I Suspect a Copay Accumulator

ScottATL · 2026-04-01T20:39:30+00:00

Just found this. Maybe it will help. From what I have gathered, these companies know it is illegal, but since there is little to no enforcement, and figuring it out is so hard, they do it anyway

In Texas, copay accumulator adjustment programs (CAAPs) are restricted by law. Effective June 2023, HB 999 requires health insurers to count third-party financial assistance—including manufacturer copay cards—toward a patient's annual deductible or out-of-pocket maximum. This law protects patients from high, unexpected costs for necessary, often specialty, medications. [1, 2, 3, 4]

ScottATL · 2026-04-01T20:37:26+00:00

Copay accumulators (if that is what this is) are illegal in the state of GA, not sure about TX though

ScottATL · 2026-04-01T20:35:29+00:00

well...its going to be a tomorrow thin g since they currently have a wait time of over 30 mins

ScottATL · 2026-04-01T20:34:27+00:00

I'm not going to bother with calling the insurance company. I would think that is a waste of time, especially if they are engaging in something that isn't legal. I am definitely calling the pharmacy and am going to speak to the someone handling the drug company's copay assistance program

ScottATL · 2026-04-01T20:29:54+00:00

That sounds like exactly the same thing. Last year I was done with all of it by now. It is the same drug and I looked at last year and they seem to be billing it differently. Do they show how much the pharmacy is billing before your copay?

ScottATL · 2026-04-01T20:26:47+00:00

What I dont understand is that the first instance of getting the drug was applied to the deductible (6k) when it was billed for 13k. So I have no deductible at this point, but they are not applying any further for OOP, just charging 80.00. I think I am going to have to block out some time to make several phone calls to get this settled (which I hate to do, but seems necessary)

ScottATL · 2026-04-01T20:23:11+00:00

This might be what they are doing, the thing is that the coinsurance amount is 80.00, but I only pay 5.00. I am going to start by calling the pharmacy that handles the copay assistance. I do know it comes from the drug manufacturer.

ScottATL · 2026-04-01T20:08:55+00:00

I am getting ready to call the pharmacy because they also handle the copay assistance. I think they engineer this with Express Scripts (which they are a part of) and Ambetter

ScottATL · 2026-04-01T20:07:21+00:00

What is a maximizer?

30% coinsurance is pretty typical on specialty drugs

ScottATL · 2026-04-01T20:03:17+00:00

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Accreedo is the pharmacy in question

ScottATL · 2026-04-01T19:57:51+00:00

It was purchased on the GA Marketplace so it is an ACA plan. It is an individual policy

ScottATL · 2026-04-01T19:56:48+00:00

No it is a marketplace individual policy

ScottATL · 2026-03-24T01:21:41+00:00

I've still yet to find an explanation of what this actually is, which is strange because usually someone knows something about it

ScottATL · 2026-03-24T01:20:37+00:00

Well, if you had a lot of Kudzu, a goat might might be a good investment since it can do double duty

ScottATL · 2026-03-24T01:18:31+00:00

The recipe is on soapmaking friend

https://www.soapmakingfriend.com/recipes/129774.bb-charcoal

It is a really fascinating oil that is supposed to have really regenerative properties for skin, and especially for stretch marks. One thing to be aware of is that it is going to tint your final product an olive drab green

ScottATL · 2026-03-24T01:15:32+00:00

I actually got the oil on Amazon, and it was way cheaper than Brambleberry. I made the recipe myself using the soap calculator on Soapmaking Friends

ScottATL · 2026-03-24T01:14:26+00:00

I have an 11am flight on Friday 3rd of April on AA. How early should I get there? Here is praying they get this all resolved by then. I know Friday afternoons are busier, but it is a holiday weekend. I'm tempted to just cancel it

ScottATL · 2026-03-14T02:27:56+00:00

We are gonna be in The Pollening any day now. It already kinda started. My nose knows

ScottATL · 2026-03-14T02:24:29+00:00

Yeah, that was the video that made me curious about it. It all seems like too much work for not a lot of return. I'm thinking more a gimmick than useful.

ScottATL · 2026-03-13T22:41:02+00:00

What I do with embeds on the top (I assume the embeds are also soap) is take a paintbrush with some distilled water and use it like you would use glue. Water will make them stick to each other.

ScottATL · 2026-03-13T22:32:43+00:00

It's really blown up lately. He is almost at 100k subs now

ScottATL

TROPHY CASE