Anthem blue cross blue shield inr equipment

[Watermelon]

Could anyone please help me to find out which durable medical equipment company is in network with Anthem. I have this big problem and noone from Anthem could help. My Inr is not stable and doctor office only tested every 2 weeks or so. I used to have MD INR but next month it will not be in contract with anthem. Anthem Blue Cross Blue Shield give me a list of 100 providers but I called them no no none of them had the INR monitor. I'm new to this for a room I hope someone would help thank you have a good day

 

[MdaPA]

Could anyone please help me to find out which durable medical equipment company is in network with Anthem.

As it appears you are in the U.S., unless you want to get your equipment/supplies on the 2nd market (e.g. ebay), you will need to go through a monitoring service (some here use Philips BioTel service).

See below link for more info re: this:
home-testing

 

[unckle-t]

i have BCBS tx and use mdinr.com and use a CoaguChek#XS and test weekely been testing with them they bought out the first company i used and been doing it now for 10 years it has never cost me anything

 

[TGM]

I’ve been shopping around for a supplier as well. I have Aetna and there is only one in-network provider (Acelis) whom I can no longer work with due to their rigid policies regarding the frequency and number of slides they will send. They refused to send me more supplies when my son had surgery and after bridging, needed to test much more frequently. I called Phillips and MDINR and found Phillips to be more flexible and very informative over the phone. They are out of network for me but I will probably just suck it up and pay the 30%. Good luck in your search for providers and be sure to learn about their monitoring policies.

 

[Aquila]

I can empathize as I was in the same predicament at one point. I started with Roche Coaguchek Patient Services and found out with my first claim that it was deemed an out of network provider even though they had verified my insurance and told me the network coverage rates. I sought help from insurance customer service and was given the useless list of 'durable medical equipment' suppliers in my area. From my searches at the time, the handful of home INR service providers I found operated nationally, and it seems the trend has been consolidation toward fewer providers. My out of network predicament was resolved when RCPS was bought by Biotel. Biotel was subsequently bought by Philips.

My insurance is a self-funded plan through my employer that is administered by Anthem. I note that as a caveat in case there are different provisions among different Anthem BCBS plans, but perhaps there is some alignment in network providers. My provider is Philips Remote INR by Biotel which was in network. However, their billing switched to Cardionet (i.e. subsidiary in same company but with a different NPI provider code), and fortunately the Cardionet NPI is still in network for my plan.

US claim filing is for every 4 tests reported per procedure code G0249. The prescription from your doctor to begin service outlines a frequency range such as 2 to 4 times per month. In practice, this constrains US insurance-covered home INR testing to at least every two weeks but no more than once weekly as stated in G0249 guidance. I don't know how they would handle two consecutive claims filed less than 4 weeks apart.

At some point I decided to purchase my own meter and test strips through ebay so that I rely on a combination of home INR reporting to my doctor/clinic via the provider and unreported personal meter results. Thus, I 'informally self-manage' to my target INR with more freedom in how frequently I test.

 

[Protimenow]

It looks like you're already self-testing, Self management shouldn't that big a challenge -- there are people (Pellicle and maybe others) who can help you self manage BETTER than a service or doctor's office (if your doctor is okay with testing every two weeks, you aren't getting the best management).

The biggest challenge you may encounter is getting a doctor to write prescriptions for warfarin. If you keep records of the date of each test, test results, and dosage, you should be able to convince most doctors that you are able to manage your INR by yourself.

 

[slipkid]

I can empathize as I was in the same predicament at one point. I started with Roche Coaguchek Patient Services and found out with my first claim that it was deemed an out of network provider even though they had verified my insurance and told me the network coverage rates. I sought help from insurance customer service and was given the useless list of 'durable medical equipment' suppliers in my area. From my searches at the time, the handful of home INR service providers I found operated nationally, and it seems the trend has been consolidation toward fewer providers. My out of network predicament was resolved when RCPS was bought by Biotel. Biotel was subsequently bought by Philips.

My insurance is a self-funded plan through my employer that is administered by Anthem. I note that as a caveat in case there are different provisions among different Anthem BCBS plans, but perhaps there is some alignment in network providers. My provider is Philips Remote INR by Biotel which was in network. However, their billing switched to Cardionet (i.e. subsidiary in same company but with a different NPI provider code), and fortunately the Cardionet NPI is still in network for my plan.

US claim filing is for every 4 tests reported per procedure code G0249. The prescription from your doctor to begin service outlines a frequency range such as 2 to 4 times per month. In practice, this constrains US insurance-covered home INR testing to at least every two weeks but no more than once weekly as stated in G0249 guidance. I don't know how they would handle two consecutive claims filed less than 4 weeks apart.

At some point I decided to purchase my own meter and test strips through ebay so that I rely on a combination of home INR reporting to my doctor/clinic via the provider and unreported personal meter results. Thus, I 'informally self-manage' to my target INR with more freedom in how frequently I test.

Be careful about the whole Philips/Biotel/Biotelemetry/Cardionet vs Anthem BC/BS situation.

I am now in a huge mess caused by Philips/Biotel/Cardionet/whatever they call themselves or bill as starting in 2022 because they stopped billing Anthem BC/BS (like they did with me in 2021) and instead started billing some "local" to them branch of BC/BS called "Blue Shield of CA" who keep denying all of their claims.

This has been going on for almost 2 YEARS only now is finally resulting in Philips/Biotel/Biotelemetry/Cardionet billing ME directly for those denied charges bypassing my insurance completely.

I have gotten nowhere with them in the past 4 months in trying to get this ironed out and seems as if their own billing reps do not have the slightest idea of what they are doing (nor do they care).

Not to mention that after doing a lot of research into this company by all their names that I know of I have discovered many other patients with similar problems, that their billing is both crooked and dysfunctional, that they jump to collection agencies to pressure patients into paying inflated charges, and that they have even been pressured themselves by the US Dept of Justice just last December into paying $44 MILLION to "make up" for improperly billing Medicare, the VA, etc and violating something called the False Claims Act.

Stick with your ebay unit and self test rather than risk getting sucked into the mess that I am in now....

 

[pellicle]

Hi

I'm new to this for a room I hope someone would help thank you have a good day

I stayed out of this because I'm not American and know nothing about US insruance., but as this was said:

Stick with your ebay unit and self test rather than risk getting sucked into the mess that I am in now....

and appears to be seconded by this member (well, firsted, but)

I have a CoaguChek that I bought new on eBay in 2014. I also buy my strips on eBay. I test every 7-10 days. Have been on warfarin since June 2003. Got my first INR monitor on Nov. 26, 2003. I have never had to report INRs to a 3rd party.

and its what I do here and is what I know a number of other members do too.

Think about it. If your only hesitation is "how do I do the dosing and adjustment, then reach out by a private message ("Conversation") to me and I'll show you.