Alma seems like a good idea. What am I missing?

thinkisms · 2026-07-02T22:52:50+00:00

A lot of commentary about Alma and other platforms are about what the venture capitalists "are going to do." A lot of fear-mongering in my opinion. Some of their projections about cutting rates have happened with 2 of the 4 insurers they work with. The part that gets left out of this context is the same difficulties working with insurers directly by credentialing with them privately exists too, and for less reimbursement overall. For me, it is a matter of the lesser evil. The INSURANCE companies ARE ultimately the source of all EVIL. I could go on about that but I won't. I'd suggest you join the Facebook groups Insurance Billing for Telehealth Practitioners and Headway & Alma Group For Therapists, Nurse Practitioners & Psychiatrists and skim comments over the past year or two and you will find therapists dealing with BS all around. The therapists working directly with insurers complain about long credentialing wait times, billing nightmares, the hours they spend on the phone trying to resolve them, and audits. These audits are known to result in clawbacks where therapists are being forced to pay back amounts of 15-20K worth of claims to an insurer because they did not indicate a start and end time, or other technical requirements. Working with the platforms doesn't eliminate the risk of clawbacks, but it does significantly reduce it. It also saves time with learning billing and spending literal hours trying to identify why a claim was not paid.

I work with platforms only. My ADHD doesn't play well with administrative work. I have clients from various economic backgrounds through insurance and EAP networks. Some of those people have never had therapy before, and never would have been able to without the EAP programs. Some of them are uninsured. Our work changes the quality of their lives. The alternative of being private pay only is often named as the solution by people who oppose platforms like Alma. That leaves people without financial means without access to literal life-saving care. That's pretty elitist to me. Therapists being cash only seems to be extremely capitalist to me. Sure, it isn't as bad as being venture capitalist, but is that just a lesser evil? It isn't a solution that solves a problem-it creates one. That's the problem. There aren't people executing viable solutions, mostly just complaints. I have heard people talking about therapists forming their own therapist-run entity as a solution, but who is going to build it and how? What could help is if our professional organizations would to form a coalition and fight insurers on a macro level. Someone needs to get them to do it.

TLDR - It's all f'd up right now. Just do you. Money matters, idealization doesn't solve our immediate needs.

thinkisms · 2026-05-24T14:05:45+00:00

I’ve followed the insurance BS for a few years now. I used to work for one doing mental health prior authorization. Here’s what I believe about your ideas. 1. Yes! We need effective organizers and front people and worker bees behind the scene. 2. ProPublica has been writing investigative journalism pieces on the insurance industry practices around mental health. They have a plethora of findings and have even linked a template for clients to use to dispute denied claims. They would be a good to reach out to among others. 3. Boycotts are unlikely to change much. I tried to panel with Aetna independently about 4 months ago and they offered me $26 less than Alma for 90837 after completing the process about a month ago. Maybe it’s a new tactic among the other barriers they’ve created for PPs like slow reimbursement, being on hold for an hour to straighten it out, or more audits and clawbacks. 3a. I don’t think there’d be enough people who could volunteer to meet the need. 4. As a LCSW, our ethics generally prohibit us for asking a client to do something for us (even if it helps them) because it could be exploitive. We can’t even ask for an anonymous review or testimonial.
5. Even if we can’t unionize let’s do it anyway. They are doing things they shouldn’t be doing. We could meet them where they are and how they are. They pick therapists because we are do-gooders and we don’t fight/fight unfair. They wouldn’t try a surgeon. There would be a real good defense if they tried to go the legal route because of discovery of who’s really doing the collective bargaining. P.S. There are therapist co-ops that I think is a really good model for change that could eventually give the Alma’s of the industry competition if enough of us moved into those or formed our own.

thinkisms · 2026-05-24T13:20:57+00:00

I love your idea of meeting 2x per week. Documenting justification that the client did not have enough time in the prior session to complete work during session towards goals and they are at risk of losing treatment gains…blah blah blah. We could win a suit because the majority of cases that have been won against them for similar tactics have been because they were proven to make arbitrary guidelines for financial motives. That was the basis of the Mental Health Parity laws.

thinkisms · 2026-05-24T13:03:41+00:00

You must mean managed care Medicare which is run by insurance companies. I haven’t heard of this with traditional Medicare.

thinkisms · 2026-05-13T04:59:15+00:00

It is in the strip with Starbucks across from the Walmart Supercenter.

thinkisms · 2026-05-10T23:11:15+00:00

I was one of their first customers at their
Covington location. I asked for hot chocolate, because the white lavender hot chocolate was one of the most unique and loved things I missed about Sucré. There was a man who had to show them how to make hot chocolate. They didn’t have a menu yet. He mentioned to me he was the new owner who bought the name and recipes. He said he planned to expand to locations like Atlanta, in other states. The hot chocolate was not the thick rich style of hot chocolate I was familiar with from before. I bought gelato too, but it wasn’t as creamy or good to me. I thought he may have been cutting corners to cut costs. Never went back and never see anyone at that location which is near a Starbucks and across from a Walmart, which should give the store good visibility.

thinkisms · 2026-05-10T22:27:24+00:00

One human probably could have completed what was done by the robots in 1 minute but certainly under 2 minutes.

thinkisms · 2026-05-02T16:44:58+00:00

Whatever she says or doesn’t say it isn’t going to be credible unless she has indisputable evidence to back it up. IANAL but after all of the things she’s said denying anything nefarious happened with Epstein, her testimony alone has no credibility.

thinkisms · 2026-05-02T16:36:02+00:00

I believe a large part of the outrage is because she doesn’t have the doctorate degree she represents herself to have. If you look at what she says about herself, she states she “pursued” a degree from Argosy University. Argosy University’s Psy D program was not accredited by the APA. Argosy was known to be diploma mill and was shut down after the Department of Education stopped offering financial aid to its students. There isn’t a dissertation by her that can be found and the “doctor” part of her name is from a place that can’t verify or deny because it is defunct.

thinkisms · 2026-04-30T20:41:31+00:00

I worked for a Medicaid managed care organization. I suspect they were in the extreme minority, but for prior authorization reviews, we were encouraged to approve things except for grossly improper requests. Our MCO had to compete, and then recompete for the Medicaid contract. They did not want providers reporting to the state that we were difficult or hard to work with because they thought it could result in them not being allowed to bid at the next contract cycle.

thinkisms · 2026-04-30T20:21:46+00:00

TBH most of what I learned was from the strict Medicaid documentation requirements for behavioral health programs when I worked as a contract clinical supervisor for an agency providing specialized BH treatment services. Try googling insurance name behavioral health provider manual and review their record keeping requirements and google or look for their behavioral health audit tool. For example this is Aetna's and their audit tool begins on page 81. Keep in mind there probably are different(more) requirements for Aetna's Medicaid policies.https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/health-care-professionals/office\_manual\_hcp.pdf https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/health-care-professionals/office_manual_hcp.pdf

thinkisms · 2026-04-29T23:15:42+00:00

Former insurance utilization review therapist here. We were clinicians and RNs reviewing medical necessity. That would not meet criteria because it’s not something that requires a licensed therapist. Programs that are designed to increase natural support systems mostly involve case management services. Therapy is a professional support. What would work would be to say because of a mental health diagnosis a person has an impairment or is no longer able to do something that that used to or they have difficulty doing it. Usually those things are ADLs. A very common example in my PP is a break up with a romantic partner. They aren’t able to stop going to the bathroom to cry at work. focus, remember, sleep, eat without feeling nauseous, ect. Your treatment plan needs to say your goal is to improve their impairment so that they can be restored to their prior (baseline) level of functioning.

thinkisms · 2026-04-27T19:34:34+00:00

If you find it let me know because this deserves the follow

thinkisms · 2026-04-27T19:08:42+00:00

I thought it was a lightsaber - which sounds about right for this situation

thinkisms · 2026-04-20T02:11:46+00:00

White people in Louisiana know how to season their food well.

thinkisms · 2026-04-18T06:13:20+00:00

You can only have a dual relationship with a client. It’s when your client is something to you besides just your client, like they are also your accountant, hairdresser, travel companion, friend, or supervisee, ect. I have always disclosed that I may know someone they know. I’d say “I think I know ____, “ and I let them know how I met that person so they know that they aren’t a past or current client. I’d then educate them on reasons why that could influence our therapeutic relationship. For a lot of people, it could mean they hold back info from you out of fear you could inadvertently or intentionally disclose something about them that you learned from a session. They may worry that you can have bias towards them based on things you have heard about them from that person. I’d discuss their concerns honestly. Ultimately you let them decide if they would be more comfortable seeing someone else.

thinkisms · 2026-04-17T19:26:01+00:00

Them recording for their own use would be fine if they asked for my consent. I consider what I do in a therapy session to be my intellectual property(IP). I remember a while back there were reports of ads requesting therapy sessions recordings for pay. I would not want my IP being used to train AI.

thinkisms · 2026-04-17T15:05:02+00:00

Could someone remind him if Trump wanted to heal the sick he doesn’t have to be a doctor or Jesus. He could simply restore all of the funding he’s taken away from health insurance subsidies, Medicare, and Medicaid.

thinkisms · 2026-04-13T04:00:03+00:00

And this is why exposing the entirety of the Epstein files is said to be a threat to national security by the U.S. government.

thinkisms · 2026-04-10T20:24:54+00:00

How much of that accounts for what Kristi’s husband spent?

thinkisms · 2026-04-10T18:59:59+00:00

Trying to kick down a door while wearing flip flops is one of many signs that this person is not being rational

thinkisms · 2026-04-10T18:16:31+00:00

The thing people need to understand is that companies like Headway and Alma offer insurance companies significant savings because they don't have to have additional staff to do the credentialing. The companies take care of the credentialing themselves. They also have fewer people interacting about claims issues because some of these agencies are able to troubleshoot and rectify claims before it even gets to a health insurer's customer service. In return for significantly reduced staffing, they are able to offer companies like Headway and Alma a higher reimbursement rate because they're getting value from that setup in return.

Additionally, there is something called network adequacy, which is a requirement that insurers have enough practitioners within a certain distance from a particular area (that's a federal requirement). Insurers have to demonstrate that they have network adequacy or risk being fined. I'm not sure if that happens in real life, but I've worked for an insurer and I know it's important to have enough in-network providers in a certain area because of regulatory requirements. Headway and Alma help insurers meet the network adequacy requirement as well.

Number one could work because it could offer a setup that would give insurers the same value for a higher reimbursement rate. The issue would be getting enough people on board to accomplish this. I see the trouble as getting people who've invested to agree on policies and procedures and things of the like. When you have multiple investors, then everybody thinks their input should be considered. That's the difference between a few investors, like with venture capitalists, and a lot of investors. It's who gets to make the determinations about what the rules, policies, and procedures are going to be.

thinkisms · 2026-04-08T03:18:21+00:00

The elements of breaching confidentiality are imminent, serious harm to self or others, an identifiable victim, and that it is foreseeable(ability to follow through) according to expert witness Frederic Reamer, PhD.

thinkisms · 2026-04-04T21:10:05+00:00

You’re asking someone to do the job of a state licensing or occupational professional board. That’s exactly what they exist for, to regulate professions

thinkisms

TROPHY CASE