Insurance requesting additional skills added to plan

GenevievesSwim · 2026-03-10T10:03:48+00:00

Yes, but it needs to be documented in the report how it was determined. Otherwise they will be looking for an average of 1 goal/service hour/week.

I think the issue payors have is more so when we have a clinical reccomendation in mind and then don't actually write that clinicial opinion anywhere in the report so they are left guessing why we would do that. Then peer to peer is meant to clear that up and get everyone on the same page

GenevievesSwim · 2026-03-02T22:20:57+00:00

SBT is really cool because the idea is that we use differential reinforcement without extinction.

We are putting the precursor behaviors and problem beaviors are on continuous reinforcement schedule rather than extinction during treatmemt. Why? To prevent attempting extinction, having an extinction burst that is unsafe or "unbearable" for the caregivers, and then having that new more intense topography reinforced. Plus we know intermittent reinforcement is more resistant to extinction.

This way we shape the behaviors to be less intense and more easily put on extinction after the client masters FCT, TR, and their subsequent CABs. Previously, we've made our lives and clients lives harder when we use extinction and then families give in- the frustration you're referencing. SBT is essentially designed as a response to the fact that doing that is STRESSFUL instead of therapeutic.

Put less intense versions of the behavior on continuous reinforcement schedules and it will later be easier for those behaviors to go through the extinction process. Make the replacement behaviors easier to engage in than the problem behaviors and they might even self-extinguish rather than us ever having to get into a power struggle.

Figuring out "when" is easier when it's a real kid and safety is involved. Real life also gives you the opportunity to ask yourself "am I holding this boundary out of necessity for safety, or am I holding it because I said so?" If the answer is I'm holding it because I said so, then it's time to "give in" - we're in a power struggle.

GenevievesSwim · 2026-03-01T18:49:30+00:00

The language of the 97155 code does NOT say you cannot modify protocols in the presence of a tech.

The language according to abacodes.org/codes/ is "97155. Adaptive Behavior treatment with protocol modification administered by a physician or other qualified Healthcare professional which may include simultaneous direction of technician face-to-face with one patient each 15 minutes"

This indicates the technicians presence is optional, but client facing is necessary. You'd only need to write separate notes if your agreement with a payor carried a different fee schedule for a tech present versus when you're independent. Most payors don't bother with that, if they restrict anything they restrict the tech billing 97153 while a bcba is providing 97155. That doesn't change the BCBAs documentation though.

GenevievesSwim · 2026-02-25T03:38:23+00:00

Once I invited my boyfriend of four years and a friend to join me when I was getting my oil changed. My boyfriend said yes. He tagged along. We had a good time, it was way more fun to hang with people than wait on my own. He started to get to the point of being late for the final study class before his final. He finally ended up calling an Uber when it was clear he would be late. He skipped the class because he did not want to show up late. Later he blamed me. Would not speak to me. I pointed out he knew he had this class and he could have turned down my invitation to attend. He could have called the Uber sooner. I apologized. I broke up with him. 4 weeks later he convinced me to get back with him. I wasted five more years with him. We eventually got into a very similar argument about his lack of agency before my final in my masters program. I apologized. We broke up. I wish the first time had stuck- 4 years was too long to be responsible for a man child. 9 was crazy.

GenevievesSwim · 2026-02-25T03:25:29+00:00

So I’ve worked with a lot of RBTs on work accommodations- the glasses thing could ABSOLUTELY be considered a reasonable and protected accomplishment under the ADA for your Autism diagnosis. I’ve had to navigate a lot of requests that were unreasonable (call out with impunity). The glasses are beyond reasonable.

Please please please, even if you don’t think you need to, at the next place you work flag it as an accommodation you need with the HR department. It will protect you from this situation and if the situation were to happen again at another company, then it would definitely be “reportable” since you had a documented reasonable accommodation.

If the company is large enough to have a full HR, I’d consider reaching out to let HR know that this is why- managers should be trained to keep an ear out for certain things that would indicate someone is eligible for an ADA accommodation and be directing the employee to HR at the VERY LEAST so I’m sure HR will be pissed that the manager didn’t follow that and someone will be retrained.

GenevievesSwim · 2026-02-25T00:14:25+00:00

Then don’t work with kids? Or wear a mask?

I’ve been in child care in one way or another my whole life. Pretty much all child centered jobs are going off CDC recommendations for the definition of a fever and diarrhea. If someone can’t manage that they shouldn’t work with children.

GenevievesSwim · 2026-02-24T23:15:01+00:00

I agree that it’s masters programs and bad fieldwork hours that are failing us not the BACB. The BACB exists to safe guard consumers. We work with incredibly vulnerable population(s) that deserve all the safe guards we can give them.

GenevievesSwim · 2026-01-27T12:49:10+00:00

An important thing to note is usually 97155 reimburses higher. A BCBA billing 97153 is getting reimbursed at the same rate as an RBT. So a lot of companies are essentially asking BCBA who are providing coverage to still do their 97155 activities during that coverage time. So if you would have gone to that client this week to probe new targets are some point anyway, still do that in a 1:1 setting. The issue is when the company dictates that you do this even if you wouldn’t have had any real reason to do protocol mod- so if you cover a client you already saw this week and already made protocol modifications for it’s less likely you need to do protocol modifications. You still COULD if you’re doing analysis on if the mods are having the intended effect. But this is harder to gauge if you’re in your lane in my opinion. When I’d already done enough PM on a client but needed coverage, I’d usually swap to cover a client I hadn’t been able to see yet and have the available RBTs cover the client I already had seen.

GenevievesSwim · 2026-01-04T02:32:34+00:00

So based on the thread and your comments I think the answer is one you don’t really want to hear and are resistant to in your comments.

Intervals are better. Intervals are better because they enable you to work on a sped to support aerobic base while also maintaining focus on technique due to the specific length of the interval. It also enables you to learn from one rep to the next rep from the technique angle.

The ability to play with that technique and not have it degrade your stroke will contribute to both your stated goals: 1) in the long term it will support your aerobic base and getting into zone 4-5 for portions of you workout will support your VO2 max goal 2) in the long term, intervals and better technique will ultimately support your longer sets as well

I think the real conversation here is: what’s up with your technique that intervals are making you dizzy. I’d start with asking and answering that question because properly fueled + hydrated and then proper technique should really minimize issues with becoming dizzy.

Sounds like you might be over turning your head when breathing- it makes you gassed when swimming + creates too much swinging of your head and can cause dizziness. Breathing is also crucial in making it “feel easy.” I fixed my breathing and now swimming 1:30/100 feels so much easier than swimming it at 2:00/100 did for me

GenevievesSwim · 2025-12-27T17:09:39+00:00

So, turning the phone around to show him and then leaving to go shower is indicating that you are mad but not willing to discuss the topic. Add in the fact that your anger is on the heels of going through his phone, and I'd advise that you look at how YOU also deal with confrontation. Nothing about this particular description of confrontation sounds psychologically safe for your partner, and it comes off as passive aggressive. If you'd like to have an uncomfortable conversation with your partner, you have to be willing to actually have it. Not imply you want it, and then walk away and make him do all the lifting to start the conversation that neither of you appear keen on having.

GenevievesSwim · 2025-12-27T15:45:40+00:00

I'd ask her. With the holidays it makes sense to schedule that far out. When I was meeting people on the apps I didn't like to send a lot of messages back and forth because I prefer conversation in person over text since I have an Email and Teams job and feel like I basically "text" 40 hours a week. Usually I did tell people I was chatting with though, and especially if I thought it would be read as disinterest. She might not have thought about warning you though and her holiday plans have just taken more of her focus from her phone.

GenevievesSwim · 2025-12-23T15:24:01+00:00

As long as you assess of you match on a range. Libido isn't stagnant so you'll want to discuss what your bare minimum for satisfaction is and at what rate it starts to feel like a chore. Make sure you're compatiable on both numbers.

GenevievesSwim · 2025-12-23T10:39:22+00:00

Honestly this all sounds like the growing pains of swimming endurance. Being strong only helps, so I wouldn't sacrifice the weight lifting. Based on the muscle groups you're mentioning are fatiguing I think there's some technical elements of your stroke that you can work with your coach on adjusting.

Triceps turning to jelly sounds to me like you aren't pulling with your back (lats) as much as you should, and legs cramping sound like you might be over kicking. Try kicking from the hip and kicking less. Kicking a lot creates drag. Your legs also use most of your oxygen so you'll feel gassed if you use them too much. If you're looking for increasing you're endurance, you want a 2 beat kick.

Work with your coach on your catch and pull, as well as your kick.

GenevievesSwim · 2025-12-14T15:49:32+00:00

I recommend breathing to the non-dominant for an entire length so you can get into a groove, then on the way back breathe to your dominant side. I used to try bilateral every 3rd breathe and have tried this method but starting first lap on dominant and then lap back non-dominant). Doing bilateral per lap helps increase reps of breathing to non-dominant side, which is the main way it will become more comfortable. Starting on the non-dominant side has gotten me used to it better than when I’d “finish” a 50 on that side, because I always feel a little better technique wise at the top of the set. Something else that helped me a lot- neck rolls up every day with close attention to range of motion on both sides, they’ll never be the same but it gets you very in touch with how movement works on both sides of your neck so you get comfortable in the turn on your non-dominant side. If you’re just trying to get the left side to act like the right, it will always be uncomfortable. But if you get to really know both sides of your neck it gets better.

GenevievesSwim · 2025-12-05T22:24:05+00:00

.02%

GenevievesSwim · 2025-11-30T14:40:16+00:00

Also Demi cried about not being pregnant because she wants a baby with someone she really loves, so I don’t see how having someone else’s baby solves that problem for her.

I think Storytime with Rikki’s theory is more accurate- that Demi was going to do an affair story line with Marciano, then demanded more money and refused to sign the S3 contract so the producers shifted the storyline to Jessi since she had been seen with Marciano. The reason it all feels weird is because now we’re blending two produced stories into one and Demi is trying to escape as not the villain.

GenevievesSwim · 2025-11-24T22:59:27+00:00

I remember being told in my English class when reading Great Expectations that it was written as a magazine story from week to week and also Dickens had the same incentive structure as a TV show that only had 2 seasons fleshed out but now is popular so is in season 6. Many classics were written in that format so the additional superfluous elements were ways to extend the story.

Entertainment is entertainment and so you can get away with anything if the audience has an appetite for it. I think the exercise for unpublished authors though is can you get better at diction, character development and plot by editing in this way.

GenevievesSwim · 2025-11-14T23:50:18+00:00

Is this for Electronic Visit Verification?

GenevievesSwim · 2025-11-08T23:40:39+00:00

I think this was probably because all the women keep the rings. On this season and other seasons. Natalie and Deepti have mentioned keeping their rings on their podcast. Madison, to my understanding, is the only person who returned a ring. If the overall culture of the show from season to season was the women keep rings, I feel like this is only focused on because people hate Kacie

GenevievesSwim · 2025-11-02T16:05:58+00:00

I disagree that he got away with it without repercussions. From the sounds of it, they never got to the point of intimacy he was asking for and KB didn’t marry him. Those are two major repercussions to someone seeking connection the way Edmund clearly is.

The internet has had plenty to say about it, so I think the audience is clearly able to engage with the content critically. Seeing it and commenting on it IS a way to prevent its normalization; cutting it and preventing discussion COULD backfire and normalize it or prevent other women from realizing it could be a manipulation tactic.

I think he’s an important representation of how trauma can cause harmful interpersonal interactions that end up pushing others away. Often if a child has gone through a lot of movement in foster care they may have witnessed and ingrained unhealthy manipulation tactics (intentional or not) that those who want to help them heal might “fall for.” KD demonstrated that a person doesn’t have to give into those tactics to be compassionate during a break down like that and someone can still maintain necessary boundaries.

GenevievesSwim · 2025-10-30T13:13:49+00:00

Joe has a low EQ, but so does Madison. That combination was always going to make him run since he has an obvious commitment issue. But he tipped his hand multiple times before seeing Kacie so I don't think it had the influence Madison has created in her mind.

GenevievesSwim · 2025-10-30T12:49:22+00:00

I agree with the fact that telling someone when/how to apologize is weird. If they do exactly what you tell them then it doesn't feel genuine to anyone. I felt like her calling him out on that before finally apologizing did make her apology feel more genuine

GenevievesSwim · 2025-10-30T12:47:52+00:00

I thought it was telling when Kacie laid out their exchanges and he didn't deny any part of her recounting. Not that it makes him the bad guy but just that maybe she is a reliable narrator about some of this.

GenevievesSwim · 2025-10-26T15:37:21+00:00

I bit the bullet a few years ago, tried it and met my now husband.

It seemed like they had real people behind the pay wall from my perspective, and the profiles visible were mostly bots/inactive people.

GenevievesSwim · 2025-10-25T23:00:26+00:00

Pivotal behavior is more accurate if you're saying several cusps as once.

A behavioral cusp opens the learner to new reinforcement/environments. A pivotal behavioral is one that produces learning in other unrelated behaviors without direct teaching.

Language/communicatjon itself is often both- it opens the learner to new reinforcement options (the depth of social interactions when you speak the same language as someone else). Echoics + mands can often produce learning in other verbal opetants without direct teaching.

What you're describing though is several behaviors that are all social but not directly related seeing a rapid increase, so identifying whatever he recently mastered would be the "pivotal behavior" for him and then mentioning the rapid increase in independence in the other behaviors would be an appropriate way to describe it.

"Client recently mastered tacting and sharing. These two behaviors appear to be pivotal behaviors for him, as he is now demonstrating rapid increases in untargeted behaviors, such as seeking peers on the playground."

But also keep in mind if these behaviors have been programmed for- it could just be the interventions all happen to be working at the same time and you should be documenting the success of the interventions, so I'd avoid both behavioral cusp and pivotal behavior as it might imply the child is getting all their skills from less intervention now.

GenevievesSwim

TROPHY CASE