The ethics of price gauging special needs families

[Anonymous]

Anonymous wrote:I see the flip side. I see a bunch of mostly women in these therapy and similar roles (dev pediatricians being the exception) making shockingly low rates for the services they are providing, the care they put into things, the "free time" they give with texts and panicked calls outside of the time they are on the books.

My rate is $1800 an hour. My friends who are doctors are around $700-1500 per hour. And OT and even MD psychs make $100-$250 per hour. My electrician makes the same or more as our therapists and didn't go to college, while every therapist has a masters or more. I think that's scandalous. I make a point of always paying extra the minute we go overtime and making sure they don't undercut their rates for me. I have the money, so of course that helps. Not everyone can. But no one expects a cancer MD to work for cheap just because the govt isn't covering the bill. Not sure why these docs and other providers should?

And to take it further, i guess we shouldn't be surprised that there are delays and errors in their work product when they're being paid insultingly low wages.

I know it sucks for a lot of parents who can't afford a lot of this stuff, but it's not your providers' fault that the US doesn't provide robust social services.

You are entirely missing the point.

[Anonymous]

Agree with OP - have had many of the same issues. Unlike PP who makes $1800/hr, I work in a specialized field making only $125/hr - and it's painful to pay $200+/hr for subpar services for my child.

[Anonymous]

I’m a provider of a SN service that ends up costing families $1,000/month with none reimbursable by insurance. It’s terribly difficult for families. And yet…what am I to do? I’ve adjusted my own rate so families can mange and I end up pulling from my retirement account to pay bills. I’m eating my family’s financial stability so I can tend to someone else’s needs. The worst part of it is the attitude among my colleagues that this is what a good provider does - we do it for the kids, for the mission, etc. Yes, indeed. But I’ll have to leave the field if I can’t pay the bills, and I need to charge an eye popping amount to do that. Families don’t see the half hour of session prep, the half hour of driving, etc.

I don’t blame OP or other families that are upset about the rates. I understand - we are a SN family too. But please don’t be mad at me. Be mad at our health care system that doesn’t cover my service, that your kid desperately needs.

[Anonymous]

The reason many don't take insurance is because the insurance company pays so poorly for their services. They cannot see 5-6 patients in an hour, or take the hours to fight with the insurance company who denies a claim, so it's easier not to accept insurance. I agree that the real beef is with the insurance companies, who take gobs of our money and don't pay providers appropriately

[Anonymous]

Anonymous wrote:I’m a provider of a SN service that ends up costing families $1,000/month with none reimbursable by insurance. It’s terribly difficult for families. And yet…what am I to do? I’ve adjusted my own rate so families can mange and I end up pulling from my retirement account to pay bills. I’m eating my family’s financial stability so I can tend to someone else’s needs. The worst part of it is the attitude among my colleagues that this is what a good provider does - we do it for the kids, for the mission, etc. Yes, indeed. But I’ll have to leave the field if I can’t pay the bills, and I need to charge an eye popping amount to do that. Families don’t see the half hour of session prep, the half hour of driving, etc.

I don’t blame OP or other families that are upset about the rates. I understand - we are a SN family too. But please don’t be mad at me. Be mad at our health care system that doesn’t cover my service, that your kid desperately needs.

Yes, exactly! Thank you for working in such an important job.

[Anonymous]

Anonymous wrote:It was a rude awakening when I realized that plenty of people in the sn world were just out for our money.

Were you born yesterday?

[Anonymous]

One could make the same case about almost any service here in the DC area vs a more affordable area. I wonder what these services cost in a more affordable geography.

[Anonymous]

This is a multifaceted problem. The system itself is broken, and healthcare is unaffordable and often unavailable (All of these services are healthcare). Beyond healthcare, we don't have a social system that adequately meets people's needs, and the inequality is profound.

Most schools are understaffed, underpaid, and staff have unreasonable caseloads. It's not possible to give 100% when caseloads are outrageous, and that's where issues with reports happen. There is insufficient training and support for school staff, and there is also a serious shortage of school psychs, SPED teachers, speech therapists, OT's, and, to a lesser degree, school social workers.

I am a school social worker & parent of neurodivergent children. I have seen a ton of private evaluations over the years, and they range in quality and thoroughness. I have seen some awful reports where the provider "diagnosed" a child with something, but collected truly insufficient and incomplete data and then slapped a label on the child, which is often ADHD or ASD. The parent has then paid all this money $1,000-$2,500 or more for a complete cr*p report and I just feel for them.

The parents put their trust in a provider and tried to take the initiative, but ended up with an awful report.

I have seen several incredible, thorough private evaluations. I saw one earlier this year that I was so impressed by! It was the most thorough report I have ever seen and if I ever need to seek a private eval in the future for my kids....that is where I'm going!

Most of the time though, the private reports fall somewhere in the middle.

I think there is a market for some exploitation and we saw this during the pandemic with certain virtual therapy providers and virtual psychiatrists that provided awful care.

That being said, A lot of providers are not looking to exploit families and just trying to make ends meet and probably pay off their student loans.

[Anonymous]

I’m a school SLP. I have 1 hour of report writing time per week. Each report takes anywhere between 5-12 hours to write and I have 4 assessments open at the same time right now. I do my best not to make errors, but do the math.

[Anonymous]

Anonymous wrote:One could make the same case about almost any service here in the DC area vs a more affordable area. I wonder what these services cost in a more affordable geography.

I came from flyover country. Drives were short and everyone had larger homes. IQ tests needed for some silly DC private school? I got it at $400 each in two days. Of course it was one page long but I was just checking boxes on a form. I didn’t need a long report.

A lot of these reports are way too long and frankly unused.

[Anonymous]

Once we started getting priced out it turned into a blessing because we found better services we could afford. Instead of social skills group, we just kept trying sports-rec sports, regular sports, different sports until DC finally found the right match. We also started planning group events at our home and outside our home to get DC socializing more.

We hired an outstanding young woman training to be a speech therapist for ST and it was a much better match. She is now a ST and we have been one of her references for years. For tutoring, we started experimenting with online platforms until we found a match. Her prices went up, but still quite reasonable. We hired a local teen to help our child with motor skills. We paid everyone well above going rate for the experience level, and I will be honest, the services most of the time were better than boutique services folks. Think outside the box.

[Anonymous]

Anonymous wrote:I’m a school SLP. I have 1 hour of report writing time per week. Each report takes anywhere between 5-12 hours to write and I have 4 assessments open at the same time right now. I do my best not to make errors, but do the math.

This was not referring to you. School ST's are free. The OP is talking about people who charge a premium and still make major errors.

[Anonymous]

Anonymous wrote:

Anonymous wrote:One could make the same case about almost any service here in the DC area vs a more affordable area. I wonder what these services cost in a more affordable geography.

I came from flyover country. Drives were short and everyone had larger homes. IQ tests needed for some silly DC private school? I got it at $400 each in two days. Of course it was one page long but I was just checking boxes on a form. I didn’t need a long report.

A lot of these reports are way too long and frankly unused.

Are you confusing an admissions IQ test and a neuropsych?

[Anonymous]

Anonymous wrote:Agree with OP - have had many of the same issues. Unlike PP who makes $1800/hr, I work in a specialized field making only $125/hr - and it's painful to pay $200+/hr for subpar services for my child.

I suspect you are confusing how much someone makes, vs. how much a company bills for their time. If you're making $125/hour, you're earning $260K per year. A healthcare provider who is billing $200K per hour, even if they're a sole practitioner, is paying overhead costs like space rental and insurance, and is spending at least 1.5 hours for that hour due to charting and planning. Add in the fact that they aren't paid for any leave they take, that they often have sessions cancelled, and it comes out to far less per hour than you make.

The healthcare system is broken. You are a victim, and so is the provider.

[Anonymous]

Anonymous wrote:This is a multifaceted problem. The system itself is broken, and healthcare is unaffordable and often unavailable (All of these services are healthcare). Beyond healthcare, we don't have a social system that adequately meets people's needs, and the inequality is profound.

Most schools are understaffed, underpaid, and staff have unreasonable caseloads. It's not possible to give 100% when caseloads are outrageous, and that's where issues with reports happen. There is insufficient training and support for school staff, and there is also a serious shortage of school psychs, SPED teachers, speech therapists, OT's, and, to a lesser degree, school social workers.

I am a school social worker & parent of neurodivergent children. I have seen a ton of private evaluations over the years, and they range in quality and thoroughness. I have seen some awful reports where the provider "diagnosed" a child with something, but collected truly insufficient and incomplete data and then slapped a label on the child, which is often ADHD or ASD. The parent has then paid all this money $1,000-$2,500 or more for a complete cr*p report and I just feel for them.

The parents put their trust in a provider and tried to take the initiative, but ended up with an awful report.

I have seen several incredible, thorough private evaluations. I saw one earlier this year that I was so impressed by! It was the most thorough report I have ever seen and if I ever need to seek a private eval in the future for my kids....that is where I'm going!

Most of the time though, the private reports fall somewhere in the middle.

I think there is a market for some exploitation and we saw this during the pandemic with certain virtual therapy providers and virtual psychiatrists that provided awful care.

That being said, A lot of providers are[b] not looking to exploit families and just trying to make ends meet and probably pay off their student loans[/b].

The providers I am talking about drive fancy cars, live in swanky neighborhoods and take exotic trips. No, they don't all have rich husbands. They charge exorbitant fees. Good for them. As long as my report is done properly and services are top notch then let them earn what they want. Otherwise, I move on and I don't recommend them to friends. One of our former providers has apparently hit hard times and reached out to us thinking we would send referrals. Unfortunately, some people learn the hard way, when you keep raising the prices, but the quality of your services does not fit your price, in this free market, people will move on.

I do think most providers do the work for the right reasons, but there absolutely about greedy people who exploit. I know first-hand from my own situation where I got a 2nd, 3rd and 4th opinion and from a mom I knew from a parent support group.