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mostlysignssomeportents · 3 hours

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Cigna’s nopeinator

I'm touring my new, nationally bestselling novel The Bezzle! Catch me THURSDAY (May 2) in WINNIPEG, then Calgary (May 3), Vancouver (May 4), Tartu, Estonia, and beyond!

Cigna – like all private health insurers – has two contradictory imperatives:

To keep its customers healthy; and

To make as much money for its shareholders as is possible.

Now, there's a hypothetical way to resolve these contradictions, a story much beloved by advocates of America's wasteful, cruel, inefficient private health industry: "If health is a "market," then a health insurer that fails to keep its customers healthy will lose those customers and thus make less for its shareholders." In this thought-experiment, Cigna will "find an equilibrium" between spending money to keep its customers healthy, thus retaining their business, and also "seeking efficiencies" to create a standard of care that's cost-effective.

But health care isn't a market. Most of us get our health-care through our employers, who offer small handful of options that nevertheless manage to be so complex in their particulars that they're impossible to directly compare, and somehow all end up not covering the things we need them for. Oh, and you can only change insurers once or twice per year, and doing so incurs savage switching costs, like losing access to your family doctor and specialists providers.

Cigna – like other health insurers – is "too big to care." It doesn't have to worry about losing your business, so it grows progressively less interested in even pretending to keep you healthy.

The most important way for an insurer to protect its profits at the expense of your health is to deny care that your doctor believes you need. Cigna has transformed itself into a care-denying assembly line.

Dr Debby Day is a Cigna whistleblower. Dr Day was a Cigna medical director, charged with reviewing denied cases, a job she held for 20 years. In 2022, she was forced out by Cigna. Writing for Propublica and The Capitol Forum, Patrick Rucker and David Armstrong tell her story, revealing the true "equilibrium" that Cigna has found:

https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance

Dr Day took her job seriously. Early in her career, she discovered a pattern of claims from doctors for an expensive therapy called intravenous immunoglobulin in cases where this made no medical sense. Dr Day reviewed the scientific literature on IVIG and developed a Cigna-wide policy for its use that saved the company millions of dollars.

This is how it's supposed to work: insurers (whether private or public) should permit all the medically necessary interventions and deny interventions that aren't supported by evidence, and they should determine the difference through internal reviewers who are treated as independent experts.

But as the competitive landscape for US healthcare dwindled – and as Cigna bought out more parts of its supply chain and merged with more of its major rivals – the company became uniquely focused on denying claims, irrespective of their medical merit.

In Dr Day's story, the turning point came when Cinga outsourced pre-approvals to registered nurses in the Philippines. Legally, a nurse can approve a claim, but only an MD can deny a claim. So Dr Day and her colleagues would have to sign off when a nurse deemed a procedure, therapy or drug to be medically unnecessary.

This is a complex determination to make, even under ideal circumstances, but Cigna's Filipino outsource partners were far from ideal. Dr Day found that nurses were "sloppy" – they'd confuse a mother with her newborn baby and deny care on that grounds, or confuse an injured hip with an injured neck and deny permission for an ultrasound. Dr Day reviewed a claim for a test that was denied because STI tests weren't "medically necessary" – but the patient's doctor had applied for a test to diagnose a toenail fungus, not an STI.

Even if the nurses' evaluations had been careful, Dr Day wanted to conduct her own, thorough investigation before overriding another doctor's judgment about the care that doctor's patient warranted. When a nurse recommended denying care "for a cancer patient or a sick baby," Dr Day would research medical guidelines, read studies and review the patient's record before signing off on the recommendation.

This was how the claims denial process is said to work, but it's not how it was supposed to work. Dr Day was markedly slower than her peers, who would "click and close" claims by pasting the nurses' own rationale for denying the claim into the relevant form, acting as a rubber-stamp rather than a skilled reviewer.

Dr Day knew she was slower than her peers. Cigna made sure of that, producing a "productivity dashboard" that scored doctors based on "handle time," which Cigna describes as the average time its doctors spend on different kinds of claims. But Dr Day and other Cigna sources say that this was a maximum, not an average – a way of disciplining doctors.

These were not long times. If a doctor asked Cigna not to discharge their patient from hospital care and a nurse denied that claim, the doctor reviewing that claim was supposed to spend not more than 4.5 minutes on their review. Other timelines were even more aggressive: many denials of prescription drugs were meant to be resolved in fever than two minutes.

Cigna told Propublica and The Capitol Forum that its productivity scores weren't based on a simple calculation about whether its MD reviewers were hitting these brutal processing time targets, describing the scores as a proprietary mix of factors that reflected a nuanced view of care. But when Propublica and The Capitol Forum created a crude algorithm to generate scores by comparing a doctor's performance relative to the company's targets, they found the results fit very neatly into the actual scores that Cigna assigned to its docs:

The newsrooms’ formula accurately reproduced the scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points of the number generated by this formula. When asked about this formula, Cigna said it may be inaccurate but didn’t elaborate.

As Dr Day slipped lower on the productivity chart, her bosses pressured her bring her score up (Day recorded her phone calls and saved her emails, and the reporters verified them). Among other things, Dr Day's boss made it clear that her annual bonus and stock options were contingent on her making quota.

Cigna denies all of this. They smeared Dr Day as a "disgruntled former employee" (as though that has any bearing on the truthfulness of her account), and declined to explain the discrepancies between Dr Day's accusations and Cigna's bland denials.

This isn't new for Cigna. Last year, Propublica and Capitol Forum revealed the existence of an algorithmic claims denial system that allowed its doctors to bulk-deny claims in as little as 1.2 seconds:

https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims

Cigna insisted that this was a mischaracterization, saying the system existed to speed up the approval of claims, despite the first-hand accounts of Cigna's own doctors and the doctors whose care recommendations were blocked by the system. One Cigna doctor used this system to "review" and deny 60,000 claims in one month.

Beyond serving as an indictment of the US for-profit health industry, and of Cigna's business practices, this is also a cautionary tale about the idea that critical AI applications can be resolved with "humans in the loop."

AI pitchmen claim that even unreliable AI can be fixed by adding a "human in the loop" that reviews the AI's judgments:

https://pluralistic.net/2024/04/23/maximal-plausibility/#reverse-centaurs

In this world, the AI is an assistant to the human. For example, a radiologist might have an AI double-check their assessments of chest X-rays, and revisit those X-rays where the AI's assessment didn't match their own. This robot-assisted-human configuration is called a "centaur."

In reality, "human in the loop" is almost always a reverse-centaur. If the hospital buys an AI, fires half its radiologists and orders the remainder to review the AI's superhuman assessments of chest X-rays, that's not an AI assisted radiologist, that's a radiologist-assisted AI. Accuracy goes down, but so do costs. That's the bet that AI investors are making.

Many AI applications turn out not to even be "AI" – they're just low-waged workers in an overseas call-center pretending to be an algorithm (some Indian techies joke that AI stands for "absent Indians"). That was the case with Amazon's Grab and Go stores where, supposedly, AI-enabled cameras counted up all the things you put in your shopping basket and automatically billed you for them. In reality, the cameras were connected to Indian call-centers where low-waged workers made those assessments:

https://pluralistic.net/2024/01/29/pay-no-attention/#to-the-little-man-behind-the-curtain

This Potemkin AI represents an intermediate step between outsourcing and AI. Over the past three decades, the growth of cheap telecommunications and logistics systems let corporations outsource customer service to low-waged offshore workers. The corporations used the excuse that these subcontractors were far from the firm and its customers to deny them any agency, giving them rigid scripts and procedures to follow.

This was a very usefully dysfunctional system. As a customer with a complaint, you would call the customer service line, wait for a long time on hold, spend an interminable time working through a proscribed claims-handling process with a rep who was prohibited from diverging from that process. That process nearly always ended with you being told that nothing could be done.

At that point, a large number of customers would have given up on getting a refund, exchange or credit. The money paid out to the few customers who were stubborn or angry enough to karen their way to a supervisor and get something out of the company amounted to pennies, relative to the sums the company reaped by ripping off the rest.

The Amazon Grab and Go workers were humans in robot suits, but these customer service reps were robots in human suits. The software told them what to say, and they said it, and all they were allowed to say was what appeared on their screens. They were reverse centaurs, serving as the human faces of the intransigent robots programmed by monopolists that were too big to care.

AI is the final stage of this progression: robots without the human suits. The AI turns its "human in the loop" into a "moral crumple zone," which Madeleine Clare Elish describes as "a component that bears the brunt of the moral and legal responsibilities when the overall system malfunctions":

https://estsjournal.org/index.php/ests/article/view/260

The Filipino nurses in the Cigna system are an avoidable expense. As Cigna's own dabbling in algorithmic claim-denial shows, they can be jettisoned in favor of a system that uses productivity dashboards and other bossware to push doctors to robosign hundreds or thousands of denials per day, on the pretense that these denials were "reviewed" by a licensed physician.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/04/29/what-part-of-no/#dont-you-understand

#pluralistic #cigna #computer says no #bossware #moral crumple zones #medicare for all #m4a #whistleblowers #dr debby day #Madeleine Clare Elish #automation #ai #outsourcing #human in the loop #humans in the loop

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escapedaudios · 2 days

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New audio, my first upload in a long time! This is a psychological horror audio that might maybe possibly have a happy ending.

Featuring Streaky Audios!

youtube

#escaped audios #audio roleplay #horror asmr #streaky audios #CW: Everything #Youtube #M4A #M4A audio

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liberalsarecool · 4 months

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We need Medicare For All. Remove profit from health care. End medical debt.

Your tax dollars should cover your needs.

#medicare for all #m4a

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odinsblog · 2 years

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“Christian” nationalism

#politics #republicans #hiv/aids #homophobia #christofascism #religious reich #m4a #healthcare #medicare for all #christian evangelicals #republicans are evil

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politijohn · 10 months

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Source

Privatized health care is a scam. Check your claims. Get the healthcare you deserve. Make your provider do what they’re supposed to.

#health care #health #important #capitalism #Medicare for all #m4a #universal health care

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wjtysghjfg · 5 months

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Hm? Oh nothin, just the roster of my favorite ASMR-ists

Insert @goodboyaudios peekin around the corner (I could not fit in into the SS)

#redacted audio #reverie audios #castle audios #yuurivoice #good boy audios #character ASMR #M4A #M4F #M4M #boyfriend asmr #girlfriend asmr

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cynnkk · 5 months

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audios

here I'll compile some of my favourite audiop*rn content

msub / bfe audios

they're going to be appropriately tagged

mostly soundgasm links, some will redirect to their reddit page

M4A / M4F

all audios can be found on the gwa subreddit

one post of mine on the topic

personal note: listening to audios is a safe and controlled way to explore kinks, sexual preferences or even simple non sexual intimacy. keep in mind that you don't know the performers and they don't know you. exercise caution when interacting with them to avoid unpleasant experiences.

be mindful of your safety on the

internet.

a t*u*m*b*l*r post with multiple audios that I like

u/defrosted is definitely one of my faves,, his whole msub content is top notch so I might as well link the page (it's not updated but his account is right there so a little search and we're set)

lovely guy sucking on a strap,, this is how I want my men to be (cw: begging, strap on, pegging)

chubby subby men deserve love too (cw: pegging)

[M4F] I Love C*umming On Mommy's C*ock (tags inside)

[M4F] Sick Days - Taking Care Of Your Needy House Husband] (tags inside)

breaking in your new d*ick on the cute salesman - salesman goes door to door to sell sex toys and meets listener, who is down for ANYTHING {cw: [M4F] [Msub][Fdom]["real" fake dick][pegging][strap on][gagging][c*um swallowing][b*lowjob][c*reampie][LOTS of begging][degredation][dirty talk][needy][sex toy][wet sounds]}

I have a soft spot for this bc he also speaks in italian which is my native language: Finalmente Insieme (translation Together, at last) [tags: [M4F] [Bilingual] [English] [Italian] [BFE] [MSub] [FDom] [Edging] [Making love] [Kisses]

[M4F] Interviewing to become your sub [Msub] ["Mommy"] [C*unnilingus] [A*nalingus] [Br*east play] [Riding me] [Cumming inside you] [41 minutes] (A MASTERPIECE I TELL YOU)

the sequel to the mastepiece above

subby boyfriend MISSES YOU SO BAD 😞 [M4F][voicenote] [improv] [mommy mentions] [praise] [overstimulation] [wet sounds]

Mommy’s Puppy Leaves Her A Voicemail To Help Her Get Through The Day [Established Relationship] [M4F] [Voicemail] [MSub] [Shy to Desperate] [Masturbating] [Fleshlight] [Sloppy] [Begging] Mentions of [Cunnilingus] [Vaginal Sex] [Blowjobs] [Pillow Humping] [“Puppy”] [“Mutt”] [“Mommy”]

Confident Boy Has A Sub Side [M4F] [Msub][Confident To Submissive Speaker][Calling You Mommy By Accident][Swallowing Your Spit][Grinding On My Lap Without Wearing Panties][Sucking On Your Nipples While You Ride Me][Cumming On My Cock After I Came Inside Of You][Cunnilingus After Creampie]

Shower Fucking the Angst Out of Your Discouraged Friend [M4F] [Shower Fucking the Angst Out of Your Discouraged Friend] [Msub] [Soft Fdom] [Friends to Lovers] [Shower Sex] [Anxious Speaker] [Closed Off] [Handjob] [Neck Kisses] [Begging] [Desperate] [Good Boy] [Affirmations] [Pussy Eating] [Worship] [Praise] [Riding] [Kissing] [Finger Sucking] CW: (Speaker discusses feelings of anxiety, despair, hopelessness, nothing mattering and the world being messed up. He feels guilty that Listener is helping him and doesn't want to accept at first that something is wrong)

turning your JEALOUS bf into your SUBBY fucktoy <3 [M4F] turning your JEALOUS bf into your SUBBY fucktoy [VERY MSUB] [Whiney] [Begging] [Whimpers] [Self-Degradation] [Facesitting] [Handjob] [Riding] [Overstimmed Speaker] [Multiple Speaker and Listener Orgasms] [Tit-Sucking] [Mommy] [Puppy] [Good boy] [Jealous Speaker] [Creampie] [Aftercare]

#nay's audios #msub #msub audios #male sub #dom x sub #dom! listener #sub!speaker #m4f #m4a #fdom #gentle fdom

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smoking-witch · 21 days

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Reframing common employer phrases into plainspeak

Laziness = poor ppl resting/playing, ever

Working vacation = rich ppl getting paid to rest/play

Rage applying = looking for a better job

Rage quitting = leaving toxic job/boss

Quiet quitting = refusing to do free labor

Blackmail = employees leveraging anything

Insubordination = talking about pay at work

Company culture = guilt trips & pizza as pay

Morality clause = make us look bad, get fired

"We're like family" = "we ask for favors, then never pay you back"

"We expect everyone to pitch in" = "we expect you to do free labor"

"HR is here to help you" = "HR is here to stop you from suing us"

Thx for coming to my TedTalk

#fishy business #antiwork #anti work #universal basic income #m4a #democratic socialists of america #democratic socialism #calcare #workers of the world unite #workers rights #labor rights #zero profit #worker cooperative #worker coop #tenant union #tenants' rights #tenants' union #union organizing

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avocadofics · 1 year

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Dealing with the executive function

Aizawa x autistic reader

This is for my fellow autistic. Not to romanticize asd but because we don’t have enough media design especially for us. And I want to write fanfic that I can be comforted by on days when my adhd and asd traits make it hard

Synopsis: the reader is having bad executive functions and feel shitty aizawa come home to comfort reader.

Content Warning: executive function problems, anxious thoughts, crying, mentions of forgetting to eat, self doubt. Stay safe friends

You laid on back to the floor. Giving off sighs and a few tears. You had things to do but they were the things you hated doing. You remember shota mentioned something about needing it done. So what did you do?

Spend the majority of the day fighting youself to get started doing anything. You wanted to cry.

You didn’t want to disappoint shota but you felt like you most definitely were. What time was it even? would shota be home soon to see you’ve done nothing.

Oh what about dinner. You haven’t made dinner. Each second of time just added more stress to your list. A tear or two fell from your eyes. While you were laying there crying The cat walked over and plopped himself on your chest. Choco your cat had alway been in tune with your emotions and the weight from the cat helped you breath even if just a little.

“Hey choco, you think shota is gonna be annoyed at me?”

“Mreow”

“Yeah probably not. Doent mean I can’t sit here and think that way” of course right as you started to feel slightly better was when you heard your front door open and the footsteps of you boyfriend walking.

“Why,” his voice spoke up “Are you on the floor?”

“Bad romantic partner with no emotional energy to deal with anything sit in floor. Floor make thing better” you tired looking boyfriend sat down next to you and started petting the cat.

“What’s the problem.” That one thing you appreciated about shota he was never one to beet around the bush. If he knew you were upset hed ask you once if you didn’t want to answer now he’ll ask you later.

“The Chores. All the thing you ask me to do. I spent all day fighting myself cause I hate doing them and I just did nothing today at all.” Your could feel your tears starting to get bigger in your eyes.

“When did you eat last,”

“Huh?”

“When did you eat last,”

“Breakfast I think I don’t remember if I ate lunch or not.” He gave me one of his gentle sighs and stands up.

“Okay up. I’m going to have you go lie down while I make food and do a few chores.”

“But you just got home from work and guy normally take a nap so you can feel decent enough for hero work tonight.” You say staring up at him as he stood above you.

“I’ll see if anyone can cover my zone tonight. You are overwhelmed and I’m not gonna let you deal with it alone. If I got to tired from work you would call up the school and make them give me a day off. I think me taking one night from hero work to support my partner is aloud.” He put his hand down waiting for you to grab it.

“Okay,” you grabbed his hand and he helped you up. You headed to the bedroom exhausted from fighting yourself mentally. You wrapped yourself in a blanket and opened you phone to watch something.

Shota walked in behind you where he switches his hero clothes and puts in some grey sweatpants and a t-shirt you had bought him.

After a few minutes you smell the amazing sent of one of your safe foods. The one you’ve been talking about the last few days but just haven’t had the energy to make it. You were glad that he was taking the night off. Night where shota took time off meant cuddles and getting to rewatch shows while eating yummy food.

Shota walked in and handed you a plate. He moved his way into his side of the bed.

“Thank you shota,”

“Anytime.” You leaned into shota and he wrapped an arm around you.

#aizawa #aizawa x reader #aizawa shota x reader #aizawa shōta x reader #shota x reader #shōta x reader #x reader #fanfiction #autistic #x autistic reader #writing #m4a #aizawa x autistic reader #mha x reader #mha #my hero academia x reader #bnha x reader #Boku no hero x reader #mha x autistic reader

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auralsexx · 8 months

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Masturbation fantasy. If you have an ass, this one's for you.

#nsft audio #nsft audio aural sex #m4a #M4W #M4M #male reader #male moan

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liberalsarecool · 27 days

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The idea of profit in health care. The idea of losing your health care. The idea of children not receiving health care. The idea of medical debt.

We are the ONLY country who legisltates this.

#medicare for all #m4a

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odinsblog · 7 months

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Welcome to America. If you’re poor, you’re dead. And it ain’t “inflation” that’s killing you, it’s corporate greed + government policies that, even in a pandemic, favor capitalism over human lives

👉🏿 https://theintercept.com/2021/09/07/joe-manchin-epipen-price-heather-bresch/

#politics #mediicare for all #profitized healthcare #privatized healthcare #capitalism #joe manchin #heather bresch #corporate greed #corporate profits #epipen #healthcare #m4a

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mirnsey · 2 months

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When he would care less about you but he could be obsessed with you and how you feel all the time, 24/7, 365, at a 100%

When he would literally watch you burn if he came to it, but he could hold your hand while running his thumb over your knuckles

He would literally be the cause of your torment, but he could give you a back massage after a long day

When he literally is a monstrous excuse for a human, that barely resembles one in both looks and morality, but, he could beg for you to cum on his fat stupid cock

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politijohn · 11 months

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Source

#Health #health care #politics #us politics #government #the left #progressive #Medicare for all #universal health care #m4a #current events #news

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maximum18 · 5 months

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Hello again, my Bunny- Chan part 1

Yandere Naga x Lapicentaur reader

Warning ⚠️!!:

Cursing

Info:

Your a Lapicentaur ( for those who don’t know, you’re a half human bunny ) Lapicentaurs are rare and mostly treated as pets. Nagas on the other hand are very common, but rare to find or see, there not treated as pets like Lapicentaurs, Naga are treated like a dangerous animal. You had recently escaped the animal control. And you ended up injured and lost in the woods.

History/backstory:

Before you were captured by the animal control, you would play with a naga called Ibha, but you called him night because his scales were breach black. Ibha was your best friend.

Personality:

Ibha:

When you were with him, he was lazy, possessive, angry, cocky, and jealous. He is over confident, and thinks he can do whatever he wants.

Y/n:

Your nice, confident, brave, smart and loyal. You will help anyone. And can be bratty.

Appearance :

Ibha as a kid:

He as tan skin, black scales and hair, yellow eyes and one scar on his cheek.

Ibha as a adult:

He looks the same but as a lot of scars.

Y/n as a kid:

You were very small. You have y/e color eyes, and y/h. You have pale skin.

Y/n as an adult:

Your still small. You have long hair, large ears and a scar on your nose.

Nicknames:

Idha:

Night

Dark

Y/n:

Little bunny

Bunny

Bun bun

Bonnie

Bunny-Chan

Shorty

———————————————————————————

You were running from the animal control, you couldn’t go back there again. You managed to lose them, but got lost in the process.

You sat down and looked at your injury on your foot. It hurts like hell, but it was manageable. Your ears puckered up. You didn’t pay attention to the noise. You wished you did.

A long tail wrapped around your body. Not even to hurt you but made sure you were unable to move.

“Hello my little Bunny-Chan~~”

You know who this voice belonged to….Idha

“Idha it’s good to see you” you said nervously. Idha moved closer to you.

“Mm you look surprised to see me.”

“You shocked me, that’s all.” You pouted.

“Well, little bunny you’re in my territory, you’re lucky I didn’t kill you.” He says softly.

“Sorry Idha, I didn’t know. Now can you let me go?” You ask. Ibha leaned closer to you.

“No.”

“Oh come on Idha.”

“No, I haven't seen you in years, and now.” Idha paused. “I have you.”

“What does that mean? I'm not going anywhere.”

Idha looked angry.

“Did you forget what I told you before you got taken.” Idha said angrily.

Flashback:

You were sitting down under a tree, reading a book. Idha suddenly came to you. He looked nervous.

“What’s wrong Idha?” You asked worried. You’ve never seen Idha nervous before.

“Y/n, I…I uhh I think I … like you.”

You smile.

“Ohh Idha you had me worried fo—“

“NO, I didn’t…. I didn’t mean that type of like.”

Idha started looking mad.

“Ohh, that type of like.” You blushed.

“Do you like me too?”

You thought for a moment.

“Yeah! I like you too!”

Idha looked relieved.

“Good! Now you have to promise me, when we’re older, we’re get married!”

“I promise Idha!”

End of flashback

“We were kids, kids made promises that they don’t do.”

Idha liked pissed. His tail tightens up.

“Well, guess what! I waited for you, to come back!!”

“Idh—-“

“NO! You’re going to marry me, and you won’t do shit!!” He yelled angrily.

Continued

#yandere #x reader #story #to be continued #part 1 #m4a #yandere x reader

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