• ⁨Comment⁩ on ⁨where do you draw the line if you ponder quitting a job?⁩ ⁨⁨1⁩ ⁨week⁩ ago⁩:

  While this is absolutely true effective supervision and competent management make a world of difference with this issue.

  Lazy staff continue to exist because they are typically inadequately supervised. As a result the extent of their behavior is not clear to management. So that needs to be corrected. But if that’s corrected (it could be) management needs to respond to the problematic behavior with appropriate consequences (eg constructive feedback, warnings, corrective action, firing) to shape the behavior going forward.

  There’s a lot more to it; a huge part that is often overlooked is that management should also be providing ongoing consequences in a positive sense to entice the desired behaviors. Fear of punishment isn’t really a great consequence for operant conditioning. So we look at some other options: how do we create motivation to make people want to do their job tasks? How do we build morale? How do we build enthusiasm? This can be as simple as “if you get [x] done consistently you get [special privilege]”. Corrective and punitive action should be a last resort for when these systems are failing, even if you’re adjusting them to try and make them work

  This is a cultural problem in the us (and many other places) though. We have this view of “I gave you a job and I’m already paying you so you should be so fucking grateful to me”. We love the hierarchy model. The idea of management and ownership taking care of workers is something that’s laughable or, at best, paid a pittance (here’s a small bonus, keep working a lot). It’s only very recently that companies have started giving a shit about industrial and organizational psychology/organization behavioral management/etc and even when they do it’s usually lip service to buy street cred

  But ultimately it’s managements job to create an environment that makes employees want to work. The frustrating part though is that this isn’t really a problem to most management because the financial impacts are hard to measure. They’re definitely there and sometimes they’re more directly measurable, stuff like increased turnover as you burn through staff, but more often than not it’s stuff that’s far more subtle and difficult to measure like decreased utilization and productivity.

• ⁨Comment⁩ on ⁨Will the price of Freeze Driers go down? (USA question)⁩ ⁨⁨2⁩ ⁨weeks⁩ ago⁩:

  No. For every one freeze dryer that is sold 1000 microwaves are sold. The consumer demand simply isn’t there outside of niche communities like survivalists

• ⁨Comment⁩ on ⁨Anon shares how they survive⁩ ⁨⁨2⁩ ⁨weeks⁩ ago⁩:

  Ssdi ranges from 943 to 3627 per month depending on your work history. It’s a pension system so if you’ve paid nothing into it you get the minimum. It can also pay a bit more depending on state because some states have supplements in addition to the federal payment

  Section 8 is tough depending on where you live. Some places around here the wait list is so long that it’s literally years and as a result they won’t let new cases join until old ones are purged; which is this nightmare process where they contact you if you’re on the list and if you don’t respond you’re kicked off and then a few spots may open up and people scramble to apply for the day they’re open.

  The attitude is generally “you don’t have a job so you can spend your time managing your benefits”. For some people this isn’t wrong but for a lot of people it’s a serious issue; they’re disabled so they don’t work because they spend their time managing their healthcare, or they don’t have the capacity to manage this kind of stuff to begin with, etc. but in a lot of places there’s little sympathy for this and then your benefits are cut, the process to re-enable them can take weeks or months, and in the interim that can mean you lose housing, access to medical care, etc

• ⁨Comment⁩ on ⁨Anon has the spirit⁩ ⁨⁨2⁩ ⁨weeks⁩ ago⁩:

  older millennials can remember a pre internet time where culture was a little easier to heavily influence by record labels and shit because where else could teens go for culture? like now you have the internet and you can go on tumblr or reddit or whatever and any of the million sub communities there to develop culture. Corporate influence is still very much there of course (see the part with reddit, tumblr, and the massive advertising industry that drives it all, etc) but itll never be as concentrated as it was in 1994

  Thats probably why corporate interests are trying to ruin the internet. You know how people say the internet is only 4 websites now where people just share clips and screenshots of the 3 sites over and over? Condense it down and you get it a lot closer to that 1994 effect. You lose the charm of having a bunch of geocities pages about putting cats in jars and peoples weird looney tunes fetishes and shit but then you have a sanitized advertiser friendly internet thats easy to browse and much more contained

• ⁨Comment⁩ on ⁨This world is cruel…⁩ ⁨⁨4⁩ ⁨weeks⁩ ago⁩:

  what if I read a ton of books every day but it’s all manga and light novels. trashy ones

• ⁨Comment⁩ on ⁨This world is cruel…⁩ ⁨⁨4⁩ ⁨weeks⁩ ago⁩:

  when you worry about “plating”

• ⁨Comment⁩ on ⁨Frog's Gift⁩ ⁨⁨4⁩ ⁨weeks⁩ ago⁩:

  This is a regularly done conservative tactic. Attack research because it’s frequently stupid sounding. But sometimes stupid sounding research leads to incredible things.

  Sometimes you research the mating habits of red eyed tree frogs and you learn a lot for conservation efforts and stuff about the species. Conservatives love this because they can hand wave and go “who cares about this thing I personally don’t care about”

  But those science nerds sometimes do stuff like researching gila venom in the 70s which eventually led to ozempic now, one of the potential major treatments for t2 diabetes, a scourge of our morbidly obese modern society. This has gigantic positive implications for public health and financial benefits

• ⁨Comment⁩ on ⁨This means I close the tab, regardless of what is on the site.⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  I don’t even need to worry about the tracking at fandom because they do that stupid “auto play an unrelated video at the top of the screen and once you scroll past it it moves down and perpetually stays on the screen, taking up 30-50% of your mobile screen” so I will always immediately close the page once I see that fucking bullshit

  Truly hostile ui design. Just open disdain for their users. At least it’s muted by default

• ⁨Comment⁩ on ⁨Anon recommends a cast iron pan⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  The best pan is the $20 no name stainless steel pan from a restaurant supply store. Cast iron is for Dutch ovens that need to retain heat for stews and curries and shit. Anyone that genuinely prefers cast iron over stainless just doesn’t know how to preheat a pan and use cold oil. “Oh I want a pan that requires ongoing maintenance, can never be properly cleaned, isn’t actually non stick at all, and weighs 900 pounds so doing any kind of toss is a total pain in the ass”

• ⁨Comment⁩ on ⁨Anon enjoys life⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  I bet the replies to this were all from kind well adjusted people wishing anon well

• ⁨Comment⁩ on ⁨Anon wants to stop the mad painter⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  nothing like playing leisure suit Larry 2 and finding out you have to replay the last 4 hours even though you saved because you didn’t type look in trash can while standing next to the trash can on the first screen of the game

• ⁨Comment⁩ on ⁨How come LED Light Bulbs only last for about 2-3 Years?⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  That’s good to hear. I have a zigbee stick but haven’t found the time to repair them that way yet. I definitely agree they’re good products, it just left a real bad taste in my mouth when after years of using them I got a notification in the app that soon I’ll be required to put them online, which is nonsense

• ⁨Comment⁩ on ⁨How come LED Light Bulbs only last for about 2-3 Years?⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  Just fyi for anyone who would care about this: while hue bulbs are built well they are moving towards a model that requires you to put them on “the cloud”, even though they were sold for years and years without that requirement. The update will be mandatory whether you want it or not as part of Philips security being integrated into the app. It’s unclear what will happen if you don’t create an account and sign in at that point

  So if you’re like me and put all your iot shit on an isolated vlan without internet access they may not be the best option for you. Or if you just don’t want to support a company that wildly changes the tos years after purchasing their (expensive) product. I don’t want my home shit on the internet, I don’t trust Philips to put enough cash or effort into securing their servers, etc.

  The bulbs do work with zigbee though and that seems to be a viable alternative to using their hub/app although I haven’t tested it fully. This also means if you’re using them via HomeKit you’ll need some kind of bridge like home assistant

• ⁨Comment⁩ on ⁨Youtube's War on Adblock Got Worse⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  my tv, laptop, and phone continue to play ad free. good thing googles fighting this war on what’s probably under 10% of their user base though

• ⁨Comment⁩ on ⁨Mental hell⁩ ⁨⁨2⁩ ⁨months⁩ ago⁩:

  Depends on the program. Diploma mills for graduate degrees absolutely exist but many are extremely competitive.

• ⁨Comment⁩ on ⁨Every show with a suicide now has a disclaimer with a suicide hotline at the beginning. Is there any evidence that these warnings make a positive difference?⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  journals.sagepub.com/doi/…/2167702620921341 - the bigger takeaway from this one is that trigger warnings reinforce trauma as a central part of the traumatized individuals identity but they did find some incidence of drawback/harm

  journals.sagepub.com/doi/…/21677026231186625 meta finding no benefit and actually can cause an anticipatory reaction making the person more engaged with the material

  There are others, this is just what grabbed from 30 seconds on google scholar. Its been a bit since I’ve done more serious lit review and it’s not like I keep a directory of papers I’ve read

  The issue is the culture surrounding trigger warnings. Let’s be real here, people looking for trigger warnings are generally (perhaps overwhelmingly) not looking for material to help with their exposure therapy. They are looking for a “warning” to help them screen material to avoid. The issue is that this creates an unrealistic expectation that is incompatible with the real world. You can avoid suicide, sexual assault, eating disorders, or whatever in your media (maybe) but real life won’t sanitize itself or warn you. You will encounter these topics, whether through the news, careless speech from friends, or even intrusive thoughts of your own. Research continues to show that avoidance of upsetting topics can worsen anxiety and ptsd symptoms

  To your final point the idea of it helping to create a choice isn’t even as clear cut as you describe

  journals.sagepub.com/doi/…/21677026221097618 content warnings actually increase the likelihood someone will view problematic content. This point is further reinforced by similar findings in the meta linked above

  So you have a system that ultimately makes creators feel like they’re doing something noble, that is likely at best useless and potentially harmful. Said system increases the likelihood that a person will view the problematic content but also enables the reality that a person will simply avoid the things that provoke their anxiety which again is more strongly established as harmful

  www.sciencedirect.com/…/S0005796712001064 - ptsd worsens with avoidance

  www.sciencedirect.com/…/S0962184904000290 - anxiety disorders do the same

• ⁨Comment⁩ on ⁨Every show with a suicide now has a disclaimer with a suicide hotline at the beginning. Is there any evidence that these warnings make a positive difference?⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  There’s evidence that trigger warnings actually worsen anxiety and are counterproductive

  The way to treat anxiety is to face the source of anxiety to try and change your relationship and reaction. The best way to do this is via controlled access that exposes one to the trigger gradually in a context that has no risk of harm (eg a media depiction, discussing the concept, building up to discussing the source of trauma that led to the phobic response if applicable)

  Trigger warnings enable active avoidance. This sensitizes one to the aversive stimuli and makes the phobic response stronger. As a result when one encounters the stimulus (eg a friend, family, celebrity etc commits suicide, suffers an eating disorder, etc) your resilience to the trigger is now even lower and the response is more likely to be more significant than it was before.

  That said education on access to resources like 988 or other warm lines can lower suicide rates, maybe. Research is more mixed here because it’s difficult to prove causation

• ⁨Comment⁩ on ⁨People on Tik Tok peddling these scams⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  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

• ⁨Comment⁩ on ⁨Regain Control in my ass⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  Bleed in my ass

  those bass drum hertas tho

• ⁨Comment⁩ on ⁨How exactly do insurance deductibles work?⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  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.

• ⁨Comment⁩ on ⁨How exactly do insurance deductibles work?⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  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

• ⁨Comment⁩ on ⁨How exactly do insurance deductibles work?⁩ ⁨⁨3⁩ ⁨months⁩ ago⁩:

  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.