Bluecross/BS "blue card" black hole trying to get home INR equipment

[slipkid]

I've been having a very frustrating time trying to get home PT-INR testing which my cardiologist prescribed for me from Alere and logically should be covered by my insurance (BlueCross/Blue Shield).

Am wondering if anyone else has a similar experience with BC/BS or any advice to try to deal with this.

Apologies in advance for this confusing mess of a story but this is the condensed version (if you can believe that!). I have spent countless hours on the phone to my insurance BC/BS and Alere (& other medical supply companies), as well as many other hours researching much of this on the 'net to even understand the confusing nature of what BC/BS is and what much of its jargon and structure of agenices is that seem to be the root of this craziness.

The situation makes no sense as far as how healthcare or insurance SHOULD work (not that that should be a surprise to anyone in the USA that knows anything about our broken for profit healthcare system), not one person at BlueCross that I have spoken to so far has demonstrated even the slightest understanding of what the issue is and what their own company is doing, my doctor's office wants nothing to do with any of it ("we do not have time to deal with the insurance company; either pay for the unit yourself or get your blood drawn at a clinic"), and Alere (and other in network suppliers) appear to have their hands tied by BC/BS from what they are telling me.

Very briefly, the confusing mess I am caught in, as I understand it as of today anyways:

- My insurance carrier is "Anthem" BlueCross/BlueShield of Georgia despite the fact that I live in Pennsylvania. My health insurance is provided through my job (we have corporate headquarters in GA).

- I have a PPO insurance policy which entitles to me to some type of "blue card" network of providers which gives me in network coverage to providers outside of GA, which is how I am able to get healthcare here where I live as "in network" even though "Anthem BC/BS" has no "contracts" (or something like that) with health providers in PA.

- Alere is the provider which my doctor tried to hook me up with for a home INR unit and they are located in California. They are in network for my insurance via Anthem BC/BS.

[NOTE: Alere at first (mulitple times) told me they are not in network for me; but from what I know now, actually they ARE in network but are caught in what they call a BC/BS "bluecard" issue that prevents them from servicing me. It was not until a recent phone call with Alere that the contact there admitted this was a "bluecard" issue as opposed to simply being an "out of network" issue.]

- "BlueCard" is supposed to provide access to out of network providers in the event of traveling & needing medical coverage OR access to LOCAL providers in PA like me as "in network"; however this "BlueCard" thing appears to be biting me in reverse and preventing me from getting access to a provider who is IN NETWORK for my insurance coverage simply because I reside in a different state than where my policy is based, and BC/BS has made a change in how these types of claims are now submitted (?).

- Up until recently, according to Alere, they had been submitting claims to their local BC/BS which is Anthem BC/BS in California which they have a "contract" with and are considered "in network". BC/BS customers then getting the device would get it billed as such (in network"). However that is not how it works now (was changed earlier this year??). Now Alere says that BC/BS requires them to submit their bills to the BC/BS company IN THE STATE THAT THE PATIENT resides in rather than where Alere is based (or to my own branch of BC/BS).

Which for me means Alere has to submit billing to one of the Pennsylvania BC/BS insurance companies, which are not Anthem BC/BS (which would be IN NETWORK), and that Alere has no "contract" with BC/BS agencies in PA, so either Alere charges are processed as OUT OF NETWORK by BC/BS, or simply that Alere cannot even submit anything to BC/BS in PA at all and can only offer me their services as not covered by insurance at all (I have been given conflicting information from Alere on this point, but that is par for the course with this issue with everyone I have talked to at multiple agencies regarding this, over and over again, getting numerous conflicting answers depending on who I talk to).


- Alere originally told me I was "out of network" and had me try to get the INR equipment from another company (Edgepark) which works with them to submit the billing. Edgepark then told me that I WAS in network and all set to go but then when setting up my account in the sales department they retracted that and instead said that they had a "bluecard issue" since I was in Pennsylvania and could not service me. This was the first that I heard the words "bluecard issue". Later only after many other round and round phone calls did I learn that Alere had the exact same issue (as does another supplier which BC/BS had directed me to to try).


Today I have spent about 5 hours trying to understand more what this "bluecard" terms means, and how BC/BS "works". I have already wasted hours speaking to clueless BC/BS claim representatives as well as someone in their "utilization management" department who insisted that Alere was in network for me and that they should not be telling me that they are not, but at this point I plan to (probably) waste even more time, but instead of talking to those people I am going to try calling places like various BC/BS corporate offices and various numbers I've found associated with "bluecard" policies. I doubt any of that will help me but I'm not giving up yet. I really feel that I am paying for the coverage for this device yet I am being denied that coverage solely because of bureaucratic red tape and something broken internally at BC/BS. But I could be wrong.

Also note, Alere tells me there will be a solution to this eventually - that they now have to negotiate contracts with BC/BS separately in every state/region - but that could take years.

In the meantime, I cannot afford to spend the $ for home INR out of network, or (worse) directly out of pocket. The only reason that I can "afford" to get this device now is because I have already exceeded my (huge) deductible and out of pocket medical insurance copays for 2014 due to my recent medical bills, so that if covered in network it would be free for me for the duration of this year.

 

[Aggie85]

And just NOT the kind of headache and STRESS you need right now while recuperating from the heart attack! I'm sorry I can't add information that might help but wanted to offer support and good thoughts.

I do have one thought that might be at issue and yet not being said by any of the above idiots. Please bare with me as this may not SEEM to be on topic as you keep getting policy disconnects, but it may be a hidden issue generating these disconnects. I was initially told I'd be set up with home monitor ASAP but when it came down to actually doing it, was told I actually have to wait till on Warfarin for 3 months. My cardiologist seemed to think he could do it just by writing the script, but it actually had to be coordinated through the Anti-coag clinic and they stated there's a hardwired waiting period in the process of doing so. I read somewhere else as well, I think on Allere's own site, that same thing (3 mo wait) as one criteria. I wonder if that's the heart (forgive the pun) of the issue but isn't coming out in discussions. We, hubby and I, are used to dealing with these sorts of disconnects within the military health care system. Often it's a matter of left hand having NO clue what right hand is doing.

Maybe try asking if the three month wait could be an underlying issue that's throwing an unknown wrench into the whole thing?

Good Luck and best wishes!
Linda

 

[slipkid]

Thanks Linda.

You don't know the half of it (or you probably do if you've had to deal with US "Healthcare").

No one (either the doc or Alere or Alere's "partner" Edgepark) had mentioned anything to me about a 3 month wait. But that would not surprise me at all (someone connected to my healthcare doing something incompetent - after what I've seen recently I am amazed that I am even alive, seeing all the incompetence, mistruths, confusion, deception, etc, rampant in our healthcare system).

When I tried to mention to my cardiologist's office that I was having problems getting the home monitor, and that one of the companies had told me that the "bluecard" issue could be gotten around if the doctor's office did something with BC/BS, the assistant in the office first told me something like "why are you trying to get a home unit? We don't deal with this - why do you want one?". I was dumbstruck! I had never even heard of home monitoring b4 and was not asking for it out of my own accord, it was the CARDIOLOGIST HIMSELF WHO TOLD ME HE WANTED ME TO HAVE ONE. I had to tell the assistant that! At which point he basically switched gears making up excuses that I could just go to a lab - and he told me now to wait TWO WEEKS for testing instead of one week intervals like I've been being tested since discharge because "my numbers have been constant". DESPITE THE FACT THAT THEY WERE EITHER TOO LOW OR TOO HIGH after I got home and my dosage had to be changed 3 times!!!! But that was while I was still under the surgeon's care as far as monitoring my PT-INR, and it was only in the last 3 weeks that the cardiologist has been in charge of that instead, so they don't know what already occurred (even though I then tried to tell him). I gave up at that point in trying to deal with him. I believe I still need to be monitored weekly but I am too tired and frustrated with everything to bother arguing about it.


In addition I've also had to cope with stuff like below, and it seems never ending.... each day seems to bring yet another health care related trial....it helps talking about this stuff and I hope some of the nonsense I've been through can help others navigate the minefield of healthcare insurance, hospital charges, doctors, etc....apologies if this rambles on and on but this is how I am (I have the soul of a writer and can't stop once I get going)....


(1) The "financial adviser" of the hospital in came and saw me in my room, about 6 days post-op (I was discharged on the 10th day). Even though I was very sick and in mucho pain, I had already had to call BC/BS myself to verify many things and figure out what amount of $$ I was going to end up being stuck with, as well as deal with work insurance issues for things like starting "FMLA" (so work won't fire me for being "absent") and short term disability so I could collect a minor pittance while I am out of work.

At first the adviser's visit was welcome as she had researched my insurance issues and her information was useful as confirmation for my foggy brain what I had already found out. Things like having a $1600 deductible, and $3000 out of pocket max (btw just last year work changed our insurance and prior to this year my deductible was only $100 and my out of pocket max was $1000, if I remember right, but work changed our policy choices), don't actually mean what you think.

I originally thought (and it was deceptively presented in our work insurance documents this way) that "$1600/$3000" meant that I pay $1600 "out of my own pocket" as a deductible, then after that BC/BS pays out at my coinsurance rate (80% in network) until I reached a total of $3000 "out of my pocket". I thought that meant my maximum outlay was $3000.

But what it really means is that I have to pay $4600 (!) out of my own "pocket" because the $1600 deductible that I pay "out of my own pocket" does not count towards what insurance means by an "out of pocket" maximum (wtf?). BC/BS pretends we haven't paid out any money ourselves until after we pay the deductible. How nice. I realize now that this is standard policy B.S. and "obvious" perhaps to some people but not to me since I've never had any sort of serious illness before and had no experience with this crap. But I digress - here's the good part, which is about the financial adviser...

She proceeded to tell me that of this $1600 deductible, plus $3000 "out of pocket" maximum, that if I was able to pay her either of these amounts within ten days of discharge from the hospital that I could get a 10% discount on each. Or I could arrange financing at no interest (but with no discounts for that). I told her I needed to think about it, and was too sick to make any decisions on that yet. I asked her though, since I have never been in the hospital before facing this kind of stuff, or ever had experience with a serious illness and large medical bills, how does this all work? How does she know that the "hospital bill" is the one that is going to have my $1600 deductible applied to it? Won't I get all sorts of separate bills from the doctors, the surgeons, the anesthesiologist, various tests, labwork, the ambulance, the ER etc??? Which one gets the deductible???? Do I get to decide that? Or what???

She acknowledged that yes I would be getting all sorts of bills, and that she only represented the HOSPITAL itself and her "charges" were only for the "hospital stay", but she ASSURED me in no uncertain terms that my hospital bill would be going into BC/BC "first" (that it is some kind of first-in first-out billing thing) and the deductible would be applied to the HOSPITAL CHARGES, not to any other bills, so right there is a way for me to save $160. PROVIDED I PAID HER WITHIN 10 DAYS OF DISCHARGE. And then she went on to also say that the $3000 out of pocket afterwards was something that I was sure to get hit for WITH THE HOSPITAL BILL, which even after 6 days I was probably way over that amount; so right there I could save $300.

So while I was laid up in the hospital I gave this much thought and with my current financial situation I thought I might as well give her my deductible & save $160, then finance the other $3000 over the next year for 0% interest. I put all that on the back burner as I was pretty overwhelmed just trying to recover but felt somewhat relieved to just put all that out of my mind as "OK I've got the financial part taken care of".

After I got home I was even more overwhelmed with many many issues (including my health obviously) and how I was going to cope. Most of which I will not go into other than to say that in the 11 days worth of mail which I checked that very first day home was a notice from my credit card company saying my card had been put on hold for suspicious activity!!!! That card, and two debit cards, had been in my wallet when I was rushed to the hospital, and not retrieved for me for safekeeping until about day #3 by one of my sisters. And on the 2nd day of my hospital stay, whilst I lay unconscious hooked up to a respirator, someone used my card to make a bunch of crazy charges all over the country (which thankfully my credit card company flagged). BUT WHAT ABOUT MY DEBIT CARDS? I COULD HAVE HAD MY BANK ACCOUNTS CLEARED OUT TOO!!!!!!! Talk about stress. Somehow, although I was so tired I could not even stand up, I managed to spend 2 hours on my home PC that day checking my debit card charges....but I digress...back to the hospital financial adviser fiasco....

So I am at home trying to recover. Sleeping most of the time (with great difficulty, too painful to lie down). Waiting for the bills to come in, for the hospital to contact me about payment etc. And on the 8th day post discharge (a Thursday) and still not getting the hospital bill, I figured I better call the financial adviser (who had given me written materials about the discounts with her phone #), to clarify about that stuff. I was wondering if instead of "pay 10 days after discharge to get the discount" that maybe she meant "10 days after RECEIVING the bill", since at this point it would be impossible for me to get a bill and pay it before day 10 was up!

So I called her. She was not there so I left her a voicemail that I was interested in taking advantage of the "discount" programs and had some questions. She returned my call in something like only 5 minutes.

She said that the "deal" only applied to "10 days after discharge". That I did not have a bill yet did not matter, that I could pay her over the phone with a credit/debit card right then and there. Again I asked her about how could I be certain that the hospital charges would be the ones to be applied to my deductible etc rather than all the other bills I would be getting - also that at that point I was only interested in the deductible discount and that I could not afford the $3000 one (I wanted to finance that one). Again she SWORE that the "hospital bill would go in before any other bills and that my deductible would be applied to that".

So, like a gullible idiot, who thought she knew what she was talking about (this is her JOB after all and she does this ALL THE TIME AND WOULD KNOW HOW IT WORKS), and that she was being HONEST and was TRUSTWORTHY, I elected to pay her the money over the phone with my main checking/debit card.

Well I learned a painful lesson. SHE LIED TO ME.

The first bill I received was about a week after that. It was from the surgeons. On there, and also in my BC/BS "EOB" (explanation of benefits) the SURGEON was allotted my $1600 deductible, plus additional coinsurance on my part, to give me something like a $2300 bill. Regardless of how I already PAID MY DEDUCTIBLE TO THE HOSPITAL!

At that point, I thought the surgeon bill was some sort of mistake. I first called the surgeon's billing office, and tried to say that I had already paid the deductible as per the hospital and that their bill was wrong. Their billing office however instead explained to me how BC/BS billing really works, and that NO PROVIDER IS ALLOWED (LEGALLY OR ETHICALLY) TO DANGLE A PROMISE OF DISCOUNTS FOR PAYING A BILL/DEDUCTIBLE ETC. THEY CANNOT KNOW WHAT BILL IS GOING IN FIRST, OR HOW BC/BS IS GOING TO PROCESS ANYTHING. AND WHAT'S MORE, IN THE CASE OF A LONG HOSPITAL STAY, THAT TYPE OF BILL GETS EXTREMELY LARGE AND COMPLEX AND IS MORE LIKELY TO GET PROCESSED LAST - NOT FIRST!!!! They so much as suggested I even seek legal counsel. And of course that their bill was right and I needed to pay them straightaway. Oh, and now, 7 weeks after discharge, I still do not have a hospital bill btw.

I then called BC/BS. They backed up what the surgeon office said. They had not received the hospital bill yet. The surgeon is getting my $1600 deductible. That I would need to contact the hospital and try to get my $1600 back. That in fact the hospital bill itself even once received would have to go through a long review process - it will take weeks!

So I then called the financial adviser. She was not there so I left a voicemail. In there I expressed serious concern that what had happened was exactly what I had already asked her about (multiple times) in regards to how my deductible would be applied to various bills, and that she was 100% wrong in what she told me, that I now had to pay that $1600 to the surgeon instead and I needed my $1600 back from her asap so I could pay that bill. This was 5+ weeks ago. Unlike the first phone message that I left her when I expressed interest in being a ******* sucker and taking advantage of her "discount" when she called me back in less than 5 minutes, I have still not heard back from her over 1 month later.

I gave her a couple days, then still hearing nothing I called the hospital billing department itself to discuss this. All that came of that was that once their bill was finalized and settled, they would ONLY THEN AT THAT POINT refund any money which I "was owed" over and beyond their charges. The fact that they basically STOLE $1600 from me through deceptive business practices doesn't matter. They have my money and that's that. To get it back I have to wait for all the bills etc to get processed after which time I can then try to get it back. Talk about stress....and anger....I really wanted to (1) exact vengeance and dissect that financial adviser ala Dexter Morgan (TV show reference) and (2) burn the hospital to the ground. Perhaps extreme reactions but after going through open heart surgery, being in unbearable pain, taking hallucinatory painkillers, getting 2-4 hours sleep a night for 2 weeks, having no appetite, having everything I eat taste like straw, having a relative in my house looking after me who is throwing out all of the food I (used to) like to eat because "you can't eat this stuff anymore it is not healthy", having another huge issue to deal with my car as well that involved yet more incompetence on the part of a mechanic, and much more stress.....hell yeah I was ready to do a Dexter and also burn down the hospital if only I was well enough! I kid, but man, I could have done without all that B.S.

And that is just one example. I have another BC/BS story I will relate another time, one I just had to deal with last week, that involved days worth of repeated phone calls to finally resolve (the lesson learned there is that if you do not get the answer you want from BC/BS you need to keep calling and calling and calling until you get a rep who actually knows what they are doing and can process things correctly - if you can ask nicely enough to even make them want to even bother that is).

On top of that I also have to cope with some medical issues and lack of response from the doctors, along with being told one thing one time then something totally different yet another time. And I haven't even told the story about the vitamin K shot which I got in the hospital that I later found out no one had ordered that I even be given. That one was an eye opener (which nobody cares about).

Oh yeah, 7 weeks out I still don't have a hospital "bill". Although I did call BC/BS and ask about this on Friday and they said that the hospital bill is finally "settled" now. They initially billed something like $470,000. BC/BS knocked that down to about $69,000. My charges from that are less than what I paid the hospital for my "deductible" which they are not entitled to have gotten in the first place, so they owe me money back. Normally I'm sure they would be beating my door down to get paid but since they owe ME I probably have to beat their door down to get them to send me the "bill" & refund before I die of old age. Also, a month ago I told the billing dept. that I wanted a complete breakdown of what all the hospital charges were, as is my right. I was assured that they would be sending that. I don't think it is too difficult to guess whether I got that (or ever will).

Apologies for that rant but that felt good to get out of my system. I realize many people have it a lot worse than I do (like not even having insurance at all), or have open heart surgery and major complications, but all I can do is talk about what happened to me. I probably have it ez but it sure is a pain dealing with all this hassle.

 

[tom in MO]

ofMy experience with Allere, BC/BS-Kansas City and Edgepark was equally confusing. However, it is BC/BS responsibility to tell you what is their approved provider. Only they can do that. You need to get that information from them directly and document who and when you called. They should also tell you exactly what will be covered. Then you need to contact the provider (Edgepark) who will tell you what they need. Usually it is a prescription from your doctor saying you must test every two weeks. Also document all calls, when, who and what they said.

In my case it was first Allere for 1/12 years but no longer. Now it is is Edgepark. Allere and BC/BS had a falling out and they are no longer approved. However, Edgepark is an Allere partner company and your monitor, when ordered from Edgepark, actually comes from Allere. Allere gives you a free monitor and supplies but charges to handle your results. Edgepark gives you a free monitor and charges for supplies, you call in your own results to your doctor...or someone else if that is what your doctor wants. My doctor does not care, so I call them in myself.

My cardiologist has a coumadin clinic that handles results and call backs for dose adjustments. I talk to them, not my cardiologist's direct nurse.

Hope that helps. In many cases home testing is more expensive than lab testing because many policies cover all in-office bloodwork for free. If you live close, that could be your cheaper option. Remember, you will not have your deductible/max payout covered next year. That's the cost you should judge your decision upon, not this year's cost.

You will not be able to get a monitor until your INR is stable for about 3 months. That's common to most insurance providers and doctors in the US. Stable does not mean in range by the way.

 

[slipkid]

Thanks for that Tom.

Interesting about the "falling out" with BC/BS that you mentioned. I definitely picked up some level of less than cooperation/disgust on their part in some of my calls. Especially the one that I was on a conference call with BC/BS and Alere and the Alere rep immediately put us on hold (for over 30 minutes and never came back) as soon as the BC/BS lady said who she was.

I've been on the phone with BC/BS today, for about an hour, talking to another customer service rep, trying to explain all this yet again. Short story now is they have a list of "providers" for 50 miles within my zipcode and they have to contact EVERY SINGLE ONE to find out if they have home INR monitoring equipment. I've called about 5 so far myself (but BC/BS rep has to to do it) and none so far do. The BC/BS rep is supposed to call me back next week (after she has enough time to call all of the "approved suppliers").

Yes, I am trying to get a home monitor for this year only. And am only even doing that since I have already maxed out my insurance for this year so any more healthcare for 2014 that is "in network" I get for free. Once the clock resets next year I will not be able to afford the $1600 deductible + 20% etc. I had already thought of that, but thanks for mentioning it in case I didn't

At no point has Alere told me that they don't deal with BC/BS anymore though it would not surprise me judging by what they have told me so far (conflicting information etc). Interesting about the 3 month thing again. At no point (yet) has my doctor, Alere, Edgepark, or Sterling Medical, told me anything about this 3 month wait period. Just you guys up here. It's probably true and will come to bite me later. Sigh. All this continuous hassle is more than I can bear to be honest.

I also had to deal with yet another erroneous medical bill today. Just last week I had one that BC/BS submitted wrong (that took me about 2+ hours of multiple phone calls to get cleared up) but this one is the fault of the x-ray department that submitted the bill. Incredibly all this stuff then ends up going to us (the patient) and if we are not sharp enough to realize things are fishy then we end up paying $ we do not even owe.

Man, all this stuff is so friggin' time consuming and exhausting. According to a voicemail I just got while on the phone with BC/BS, I think my GP filled out my ShortTermDisability paperwork wrong and even may have lost some of the important information I left in the envelope that needs to be mailed, and I have to go in there to try to sort that out tomorrow. Good thing I am too tired to have a heart attack again over all this never ending stress.

 

[mainframe]

Isn't this alot of work to avoid a handful of INR tests? Once you get stable, your likely to only need a test once a month? Especially if your planning on not having the machine to self test next year. But I have to admit to not seeing the big benefit of self testing.

 

[pellicle]

I just wanted to say how much simpler it all is here in Australia

You buy the machine yourself, you can choose to monitor and self dose or choose to go with a clinic.

ATS actually gave me a Coaguchek XS so I just pay for strips. My surgeon isn't worried and just asks me to check my measurements against a lab "now and then"

You guys are regulated to hell over there.

 

[pellicle]

But I have to admit to not seeing the big benefit of self testing.

Self testing has shown to provide patients with much better outcomes, reducing both bleeds and thrombosis significantly. Further its shown to save thousands in per patient care costs over year so that can amount to millions quickly at state level.

Monthly testing is insufficient to catch changes which can happen.

Countries around the world are moving towards it. The USA which is mired in the most entangled and lumbering behemoth of health care (often it seems to extract monies for the industry, rather than benefit people) wants to forcibly funnel people into dependency rather than being able to look after themselves.

Imagine asking diabetics to go to get tests at the Dr office....

 

[newmitral]

Hello Slipkid,

I have BlueCross/BlueShield insurance, and was with Alere in their home-test program until November last year.
It was very simple to set up for me, although this was 3 years ago. You _DO_ have to wait until you have been "stable" on warfarin for 3 months or more.
My doctor wrote the prescription, and his office called Alere, who then coordinated it with my insurance. I didn't have to do anything and the meter and supplies simply showed up at my home shortly thereafter. Alere scheduled an in-home training session with one of their reps. While the in-home training is useful, you can probably do without it if you are reasonably competent.

I personally think that home self-testing is the only way to go - much more convenient, and, as Pellicle noted, has been shown to be superior in terms of time staying within range. This means reduced risk of strokes/bleeds.

Like you, I had reached my out-of-pocket maximum for the first year (in which I had my valve replaced) and I also reached my deductible limit the second year in which I had some additional surgery to address some complications from the endocarditis that necessitated my initial valve replacement. So, the testing was free my first year, and I only had to pay my co-pay for the testing the second year.

However, there are some things you may wish to know, and which are the major reasons I cancelled my participation in the Alere program and went on my own with my own meter, starting my 3rd year post-surgery.

1. - Alere only leases you the meter. You do not own it, and it needs to be returned when you leave their program.

2. - Alere wants to charge you about $280.00/month for the privilege of home testing. BC/BS negotiates this down to an approved rate (cost to you) of "only" about $180/month (may vary by region). If you are paying this up until you hit your deductible, it adds up fast.

3. - You can buy a meter for a few hundred dollars, and the test strips are about $5 each, so you come out way ahead buying your own meter and supplies and home-testing for about $20/month if you test weekly.

4. - BC/BS will pay for a monthly INR lab test at a negotiated rate (cost to you) of only about $5/month. You can use this to check your home-test meter accuracy on a monthly basis if you like. So, you can home test weekly (or whenever you and your doctor decide) outside of the insurance system and have your insurance cover the monthly lab test.

5. - Alere changed their home test operation and my billing got completely screwed up for the last month or two, which fortunately coincided with my decision to leave their program and return their meter anyhow. Curiously, they processed these last incorrect bills through Anthem, which was bizarre since Anthem is not my BC/BS provider here in Maryland (we're CareFirst down here). I think Tom may be correct and "Alere and BC/BS had a falling out" about that time. I believe Alere sold their home test operation to another company, but I'm not certain. I called Alere's billing department several times, sending them the BC/BS "Explanation of Benefits" showing my obligation, and paid them what BC/BS showed rather than the seemingly random numbers Alere was trying to charge me. They seem to have concurred as I have not received any further incorrect bills from Alere.

So, the point of all this is that based on my own experience with Alere and their program, I would not bother fighting for entry into their home-test program. I would suggest that you might be better off just buying your own meter and self-testing independent of the insurance system. It is not going to cost you much this year and will save you a lot of money in future years.

UPDATE:
I found a letter sent to me in July 2013, and the home test program did indeed change hands back then. Quoting from the notice:

"Raytel Cardiac Services, lnc. d/bla Remote Cardiac Services ("RCS"), formerly known as Philips Remote Cardiac Services, has been purchased by Lincare. "

 

[slipkid]

Thanks for the great info, newmitral.

I've done a lot of research the past week, and I'd really like to be able to do weekly home testing in conjunction with 2 week/monthly/whatever the cardio guys decide for venous puncture tests. Up until last week I had been tested 2x a week (some finger stick, some as blood drawn & sent to lab).

At this point I do not think my INR/dosage is actually stable/right; I was all over the place the first couple weeks at home, and the past 2 weeks or so (testing twice a week thanks to a visiting nurse which I no longer have now since I just started outpatient cardiac rehab) was 3.3, then 2.9, then 2.8, then 2.6, then 2.4 last Wednesday (my last test). So I think my INR is falling again (I fell to 1.1 at one point last month).

Unfortunately the assistant in the cardiologist's office, who is now "managing" my INR/medication, seems to be totally oblivious of what my numbers had been prior to his involvement (the last 4 tests only). He seems to think I am "stable" and can wait another 2 weeks to be tested again. I did try to explain to him how my latest numbers seem to be consistently dropping and that my previous tests were all over the place (some low, some high, some fine) but he expressed no understanding of this being the case. This is a big reason I would like to get a home unit to try to stay on top of this more often than what he wants (I think he wants to go to a monthly schedule asap!). Seems like the right hand/left hand through all this has no idea of what is going on with me, as I get conflicting advice from these people depending on who is saying what. I wish I could actually speak with the cardiologist himself as it was his recommendation in the first place that I go on home monitoring but instead he has these assistants act as "filters" for him and it is not possible to talk to him at all.

Anywho, thanks again.

 

[dwhist]

Not sure this will help, but when I had issues with my insurance a few years back, I called the HR department at my job and got them involved. They contacted the company that sold them the insurance and got their contact at BCBS involved to help smooth the situation out.

As to monthly monitoring. I did it for a year and then our insurance changed and I returned it as it was going to cost me $1600 for the year as monitor company was listed as out of network. I am back to blood draws, which is easy as clinic is 2 miles from my house.

I am watching ebay and may get my own device one of these days as recommended by many on th board.

 

[slipkid]

Thanks for the HR advice but the job I have is pretty crappy. The entire HR department consists of 2 people. I've had issues/questions before, some healthcare, others vacation or pay related, and they never do anything. Most of the time you cannot even reach them on the phone, and if you can manage to talk to them the "answer" is usually "we'll get back to you" (and they don't, or do so only in email with non-answers).

Guess I will just go the blood draw route at this point, I am kind of giving up on getting a home unit. Have wasted too much time & energy on this as someone observed above. Who knows though, maybe BC/BS will still get back to me.

Also since I believe my next INR will be too low (since it keeps dropping in last month of tests), maybe that will motivate the doctor(s) to try to do something to monitor me better. I dunno. I've got so much other stuff going on right now (my heat pump/Airco broke down & my house reached 95 degrees inside yesterday) I can't cope with everything. Pursuing home INR is not even on my radar anymore.

 

[Aggie85]

Dwhist, post a thread asking for anyone selling machines. I can't remember which of the many threads I'm posting on, but someone offered me an INRatio machine for reasonable price and I don't want to get one yet. Also, if I'm ever able to get the machines to record my INRs right (see other thread I started for details; also probably where the machine was offerd), my insurance will cover one for me. I don't know how to link a thread but look for "POCs not reading INRs accurately", under this forum, started by Aggie85. The offer was just a day or so ago, so in the more recent posts.

But, might find lots more if you post your own request. I've been seeing people getting them on Ebay too but that kind of scars me as you have no idea how well machine is working.

Good luck!
Linda

 

[dwhist]

Hi Linda,

Thanks, good idea. I am due for test at hospital this weekend and so far I think I am good with the monthly. But if the number is way off this time, I am going to start looking for my own machine. The ones on EBAY intrigue me, but I would want a brand new one and would confirm that before buying.

Not sure I want a used one.

 

[slipkid]

Btw, to give credit where it is due (assuming this works out), a very responsive BlueCross rep (who helped me solve a billing problem already) took it upon herself to try to help me with this.

Long story short she found a company who is supposed to be covered by my BC/BS policy and she got a "Physician Prescription Form" that she sent to me, which my doctor has to fill out to (hopefully) get me started. I think this company is one that was mentioned either somewhere above in this thread by another poster (or could have been another thread, I can't remember). The company is "RCS/Remote Cardiac Services", based in CT.

I tried to call this company myself to double-check that I am in network with no unseen hassles but they won't talk to me until they get the form filled out by my doctor (sigh). I had hoped to double-check that for 100% first so as to not waste the doctor's time then have to come back and tell him later "Oops, turns out that company has an insurance issue as well".

They do have the previous 90 day restriction thing going on, as folks mentioned above, they want you to be in range for 90 days prior, I guess to minimize any hassles or emergencies that they might be responsible for. So I will try to explain that to the doctor as well. And I am definitely not "stable" in range yet. Sigh. By the time I am in range for 3 months 2014 will probably be over and I won't be able to afford this next year anyways as my health care deductible and out of pocket limits start over at zero.

Ironically in today's mail, I also received a notice from Alere saying how important home monitoring is and that my doctor tried to enroll me, but because I have not followed through or whatever they are removing me. Crazy...at least they sent me a courtesy "INR Log Book" so I guess all my time was not completely wasted for nothing.

 

[dick0236]

The company is "RCS/Remote Cardiac Services", based in CT......

.........I tried to call this company myself to double-check that I am in network with no unseen hassles but they won't talk to me until they get the form filled out by my doctor (sigh). I had hoped to double-check that for 100% first so as to not waste the doctor's time then have to come back and tell him later "Oops, turns out that company has an insurance issue as well".

.

If RCS doesn't work out you might try Coaguchek Patient Services, 1-800 779-7616, coaguchekpatientservices.com. Because of the current problems with INRatio test strips on ebay I decided to go back to one of the "lend/lease" programs. I contacted Coaguchek Patient Services in late May, 2014. They confirmed that my Humana plan was in their network and where able to give me a monthly estimate of $23/mo for weekly testing(4/month). They did this prior to having the forms completed. Humana confirmed the coverage and my meter was delivered to me a couple days ago. It might have been easier for me since I am on Medicare(home testing endorsed by Medicare) and Humana administers my Medicare Advantage Plan and I have been on warfarin for decades. The 90 day rule is universal with all home testing programs...as far as I know. They want to know you are reasonably stable and have some experience with "finger stick" testing before starting home testing.

Incidently, I find the CoaguchekXS a lot easier to use than the INRatio2 I had been using. Hopefully, the service from Coaguchek Patient Services will be better than my past experience with Alere....although it would be difficult to be worse than Alere(my experience). They also seem more flexible than other programs and will allow bi-weekly testing, if desired. I chose the weekly since I have gotten comfortable with more frequent testing.

PS. The supplied ACCU-CHEK Softclix lancet pencil is far better than the Unistik lancets I had been using....bigger droplet with less of a "stick" pain.

 

[slipkid]

Thanks for the tips!

 

[joel1947]

One thing I have found with call centers is that if you do not get the answer you want then hang up and call back. Some of the people are awesome, some are lazy, some are knowledgable, some are clueless. Rather than trying to explain something over and over to someone who obviously does not understand and does not care to, just say that you need to go and that you will call back. Then hope you get someone better.

 

[slipkid]

One thing I have found with call centers is that if you do not get the answer you want then hang up and call back. Some of the people are awesome, some are lazy, some are knowledgable, some are clueless. Rather than trying to explain something over and over to someone who obviously does not understand and does not care to, just say that you need to go and that you will call back. Then hope you get someone better.

Excellent, excellent, excellent advice.

That is what I had to do to fix one of my billing nightmares. I said that above in my long rambling post. It bears repeating though....KEEP CALLING and hope you can eventually get somebody who knows what they are doing, and even cares enough to try to do something about it.

The BC/BS rep that I wanted to give kudos to above, who took it upon herself to try to find a place where I can get home INR testing covered is the same person that straightened out a billing mess which other reps had no clue what to do and were telling me the wrong thing over and over again. You have to keep calling...gets very frustrating and time consuming though.

I've given up on trying to get my hospital bill done right though. They owe me $$ but from a conversation today they have found a way to make 2+2=3 instead of 4, so they are only going to give me back "3" instead of "4". Regardless I'll take it. They've had almost $1600 of my money held hostage for 2 months now....I better stop there....healthcare in the USA is hugely bent, twisted, crooked, and evil. It is all about the money & who can make the most out of sick people, anyway they can extract it.

 

[cooperman]

Blue Cross Blue Shield is a joke for home INR testing. (Though they have been awesome for everything else over the years.) I tried for several months to get home testing stuff, but eventually just gave up. This included multiple calls talking to various agents. I got all of the billing codes and tried to get them hooked up with multiple home testing agencies. No dice. Eventually I discovered that just buying the meter and other items was faster, easier, and in the long run cheaper. I bought my own meter and strips to test weekly or biweekly and go to visit my cardiologist's once a month for a test in the lab. It's a $3 copay.
I recently switched to AMbetter since the plan was a better fit for me.