authorization

[caterb85]

Has anyone had a difficult time getting the Dr. to give your insurance a authorization so that you coud get your home monitor. Neither of my husbands Dr.s (pcp, or card.) will send on to our insurance even though they would pay it 100% if they would send one. He has been on coumadin for three years and will be on it for the rest of his life.(Has St. Jude aorta valvue.

 

[Protimenow]

This forum seems to be filled with similar complaints about doctors refusing authorization for monitors or home testing. Some doctors just don't seem to believe that home testing works - although there are many papers that contradict this claim.

Aside from ignorance about the ability of many patients to do self testing (and even anticoagulation management), there are reasons why some doctors refuse to give the authorization for the meter purchase. One reason for refusing is that the doctors may not be convinced that the patient would be able to successfully do the self-testing. Not knowing your husband, I'm certainly not going to assume that this is true, but it's a possible reason for the refusal. I don't know if this is the case -- it may help if you can get some of the research papers that document how much better people control their INRs when they do self-testing than when they need less frequent lab blood draws. (I don't have links at my fingertips, but there may be papers at the websites for each of the meter makers).

You might ask your doctors about anticoagulation clinics (I'm assuming that your cardiologist sends your husband to a lab). This may be easier to handle. Once your doctor sees that the small meters DO work, and that it's possible to effectively manage your husband's INR, you may be able to convince the doctor to authorize the meter and call the results in for dosing advice.

You might want to talk to Alere or Philips, which work regularly with doctors and insurance companies, and may give you some advice on how to convince your doctor that your husband should self-test.

Good luck with your challenge. I'm looking forward to hearing that you've successfully convinced one of the doctors that your husband should have a meter, that he CAN effectively self-test, and that a LOT of people taking warfarin are doing it very successfully.

 

[caterb85]

We did give the Dr. some statistics and papers on selftesting and I must say that we have been managing his dosing kind of on our own through the web calculator because of the Dr.s ignorance. There has been many times that he would tell him to skip several daysif it was a little high and when he would be retested a week later even with him not skipping a dose and it would be back in range. One time when this happened the nurse asked what his dosing was for the last week and when I told her that he halved two days instead of skipping she grumbled at me even though it was to low doing our way. This does get very frustrating, that is why we would like to home test instead of going through the Dr.

 

[Philip B]

Authorization?

Authorization?

Give some thought to changing doctors. There are probably other doctors who will be more responsive to your husband's needs.

-Philip

 

[Protimenow]

I agree with Philip. If your doctor doesn't understand dosing or appreciate the fact that you can test or manage at home, you should try to find one who is more enlightened about it. I'm assuming you have insurance, but this may not mean you can't call doctors on a provider list and ask about their positions on home testing before you make the switch.

 

[lance]

First I would find out the reason he's doing what he's doing and then you'll be able to deal with it. I had a similar problem with my POC too--he wouldn't write the necessary prescription for the monitor. I found a hospital that uses them and they trained me.
I hope this helps.

 

[olefin]

I'd ask what's the reason and if they still refuse I'd find a new physician.

My previous cardio wasn't over joyed with home testing. I was his first patient that home tested. After problems with his wife about billing to Medicare I soon found another cardio that thinks home testing is great. He did comment that he wouldn't approve home testing for some of his patients.

I used Alere Home Monitoring and received approval from Medicare within a week. A trainer from Alere delivered the monitor to my home.


Good luck!

 

[caterb85]

He told us that he doen't feel that they are as accurate as the other testing even though he gets the stick test anyway as long as it isn't over 4.0, then he gets a draw.

 

[Jkm7]

Cater,
Do you test at his office or at a hospital or independent lab?

 

[Protimenow]

The odd thing to consider is that lab tests are also not always 'accurate.' The reading has built-in variables -- the value of the thrombin being used and how the blood is collected and handled can also make a minor difference. Although the meters may not be quite as accurate, there are many articles that show good correlation with lab draws (especially below 4 or so), and the meters are adequate for verifying that a person is in range. Thousands of practitioners use and trust these meters...and for high values, it's always good to do a lab test for confirmation.

 

[caterb85]

jkm7, he doesn't go to the pcp but to a local health campus and then they call in the reading to the pcp.

 

[Jkm7]

That takes away a financial consideration, then. I was speculating there could have been a monetary incentive to continue having his patients test in his office.

I'm frustrated for you. It seems so 'backward' to not allow his competent patients to be proactive in their own care.
Some people probably are not capable or even interested in self-testing but many are more than able.

Good luck. I hope you find the magic formula to get one or the other of DH's doctors to write the authorization.

 

[caterb85]

The Drs office does get paid around $75 for calling us to tell us how to dose and when to go get checked again. So that could be some of the reason.

 

[Protimenow]

So - the PCP is getting paid for reading from a dosing chart. If this doctor wants you to test weekly, that's nearly $4000 a year for doing practically nothing. Looks like a pretty good incentive to me for not approving home testing. (Perhaps you can convince this doctor that you will still want dosing advice - so he or she can still gouge the health care system - but you'd prefer to be able to test at home because the trip to the clinic is a problem for you (or something). This doctor may still get the $75, but you'll have the freedom of testing at home.)

 

[Davidr]

Your health, your decision!

Just because a doctor had studied extensively, does not make him or her God!

Unless the doctor has a good reason to refuse, they should not have the right to! I also disagree with home testing, and then allowing doctor to make $4000 per year by reeadng a chart!

There are at times good reasons for not allowing home testing...but if they are present (inability to self test, forgetfulness or medical reasons), then they should be explained, but if it is doctor's greed, take that away and change doctors! If it is ignorance, educate the doctor, if he/she refuses to be educated, then go above their heads, or change doctors!

While I was in hospital, I asked my resident (I assume) doctor about home testing for ACT. I had been reading up on it online while in hospital. He explained very impatiently that this was only for glucose monitoring, and then left before I could say anything.

The next day, the attending doctor was on rounds with him, and I asked the attending the same question (without mentioning the previous days discussion), the attending doctor said it would be an excellent idea, and arranged for all the information for local acquisition to be in my hands within an hour! The other doctor looked embarrassed, and irritated with me, but bottom line - he wasn't prepared to learn, and needed to be taught a lesson!

Within 2 weeks I got my CoaguChek XS, and am happily using it now. No insurance here in HK for such devices, unfortunately, so I paid out of pocket. On the other hand, no doctor's letter of Authorisations/prescription needed either!

David