Swimming with sharks

An Arm and a Leg

Society & Culture, Medicine, Health, Health & Fitness, Documentary

4.8 • 1.1K Ratings

🗓️ 10 March 2022

⏱️ 26 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Pharma and insurance companies play devious, clever games, competing for dollars. They’re sharks! It’d be fun to track, but they’re eating us alive.

If anyone could beat the sharks at this game, we’d pick Lillian Karabaic, who runs the personal finance show/community called Oh My Dollar! — and is SUPER on-top-of her stuff.

But Lillian recently got socked with an unexpected $3,000 charge— and expects to lose her very-organized fight against it.

Understanding how Lillian got here — how pretty much any of us could, and how we can start to fight back, together — means understanding the games these big sharks are playing.

Which is exactly what we do in our latest episode, with Lillian’s expert — and often very-funny — guidance.

This episode goes deep on a shark game called a “copay accumulator” policy. In short, they’re an invention by the insurance industry to make sure only YOUR money counts toward your yearly deductible — not any assistance you may receive from a drug company.

One thing we learned: Finding out if your insurance plan even includes one of these policies can be extremely tough: Otherwise, Lillian — who did her extremely-good best to check for this very information — wouldn’t have gotten taken by surprise.

We’ve got a little bit of help to offer: Researchers from a nonprofit called The AIDS Institute also researched this question, looking at hundreds of plans across the country. And they developed a tip sheet a tip sheet to help guide their search: How to search online, what questions to ask if the information just isn’t online (which happens).

More resources:

For tips on how to avoid overpaying for drugs — when that’s possible — check out the latest edition of our First Aid Kit newsletter.
There’s a third bunch of sharks involved in this drug-pricing game: Middleman companies called Pharmacy Benefit Managers. If you want to understand the role they play, here’s an Arm and a Leg episode about them.
A dozen states have banned copay accumulators, and more are considering it. This short report includes a list of those dozen states.

Here’s a transcript of the episode.

Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG

And of course we’d love for you to support this show.

Hosted on Acast. See acast.com/privacy for more information.

Transcript

Click on a timestamp to play from that location

0:00.0	Hey, there. Here's the thing about Lillian Carebeck. I talk sometimes about building a dojo,
0:05.4	like a self-defense training school for dealing with the horrible cost of health care.
0:09.6	And, you know, it's a metaphor, a work in progress, a metaphor in progress.
0:14.4	Lillian is a black belt in this stuff. In fact, she's a teacher. I asked her to introduce
0:20.0	herself and she says, I'm Lillian Carebeck and I am a podcast and YouTube host that talks about
0:26.1	personal finance and unfortunately, a lot of the time that has to do with health care.
0:30.4	Lillian comes by all of this so honestly. She's always been good with the dollar and she's had to be.
0:36.4	One, because she's always wanted to do good things. She spent her 20s working for nonprofits,
0:41.0	which doesn't pay a lot. And two, because she's got rheumatoid arthritis,
0:46.0	started having symptoms when she was 18. Couldn't hold a pen. So, unlike people who are young and
0:52.3	indestructible, she experienced herself as being pretty destructible and as needing to think hard
0:58.8	about the financial side of health care, especially when she finally got access to a drug called
1:04.3	Enbrel. Within about three weeks, I went from not able to make a fist to like 99% symptom free.
1:11.7	It was spectacularly life-changing for me. I was like, other people live like this? You can just like
1:17.5	open door knobs. Yeah, but Enbrel was not cheap. Lillian says it was like 800 bucks a month when
1:25.8	she started taking it in 2015, which on her income or on most people's income, it's a lot of money.
1:31.3	When I went into covering personal finance, it just, yeah.
1:36.0	Health care is such a large freaking part of it. And the stakes for her have only gotten higher.
1:41.6	Right now, Enbrel's list price is about $12,000 a month. Yeah, it's gone from $800 a month to
1:49.2	$12,000. That's 15 times more expensive than it was seven years ago. Lillian plans and plans,
1:56.4	like she had to pick new insurance recently. She went over the options with a fine tooth comb.
2:01.5	And in January, with new insurance, she's got a whole routine of chasing the pre-authorization
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from An Arm and a Leg, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of An Arm and a Leg and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.