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Effects of ObamaCare on Practice of Psychology

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by aequitasveritas, 03.11.12.

  1. aequitasveritas

    aequitasveritas PhD

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    I attended a seminar on the incoming effects of Obamacare on: notes, utilization review, treatment plans, and how each are tied with reimbursement decisions from private insurance companies under the newer reforms.

    Here are the major take aways:

    1. As there are more mandates for coverage and parity, there will be more aggressive utilization reviews. So when you have an audit from an ins co. they will more and more be interested in whether you can account for the type of tx pursuant to sx, length, tx plan, and whether there is improvement. One problem is that many of the reviewers, similar to now, will be non-psychologists.

    2. This is a biggie. There will probably be ACO (Accountable Care Orgs) that become the dominant service providers under Obamacare. Private practices will be under increased pressure to shut down. Here's how it may work. The new fleet of "health clerks" that will be hired by ins co's cos and by the govnt will have access to the federal electronic data-base. They will be able to track whether someone has missed their appnt with a private practice doctor-not affiliated with an ACO. They are then able to call the patient and essentially say "hey, we noticed you missed your appt. with doctor so and so. Did you know that you could also go down to "Insert Name" ACO where the following services are provided?" They will be ushering people into these new care facilities.

    For psychologists I see the effects as following:

    1. Potential positives: The ACO may be a stabilizing employment opportunity. However, this will not be true if the requirements for the ACO are "mental health" driven and not "clinical psychology" driven. So if they operate like HMOs and employ mid-level providers in our stead then this will absolutely screw us. However, if they have some reason to employ psychologists rather than mide level providers then there is an opportunity for: 1. elevated requirements in standards of training in order to be hired (like the VA) and 2. A better quality of life for a shrink...no billing, scheduling, etc. Shrinks wld also take a profit share from the ACO in addition to therapy fees.

    2. Absolute negatives: treatment standards will be more granulated and standardized. Longer term txs will likely be met with more resistance. Some illnesses will be excluded from coverage to meet the more concentrated and elevated demand that will arise in these ACOs. Our wages will likely have a cap. Remember, in Canada the highest a psychologist makes is appx $50/hr. So if this ends private practice, our earnings could take a serious plunge. Our methods of tx will also be more subject to bureaucratic demands and regulations.
  2. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    Do we happen to know if anyone (*cough*APA*cough*) is lobbying on psychology's behalf with respect to carving a protected niche in ACOs? The whole ACO situation came up on one of the neuropsych listserves a month or two back and essentially (if I'm remembering correctly) said the same thing, so I feel if we aren't out there making our voice heard, we really need to start convincing our professional organization(s) to do so.
  3. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    :laugh:

    I don't believe psychology even had a seat at the table when this was first broached, let alone an active voice in on-going development. The first thing people need to understand is the potential impact that ACOs will have on our healthcare system. It is huge...at least how they are currently proposed. On the most basic level, ObamaCare will drive a further wedge in between the patient/provider relationship. Treatment will be dictated by pencil-pushers, and reimbursement for said treatment will be less than now (if that is even possible!). There will be more paperwork, less treatment, and a greater pressure to turn patients over. Look no farther than the VA for an example of what can happen.

    While ObamaCare may help stabilize employment for psychologists, they will be forced to align with already established ACOs....which will kill all but the largest private groups. Some private practice survivors...err providers (Freudian slip) will still be able to get by being cash only, but they will get squeezed even further by artificial forces. It is going to be a mess.
  4. docma

    docma

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    It would also be good if we could do this in a voice that is open-minded, evidence-based and willing to consider innovations. I worry that psychology will get into an adversarial, defensive stance rather than seeing some of the significant opportunities for innovation and more effective interdisciplinary care. Yes, there are risks in this change and a lot of the players in this process have their own gain foremost but we have opportunities because we have skills that primary medicine needs. I think it is important to learn who is providing the trainings/warnings as sometimes they have a political agenda in the mix there and we have to be careful not to be frightened away from seeing what opportunities are included in the coming change.
  5. deliciousgoose

    deliciousgoose

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    Not calling it "Obamacare" is a very easy first step.
  6. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    docma...that is all well and good, but psychology doesn't even have a representative at the table! It is hard to feel confident when decisions are being made without our input.
  7. docma

    docma

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    Maybe we should start by researching who is actually "at the table." There are (or used to be) a few psychologists in the House and Senate, but we know that serving there seems to limit cognitive flexibility. Who is actually on these boards, etc. in decision making roles, I wonder? And I agree: let's not use the eponymous/politically hostile "obamacare" title. Isn't it the Health Care Affordability Act? HCAA? There must be a new acronym to go with ACO...:)
  8. anonymiss88

    anonymiss88

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    What do you recommend for those of us about to start doctoral programs and the debt that goes along with it? With this possible healthcare pathway, what would await us on the other side of our degree? Assuming we can get an internship. :p
  9. DynamicDidactic

    DynamicDidactic Unestablished Non-member

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    Rule of thumb is do not accumulate more debt than you would earn your first year out of school. In this case, stick to no more than ~60k of debt.

    I too would ask that we use less divisive language in this discussion.
  10. DynamicDidactic

    DynamicDidactic Unestablished Non-member

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    I too have heard a lot of the similar points made by the OP. However, I also understand that no one actually knows how things will shake out. Furthermore, those in the know keep saying that the best place for psychologists is within integrated primary care settings.

    I also see this as continued pressure for psychological science to better inform psychological practice. Hopefully, this can be conveyed to the managed care side of the equation.
  11. Doctor Eliza

    Doctor Eliza

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    This is an important issue for psychologists as consumers of healthcare, not just providers.

    Universal healthcare could be a godsend for psychologists who do not have insurance coverage through their employer and do not qualify to purchase a plan on their own. I found myself in this situation. I work as an independent contractor and so I don't have insurance through work. Went I went to buy a plan, I was denied by all major insurance companies. I am an extremely healthy 33 year old. The only blemish on my record was that I have clinical depression that is well controlled through meds and therapy. No one would touch me.

    What worked out for me was that I qualified for the "high risk pool" in my state. Unfortunately, to qualify, you must spend 6 months without insurance. That wasn't fun. But, I cannot help but point out that the high risk pool is an "Obamacare" program.

    Dr. E
  12. RGirl

    RGirl

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    I admit that as a Canadian who has only worked in the US in health psych settings, I'm not at all versed in what the new health care legislation means for the average American psychologist.

    However, just to clarify from a Canadian perspective, despite a more "socialized" medical system, we still do have private practice here, and the going rates for private practice endorsed by the college in my province are around $160. Now, you will never get that if you try to get reimbursed through someone's extended health insurance, but our medical system hasn't quashed the existence of private practice.
  13. aequitasveritas

    aequitasveritas PhD

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    http://www.livingin-canada.com/salaries-for-psychologists.html



    .
    Last edited: 03.11.12
  14. aequitasveritas

    aequitasveritas PhD

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    I disagree but if it makes it easier to consume the fact that a very far left program is probably going to make things much more difficult for us, ok.
  15. docma

    docma

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    Maybe we could start by researching the actual program and not assuming it is going to be very far left. The idea of health care reform did not arise in any one party and has definitely had support from the right: "The concept of the individual health insurance mandate is considered to have originated in 1989 at the conservative Heritage Foundation. In 1993, Republicans twice introduced health care bills that contained an individual health insurance mandate. Advocates for those bills included prominent Republicans who today oppose the mandate including Orrin Hatch (R-UT), Charles Grassley (R-IA), Robert Bennett (R-UT), and Christopher Bond (R-MO). In 2007, Democrats and Republicans introduced a bi-partisan bill containing the mandate." (http://healthcarereform.procon.org)

    The Kaiser Family Foundation also has some good review of the orgins and issues. This is an important issue; lets be social scientists about it.

    Also: let's keep in mind the earlier poster's point about health care coverage available to us and our families, to grad students, and to our clients. I do not believe having better health care available to more people is going to "make things much more difficult for us."

    If we come to the table angry (or assuming an us/them stance) we will either get up before we're fed and be hungry...or go away prematurely in an agitated state and others will sit down. We need to sit down at the table prepared to build stronger, healthier communities we all can live well (and work) well in...
  16. aequitasveritas

    aequitasveritas PhD

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    You know what, let's just nip this political slug fest in the bud. The fact is that the prognostication for our practice is as I stated in the original post.
  17. aagman01

    aagman01

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    Yeah, make sure you are fully aware of what you are talking about. I just interviewed for a public service related position in Canada. The starting pay (for my post-doc year) will be $75,000. This salary is substantially higher (like double or more) of the comparable postdoc positions I have seen / applied to in the US (pre-"Obama Care").

  18. Powerball

    Powerball

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    Your patients must appreciate your crystal ball.
  19. aagman01

    aagman01

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    The website you quote is a for-profit service company, which seeks to promote its site to a general audience considering moving to Canada (to promote its advertising). Among other "advertisers" are companies offering paper/legal work for people hoping to immigrant to Canada and for-profit schools (e.g. a nice ad for Capella on the "psychology" page. Degree on the page itself is not mentioned for the "psychologist". The website itself for psychologist states that "Job titles and exact duties vary in this occupation and examples of some job titles are: psychologist, behavioural therapist and clinical psychologist. " My guess is that the salaries provided are for folks ranging from pre-bachelor (e.g. case worker) to bachelors level psychology degree or related occupation (e.g. case worker), and perhaps up to a full psychologist. My guess, furthermore, is that the majority of their audience (potential immigrants) are lower level workers. There website plays to their customer base, not to doctoral level psychologists.

    I personally always enjoy your rants and inaccurate postings, aequitasveritas. Please work on those critical thinking skills while you are enrolled in your professional school program. Thanks!

    Last edited: 03.11.12
  20. deliciousgoose

    deliciousgoose

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    Please keep using Canada as an example without having any idea of what the real hourly rates of clinical psychologists in Canada are. Clinical psychologists in Quebec, the most left province of them all (eek!), routinely make $150-$200/hour.

    As someone who works in a private therapy firm in a major Ontario city I can say that therapists and counselors can make anywhere from $150-$300+/hour.

    But please, continue on about how it's increased access to healthcare (aka more clients) that is making it difficult to make money with a Psy.D. rather than the preponderance of for-profit professional Psy.D. degree-millls that devalue the designation for everyone else.


    You are my new favourite person.
  21. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    When I was up at INS, I was hearing similar offers being discussed (e.g., $70k for fellowship, leading immediately into a $100k full-time position). Apparently neuropsychologists in particular are in short supply in Canada, or so people were saying. I just don't know that I could handle the weather.

    But to avoid completely derailing the thread--to get back to something T4C mentioned, does anyone have any idea how we could go about getting a "seat at the table" at these ACO talks? I'm woefully under-informed when it comes to many of these processes.
  22. aequitasveritas

    aequitasveritas PhD

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    Impressive split Aagman

    I chose that site because it laid out the earnings in a visually palatable manner.

    Try this one. I'm sure I could find a similar Canadian Gov site for each province.

    http://alis.alberta.ca/wageinfo/Con...etWageDetail&format=html&RegionID=20&NOC=4151
  23. docma

    docma

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    Here's one I found for a start:
    (http://healthcarereform.procon.org)
    It would be great to have a reasoned exchange on resources for learning about this and for preparing students well for new opportunities. Maybe we could get a threat that is specifically about Understanding ACOs?
  24. minorityreport

    minorityreport

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    Sounds inherently racist to me. Racism is a growing problem once again in this country.
  25. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    :rolleyes:

    one of these guys, fantastic...

    I am a member of the tea party, care to make judgments about that as well?
    Last edited: 03.11.12
  26. niknok

    niknok

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    It's interesting. I remember my mentor talking in class and asking the students why there is not enough psychologists in politics when in turn, our knowledge in human behavior plus doctoral level critical thinking (supposedly) would make up a good leader. There are 2 psychologists in the senate in California not sure about other states. Maybe we need to start electing more psychologists...

    As for how we will be affected by obamacare, call it idealism but I think we dont always have to be limited by what the current definition or jobs of psychologists are. I'm actually excited bec with obamacare there will be more integration between mental health and physical health. Psychology can be very versatile. It's a matter of advocacy and drive amongst us to carve our own path to the future. Private practice is not necessarily the end all be all.
  27. deliciousgoose

    deliciousgoose

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    Sure thing. Arizona is demonstrating that the balanced budget model leads to success :rolleyes:. Constant tax-cuts are also working well in the state. Who needs water purification resources?
  28. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    Gov't run healthcare is going great, social welfare/engineering is a resounding success, and spending billions/trillions more on two unjust wars is what the American people want. :rolleyes: Btw...I'm not a Tea Party'er.
  29. DynamicDidactic

    DynamicDidactic Unestablished Non-member

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    I think we can use this thread as a microcosm of the current political landscape. Instead of openly discussing and weighing the potential positive and negatives of the Affordable Healthcare Act this thread has turned into a fight between the right and the left.

    Erg and T4C, anyone who has been on this forum long enough knows your stance on politics, was it necessary to get off topic?

    Chuck Norris, was it necessary to call it ObamaCare since that term is very divisive?

    Whenever I see a thread that goes this way I have much more empathy for politicians. Nowadays, even if they want to have an open and unbiased conversation about the issues they are sucked into a left vs right war.

    anyway, the case comes up before the Supreme Court in June and all of this may be a moot point.
  30. minorityreport

    minorityreport

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    Sure! Your "party" is filled with racist goons! :laugh:

    Watch Fox news much?
  31. ClinicalABA

    ClinicalABA

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    You should make yourself aware of the different funding sources associated with paying for psychological services. You might have to look outside your graduate faculty for this information, and realize that it may differ from state to state. You should then look to focus your clinical skill-set to take advantage of the variety of funding sources (e.g. private/public insurance, state funding, federal funding, private pay, municipal funding, university funding). For example, if you specialize in community outpatient therapy, you're largely dependent on insurance reimbursement and your earnings will be subject to variations therein. Specializing in school consultation will tie your earnings to municipal funding (with some state subsidies). Working with adult residential DD populations makes it likely that you are subject to state budgets.
  32. aequitasveritas

    aequitasveritas PhD

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    I generally agree, and this thread has been derailed. I used Obamacare because that's the most popular term for it. Even the White House Press Secretary has used it.
  33. roubs

    roubs Ph.D. Student

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    That's nice, but the term Obamacare makes my eyes roll into the next room and doesn't really prime me for a fact-based discussion of the changes this law will bring, a discussion I agree would be useful. So don't be surprised you got a pie fight.
  34. aequitasveritas

    aequitasveritas PhD

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    In all seriousness I was not trying to be offensive about it; I was not, until now, aware that it is an off-turning title. I also think my OP was fairly balanced with pros and cons.
  35. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    [​IMG]
  36. O Gurl

    O Gurl

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    Someone has already corrected your misstatement about psychology earnings in Canada. The catastrophic impact on reimbursement that your are describing would only affect those who function as glorified master's level therapists. Psychologists' bread and butter in private practice (at least in my region) comes from testing/assessment and evidence based therapies, two domains that are still very much vantage points for our field. The fact that some long-term, non-evidence based modalities may not be covered makes sense, IMO. If a person is in long-term, dynamic therapy for 5 years of self-exploration (for example) then that should be on their own dime. My understanding is that PP psychologists who practice longer term therapies tend to have private pay clients anyway.
  37. O Gurl

    O Gurl

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    :confused:

    You mean therapies with literature to support their efficacy and patients who actually improve and discharge from therapy?
  38. deliciousgoose

    deliciousgoose

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    This is your idea of fair and balanced?

  39. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    I am all for EBTs, and I think treatments like PE and CPT for PTSD are great approaches. My comments were more in regard to medical services outside of the MH arena. I have heard that some hospitals are pushing more groups than individual services, which I think it is a mistake....but I don't think that is a system wide effort.
  40. O Gurl

    O Gurl

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    VA has outranked private care and medicare services in many studies and across several domains from chronic disease care, preventative medicine, and overall patient satisfaction. There was the 2004 study by the RAND corporation that details some of these findings: http://www.annals.org/content/141/12/938.full

    If Canada's reimbursement rates and the VA's quality ratings are the basis of this widespread fear of the President's Affordable Healthcare Act, then the administration is in a good position.
  41. O Gurl

    O Gurl

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    To be clear, I would not pretend to be an expert on the subject of health care reform or policy issues. However, I do think the spirit of the law is in the right place. We live in perhaps the most unhealthy developed nation in the world. Our preventable deaths and health care expenditures are embarrassing considering the economic and educational wealth of the U.S. I have no doubt that any effort to make a sizable change in a system that is as utterly f@*ked up as our current healthcare will have its kinks. I realize this is not a political forum and I actually like and respect a great number of the detractors who posted here. However, I cannot help but sense a certain partisan bias to some of the (as yet unfounded) criticism and fear-mongering about the law.
  42. aequitasveritas

    aequitasveritas PhD

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    Potential and Absolute...because one set is more likely than the other.
  43. aequitasveritas

    aequitasveritas PhD

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    The "correction" was not correct. Aagman simply said he wasnt sure if master's level therapists were lumped in with the term "psychologist". For the record, the term "psychologist" has varying legal requirements by province.

    Do you consider Aagman's rejoinder as hard evidence? So far I've supplied the only data in this thread; limited as it may be.
    Last edited: 03.12.12
  44. slasher magerk

    slasher magerk

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    Limited Data FTW!!!
  45. aequitasveritas

    aequitasveritas PhD

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    Strong 6th post. I'm sure you'll be a real contribution here
  46. O Gurl

    O Gurl

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    No. You have not provided evidence of anything. Your blurb on "absolute negatives" of the affordable healthcare act is then riddled with qualifiers like "may"; "could"; and "likely." You provide a vague WageInfo link for one Canadian province (Alberta) for "psychologists." There is no description of their degree of specialty (PhD vs. PsyD; clinical or academic; private practice or institutional; etc). The overall results table shows that the avg. # of hours worked per week among the sample was 31.5 with an average annual salary of $77K. Uhh.... that actually looks great compared to current US stats for psychologists. And you have the gall to simply ignore comments from those with first hand knowledge of reimbursement rates for PP psychologists in Canada.

    I am not sure what prompted you to post this Chicken Little right-wing rant, but so far your efforts to scare training psychologists into rallying against the health care bill are failing.
  47. aequitasveritas

    aequitasveritas PhD

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    Find other data O Gurl. Rather than simply attacking me because I struck a nerve, try to move the discourse further along. I'm fine being wrong-just provide some corrective data

    Furthermore, you and Aagman are actually supporting my point in the OP, which was that the ACO system would move towards mid-level providers. When Canadian income brackets with their muddied term, "psychologists", evoke you to point out the problem, you actually help me elucidate my prognostication.
    Last edited: 03.12.12
  48. slasher magerk

    slasher magerk

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    I'm sorry, was I just mocked because my posting numbers aren't high enough? You'll have to excuse me if I don't like to get caught up in all the doom and gloom posts/topics that really just end up being cyclical in nature and honestly quite unproductive by the looks of them. I was just trying to add a little humor.

    Take care
  49. cara susanna

    cara susanna Predoctoral Intern

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    It's okay if the psychologists on this board don't fight it, our political lobbying probably wouldn't work anyway and the MDs are fighting it already.

    I still think that this healthcare option is putting a bandaid on a giant, festering wound. Instead of insurance companies denying our claims, it will be the government doing it instead! Big difference!
  50. Psychadelic2012

    Psychadelic2012 PhD Student

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    Status:
    Psychology Student
    SDN 2+ Year Member
    I highly doubt this will ever be the case. Insurance companies aren't going anywhere.

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Style: SDN Universal