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Joined 1 year ago
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Cake day: June 30th, 2023

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  • You can also use komf alongside komga/kavita to just scrape metadata automatically upon import. A bit finnicky to get going (a tampermonkey script is required to give it accessible setting on the komga page) but works very well and even has a gui for identifying results and selecting the correct option if the auto scrape fails similar to jellyfin

    For the actual reader part I just use komga as a server and read through Mihon (one of the tachiyomi forks) on my ereader mostly. occasionally I’ll use paperback on my iphone (although recently I’ve been trying Tachimanga, which is basically an iOS tachiyomi fork). Loads library, can sort by tag/library/date added, reads most things very well, can sync read status with the komga server (and/or manga updates or whatever), etc.



  • 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


  • “massaging tartrazine solution into hairless mouse skin over the course of a few minutes or using microneedling achieves “complete optical transparency in the red region of the visible spectrum”

    I know it didn’t happen this way but I like to believe it was someone having their unwashed dorito fingers after lunch, decided to massage a mouse for several minutes, and figuring this out


  • 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.


  • 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


  • 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.





  • but my (not really my) conspiracy theory for this is the opposite of open source: when someone is good at cracking games companies like denuvo track them down and offer them jobs to harden their product and take another cracker out of the scene. like I bet denuvo is just filled with nerds that spent their teenage years in sketchy irc rooms with handles like -DooMSlAyEr- and used to actually be members of razor1911 before they realized they could get game companies to pay them 200k a year


  • She is kind of a shithead tbf and fwiw it’s more like she’s the only person who is willing to do it. granted cracking denuvo is something that is extremely difficult and only a small subset of people can do but it’s not like she’s literally the only person on the planet who can. There was that guy who would just release the yearly update of football manager, for one.

    It’s far more likely the people who have that skill set just don’t really want to bother with cracking videogames and the potential legal issues that come with distributing them online.


  • I don’t know specifically for that state but in many states legal and medicinal weed has been overtaken by a few companies that are quickly buying each other up and rapidly expanding into other states as quickly as they can. in true American fashion the minute weed is legalized nationally we will essentially have the groundwork laid for giant weed conglomerates, the weed equivalent of walmart. keeping prices as high as possible, lowering product quality, and making the experience worse overall. I wouldn’t be surprised if they either were ready to expand into your state directly or had subsidiaries that would, probably lobbied hard to do so long before the law passed

    when I was on the west coast a while back legal weed was cheap as fuck and great. dispensaries were all over and randomly named. I’m sure there was intense rivalries and people pushing to consolidate but you could get stuff dirt cheap that was great. nothing like what I’m seeing here on the east coast with companies like curaleaf, truelieve, etc that charge $40-60 for a gram for shit that’s just okay. I quit smoking a few years ago though, maybe it’s better now, but I doubt it


  • Cloudflare has absolutely told websites to fuck off because they don’t like their content. They haven’t done it a ton of times but they absolutely have. No one cares because the sites they’ve done it to are toxic cesspool shitholes that, to be fair, the world is probably better off without. But each time it showed that cloudflare can simply wield its power if it feels like it.

    If your site becomes controversial in the future and is protected/hosted by cloudflare don’t be surprised if they suddenly send a letter saying “fuck off”. They’ve become arbiters of internet censorship and we have accepted it because the daily stormer and kiwi farms and 8chan are bad.

    The ridiculous part is all of those sites are still accessible; daily stormer and kiwi farms both still accessible from clearnet (iirc 8chan is tor only) so cloudflare dropping wasn’t even all that effective. Well funded hate speech found a way. But for the next ones that don’t have major alt right cash behind them to fund cloudflare alternatives they’ll just simply disappear. And then we will have the internet where corporations like cloudflare, who should absolutely be content agnostic, decide what we can and cannot see. You may think it’s fine right now because they’re doing it against websites that are admittedly gross and terrible, but what happens when they overstep and the line blurs?

    They should act like a proper tier 1 provider: find evidence of crossing a legal threshold, get a court order, and terminate service if something that bad has occurred. Anything less and they suck it up and honor the contract they signed. They haven’t, so fuck cloudflare. The internet is an amazing place but it’s also a disgusting abhorrent cesspool. Don’t get involved in hosting it if you can’t deal with that.


  • Flac 44.1 16bit level 3. Host with something that meets your needs. I have my files in jellyfin and navidrome and can then access the library remotely either through jellyfin web client, navidrome web client, substreamer, Finamp, kodi, etc. but this way if another amazing format comes up down the line I will always have my library in a good state to transcode from. Tag and sort everything with beets.io (or musicbrainz picard is great, I just like that beets is cli). This results in a library I can access on my phone, laptop, tv, carplay, etc

    Technically you could go for 24bit but imo the extra file size isn’t justified. though one could make that argument for flac vs 320cbr mp3, transcoding 320 mp3 is more likely to create artifacts, thus the reason for keeping around flac

    Alac may be easier for you if you use mac



  • This is pretty much what I meant by that fucked up misinterpretation of stoicism

    Like you have the actual Aurelius stoicism which has some very good value; everyone should read meditations once or twice. But then it’s been cliff notes’d and perverted by a bunch of people into to lose the message entirely from “be in control of your emotions” to what you’ve described: horrific rigidity to keep it all in at all times until of course it doesn’t work anymore and you break down spectacularly. Like somehow the message has gone from “control” to “emotional numbness”

    A similar dynamic has happened with nihilism where some the writings on it are not so bleak and terrible; that it is an expression of freedom. But over the years it’s been perverted into nothing matters, why bother



  • I am an actual licensed therapist and while there are a number of real actual creating barriers specific to men pursuing mental health treatment there are a few factors I’ve consistently seen that are ubiquitous across gender, race, sexuality, class, etc

    Money, time, availability

    Therapy is inaccessible. I am a therapist who mostly works with insurance companies. They pay me about 100-115/hr. My clients will often have a high deductible health plan which means they need to pay this $100-115 per session until they hit their deductible, which can be 5,000+ dollars. It’s a lot to ask someone to pay $100+ weekly. On top of that they still usually have a responsibility afterwards of (typically) 10-30% so $10-34.5 per meeting which is still a notable weekly cost for many people on the high end especially after shelling out $400+ a month for months on end.

    Other clients have PPO insurance which is a fixed cost per meeting but this can vary wildly. More affluent clients have excellent PPOs where they might pay $10-20 per meeting which is not terrible. But that’s rare. We are often covered under the “specialist” copay and many PPO plans have tiered provider coverage now. So a copay for me might be $50 or more per meeting (the worst I saw was $125 which was absurd because it was actually $27 more than I’d get from the insurer in question).

    So you have this on top of these plans taking hundreds of dollars out of each pay check. “Well budget for it”. Hard to do because the need for therapy can be inconsistent and many of these people are coming in fo(and specifically symptoms like poor money management). Then on top of that even if you do budget for it you have the inherent issue that the need for outpatient therapy is often not dire/acute so if something more pressing comes up (eg a serious dental/medical issue, car breaks down, short on rent) therapy might be the corner to cut if it’s already established because in the overwhelming majority of cases you won’t die without it; it will just lower your quality of life (sometimes significantly so)

    Then comes the time portion. Even if you can get past the cost barrier you have the availability of the therapist and yourself. I’m a night owl and I work late but many of my colleagues don’t. I’m pretty nontraditional though, no kids and my partner is very career oriented themselves whereas many of my peers tend to value the traditional 9-5 much more so they can be home for their children and such.

    So when you go to schedule with someone it’s often that you can only get seen during business hours. It’s one thing when it’s a doctors appointment that you have once every few months that you need to duck out of work for but a weekly hour long engagement is much harder to explain. This brings back in the masculinity issues - many men find this basically impossible to disclose to the workplace and basically wouldn’t even try to get an exception for weekly therapy. Even without explicitly saying so asking for 1 hour open a week consistently for a doctors appointment is going to be perceived as therapy by many. But stigma aside many of us simply can’t do that. I’m on the practitioner side and I know I’ve ignored my own physical health at times because it was inconvenient to schedule doctor appointments during my workday.

    Our systems of employment (at least in the USA) simply do not provide or protect for medical leave, even when it’s very brief and especially when you are a low level employee (executives and admins tend to have less of an issue ducking out for doctors appointments in my experience at least). There is no legal right to paid or unpaid time off for medical appointments in the USA and that is completely disgusting in 2023.

    The final piece is practitioner availability. I have a waitlist through October at the moment and am not accepting new clients. All of my colleagues are in the same boat. The old practices I used to work at constantly call me to see if I’ll take any referrals because their waitlists are so overloaded. The hospitals and clinics I have referral relationships with email me every week for updates. It’s extremely stressful. Every new client, especially adolescent, complains that they are happy to finally have someone after waiting 3-6 months. Even if someone wants a therapist they have to wait ages. It is not uncommon that I get someone and when I call them to start they say they don’t even remember why they called in the first place.

    We need more people doing the work. Or ideally we need to make societal reforms so that there are less people experiencing mental health issues. I’ve been doing this almost 15 years now. I, and anyone who doesn’t exclusively work with the rich, can tell you that a significant degree of what we work with is people who lack resources and not proper mental illness. I mean, it is depression and anxiety, but it’s because they have been paycheck to paycheck for years or theyre under a mountain of student loans or credit card debt and the stress is just too much to bear. And their jobs won’t give them raises and there aren’t any other jobs out there that pay more. Not everyone is a software developer or investment banker that can jump ship to another 6 figure job with cushy benefits. Most people work jobs that pay 40-60k with shit benefits and little upward mobility.

    To answer your question more directly:

    In my opinion it’s a systemic issue based around that super fun phrase everyone loves, “toxic masculinity”. I personally do not subscribe to gender labels but I am amab/male presenting and get a lot of male clients as a result. Many of them tell me they hide the fact that they are in therapy from everyone but their partner. This is indicative of the problem; that being in therapy is weak. That being in therapy makes them a bitch, a wuss, all kinds of pejorative terms. It’s bad, is my point.

    So part of the answer imo is not in having doggies and cool dude stuff in the office. Its far more complex and involves redefining masculinity to still including things like being a lumberjack or carpentry or whatever. From there though you need to shed the part where it means you have to be emotionally numb to everything, constantly display strength, embrace the fucked up misrepresentation of stoicism that has you shove all your feelings into your stomach, and glorify anger, rage, and violence as the only appropriate means of emotional expression.

    this could also be extended to the stigma surrounding therapy itself and the tendency to associate therapy need with weakness. This is an issue that goes beyond therapy though; there are people who won’t see medical doctors for the same reason even though they’re in physical pain. Our pride is our downfall.

    Tldr make therapy cheap and accessible, make protections for workers to seek medical care, increase the amount of practitioners (or decrease the need for them), and systemic reform to the societal concept of masculinity and pride. So probably gonna take awhile