The ethics of price gauging special needs families

[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.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You require a highly trained and educated professional to provide services for you. I agree these services should be covered by insurance, but that’s the real issue here, not how much they are charging. As a previous poster pointed out, these services are often provided by highly educated, underpaid, overburdened and burned out women.
Also, keep in mind when someone does an assessment for your child, it takes literally hours to write a report.

Well said.

Ditto.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You require a highly trained and educated professional to provide services for you. I agree these services should be covered by insurance, but that’s the real issue here, not how much they are charging. As a previous poster pointed out, these services are often provided by highly educated, underpaid, overburdened and burned out women.
Also, keep in mind when someone does an assessment for your child, it takes literally hours to write a report.

Well said.

Ditto.

Neuro-psych assessments are 5-7 thousand sometimes more. You are telling me even after over-head this person is underpaid?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You require a highly trained and educated professional to provide services for you. I agree these services should be covered by insurance, but that’s the real issue here, not how much they are charging. As a previous poster pointed out, these services are often provided by highly educated, underpaid, overburdened and burned out women.
Also, keep in mind when someone does an assessment for your child, it takes literally hours to write a report.

Well said.

Ditto.

Neuro-psych assessments are 5-7 thousand sometimes more. You are telling me even after over-head this person is underpaid?

A good neuropsych assessment involves meetings with the parents before and after, plus usually 2 or 3 sessions of 4-6 hours with the kids. Plus time communicating with teachers, reading background info, scoring tests, interpreting tests, writing a report. It’s easily 30 hours of staff time. On top of that there is the overhead of renting an office with a receptionist, insurance, the tests themselves which have consumable components that need to be purchased for each child.

Yes, I think $5-7K is reasonable.

What do you do for a living?

[Anonymous]

Not to worry, OP. With the changes that the current administration is making to higher education, publicly funded research, medical insurance, and funding for education, providers of specialized services will become rarer and, probably, more expensive. Such services will be less available, and even less likely to be covered by insurance plans. The “free” services are not actually “free” — but available because tax payers have agreed to pay for such services and resources in support of the common good. As the staunch capitalists become less supportive of “the common good” such services may dwindle as well.

OP, I’m curious about what you view as “price gauging” (sic) and what you don’t. It’s rare, I think, for someone to question, say, the fees of an anesthesiologist, yet services provided to children, often by highly educated and specialized female professionals are often questioned and belittled.

Here’s a question for you: How much should I charge per hour in the DC area?

I attended public schools — so, acquired a certain set of experiences and perspectives. I went to a HYP college, followed by what was then the top PHD program in my field at a top ranked university. Along the way, I worked at a well-regarded lab school, a Head Start program, school and community based programs, and trained and worked in a learning disabilities assessment program. I tutored college students in my spare time. I now have over 2 decades of experience in assessments and interventions — which has included multi-disciplinary supervision and training.

What do you think that’s worth? If you’re interested in getting a well-done report, please know that I don’t use AI, and that analyzing assessments and writing up a good, comprehensive, detailed report could easily take as much time as doing the assessments. So: What seems reasonable to you?

[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.

I think some of them are posting here getting defensive. I am all for people in the field making good money for excellent work. I won't pay good money for mediocre and sometimes even decent work becomes unaffordable. I don't think it's all about insurance either. I think some people just get so lost in greed, they raise the prices until they have little business and then they go down. I have seen it happen.

[Anonymous]

Anonymous wrote:

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.

This is just not a thing. You keep pushing this narrative because you want to be angry about what they are charging, but it doesn't change the fact that these services are grossly underpaid compared to comparable education-required jobs filled by men.

[Anonymous]

I am a school psychologist and have a son with special needs. The research on so many types of therapies is really lacking.

When he was turning three and really needed speech therapy I really looked into the research. Ethically they can't take identical twins and give one twin speech therapy and the other twin is the control, which would be the best type of study to see if the twin who receives therapy ends up being better off. The same with occupational therapy.

In my experience (which really isn't proof of anything, of course) when there is a specific targeted issue like an articulation disorder or producing sounds that can be measured pretty well then speech therapy seems to be effective.

If it is a language issue then working for 30 minutes or 60 minutes once a week really just doesn't seem to be effective. There are around 100 hours in a week that kids are awake. So that is really working on something intently 1% of the time. So you can take your child to speech therapy for language issues for years and continue to pay but how much is it really doing.

I think as a parent if I am spending money and time to get my chid therapy, then I am going to have a tendency to think that is what is making my child better over the course of time and not just they are developing as they get older. So providers take advantage of this.

[Anonymous]

Anonymous wrote:What field earns $1800 an hour?

Big Law. But that’s probably the billable rate and not what they actually earn an hour.

[Anonymous]

I’m in a special needs field and so many people in the field are money hungry and yes-take advantage of parents trying to do everything for their kids.

My favorite example are special needs camps. These are so ridiculously expensive for not even a full day. People are paying 4x the cost of regular camp for half day. It’s awful.

also advocates-total waste of money with no real credentials to be charging what they do.

Also I have yet to see an OT find a child they don’t diagnose with SOMETHING. pediatric OT is almost entirely subjective when it comes to assessments. So really-they can literally just make stuff up and often do.

And the whole “you get what you pay for” argument is so often not true in the special needs world. I have seen both amazing and terrible professionals who are covered by insurance and completely out of pocket.

[Anonymous]

Anonymous wrote:I am a school psychologist and have a son with special needs. The research on so many types of therapies is really lacking.

When he was turning three and really needed speech therapy I really looked into the research. Ethically they can't take identical twins and give one twin speech therapy and the other twin is the control, which would be the best type of study to see if the twin who receives therapy ends up being better off. The same with occupational therapy.

In my experience (which really isn't proof of anything, of course) when there is a specific targeted issue like an articulation disorder or producing sounds that can be measured pretty well then speech therapy seems to be effective.

If it is a language issue then working for 30 minutes or 60 minutes once a week really just doesn't seem to be effective. There are around 100 hours in a week that kids are awake. So that is really working on something intently 1% of the time. So you can take your child to speech therapy for language issues for years and continue to pay but how much is it really doing.

I think as a parent if I am spending money and time to get my chid therapy, then I am going to have a tendency to think that is what is making my child better over the course of time and not just they are developing as they get older. So providers take advantage of this.

I'm glad you brought this up and you have a unique perspective as both a parent and clinician. I looked at the research too and there's no way to know where kids would have been without the intervention, but I do find with cerrtain issues it's obvious the intervention helped. I didn't find in our experience a correlation between experience level or cost and ability get results. The OT who conquered shoe-lace tying was with the school system. The ST who got results with artic took our insurance and was in her second year or work. That was when we lived in an area where you could find STs who take insurance. I wasn't impressed with most high -fee providers and there were gimmicks like trying to lock us into a certain number of sessions. One provider kept contacting us after we dropped her offering free sessions if we referred friends to her.