Cardio doesnt 'believe in' self monitoring, grrr

[COLLEEN S]

New appt with new cardio coming up Wednesday. Hope I like her. Hope she will work with me on the INR monitoring from home. I have a brochure kit from QAS I am taking and also I printed off some discussions from the site to help me be a home anticoagulation monitor and eventually, self doser. Thanks for all of you who offered your thoughts in my previous "cardio doenst believe in self monitoring" post. If you havent yet, read my post in pre surg about my mom, just diagnosed with aortic ascending aneurysm. I was just there at her house(7 hours away) for 9 days. She was hosp with COPD for 7 of those days.

 

[Ross]

If you need any more info to further prove your desires to home test, just let me know. I've got years of stuff scattered all over my hard drive, but I'll dig some up if you need it.

 

[catwoman]

Colleen:

In addition to what you have printed from threads here, please include some snippets from people who are considered authorities/experts in anticoagulation management and who are advocates for home monitoring. I believe those links have already been provided here or under the must-haves at the references forum.

 

[Bina]

I remember getting my info pamphlet from Roche Diagnostics and bringing it to my Doctor.
He listened to me praise my new VR home testing friends, he knew that I had spoken to a Roche rep, and he knew that I was determined. I also promised to keep him informed of my test results on a regular basis.

 

[ALCapshaw2]

The Medicare Documentation in favor of Point-of-Care (i.e. Home) Testing might be your most convincing documentation. Blance just posted a link to where that information can be found in another thread.

Here it is:

https://www.cms.hhs.gov/mcd/viewdeci...emo.asp&id=72&

This article from Medicare provides many eveidnced based research materials on the benefits and safety of point-of-care monitoring (home monitoring). One does NOT have to be on Medicare to take advantage of the research they have provided in this article. But, the fact that Medicare endorses home testing does influence many.

(From Blanche)


'AL Capshaw'

 

[olefin]

The Medicare Documentation in favor of Point-of-Care (i.e. Home) Testing might be your most convincing documentation. Blance just posted a link to where that information can be found in another thread.

Here it is:

https://www.cms.hhs.gov/mcd/viewdeci...emo.asp&id=72&



'AL Capshaw'

Al, your link got me this;
'The requested resource could not be found.'

 

[RobThatsMe]

Hi Colleen,

I also have years worth of my home testing results and graphs. It clearly displays now much I stay in range, and also the adjustments made to bring me back into range if I go above or below 2 to 4.0 INR levels.

My cardiologist has told me many times that he wished he had more patients like me that take such in interest in their health. Each time I see him, I bring him my results log and graphic trend chart. In the beginning, I would home test, and then call in my results, they would then tell me how to adjust my Coumadin intake. It got to the point where I would guess what they would do, and after time, they just begin letting me take it over. I do not know if this would be possible, if I did not provide him the data that I have when I go to my check-ups. Perhaps as I get older, and more forgetful, this will all be changed and reverse back to the office to manage and administer. But, for now at 59, I am doing very well, and my readings validate it.

Hope your new doctor is proactive, and provides you with some positive guidance.

 

[catwoman]

I'll echo what Rob wrote,and I'm nearly the same age -- about 2 1/2 months short of turning 59.
I used to call my results in to my PCP's office, and I gradually realized I could do it as well as the folks there could. I don't remember who said for me to stop calling in, or if I just stopped calling in my INRs, but one day I just stopped. I've never had to call for advice. I used to take in my Coumadin diaries, but don't anymore. They just record my last several INRs whenever I have an appointment.
Like Rob, my PCP says he wishes more patients were able to handle INR testing and self-dosing. He acknowledges the problems that many have with getting insurance to cover home testers; I'm sure he's been down that road with some patients.

And like Rob, I've thought about the day when (heaven forbid!) I get old-timers' disease (again, heaven forbid -- my mother-in-law died of Alzheimer's) and have to come up with another way of doing my INRs. But, until (and if) that happens, I have a lot of living to do!

 

[Bina]

My doc has become super busy and he is thrilled that he no longer has to "baby sit" me.
I call him every 3 months or so, and report my INRs for my medical file.

Rob and Marsha have made a good point: if we should ever become unable to manage our own testing and INR dosing do we put ourselves back into the hands of our docs?
Maybe we should be training our spouses?
Mine won't stick me with the lancet, but I know my nurse daughter just loves stabbing me.

 

[catwoman]

Rob and Marsha have made a good point: if we should ever become unable to manage our own testing and INR dosing do we put ourselves back into the hands of our docs?
Maybe we should be training our spouses?
Mine won't stick me with the lancet, but I know my nurse daughter just loves stabbing me.

A niece who lives in the Dallas area is an RN and her hubby is a firefighter captain/EMT. I figure one of them would be happy to stick it to me.

 

[lbecker]

Home test

Home test

If you need any more info to further prove your desires to home test, just let me know. I've got years of stuff scattered all over my hard drive, but I'll dig some up if you need it.

Ross, I may be asking you for some info in the future. Following my
surgery I would really like to convert to home testing. When speaking
to my primary care about this probably a month ago, she says oh,
insurance companies won't pay for that. So may need help in getting
it auth. I will let you know. Laura

 

[Ross]

Ross, I may be asking you for some info in the future. Following my
surgery I would really like to convert to home testing. When speaking
to my primary care about this probably a month ago, she says oh,
insurance companies won't pay for that. So may need help in getting
it auth. I will let you know. Laura

Your doctor is so misinformed. Most insurance companies will pay for it. Not all, but most.

 

[Ross]

Al, your link got me this;
'The requested resource could not be found.'

Try this one instead:

http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA6313.pdf

 

[catwoman]

Ross, I may be asking you for some info in the future. Following my
surgery I would really like to convert to home testing. When speaking
to my primary care about this probably a month ago, she says oh,
insurance companies won't pay for that. So may need help in getting
it auth. I will let you know. Laura

Laura:
Bah humbug!

Do you have a complete list in detail of what your insurance carrier covers? This is usually about the size of a small manual. If you don't have one, request one through your insurance carrier or employer's HR office. You can also probably get a pdf version of it to put on a flash drive.

You'll need to find DME (durable medical equipment) in the coverage details. There's an annual limit. Mine is $10,000 annually with Aetna, covering 80% for in-network providers, I think 60% for out-of-network providers-- but I'm not sure where it's hidden that the 80% is usual and customary charge, meaning whatever Aetna deems is reasonable.
Some insurance carriers will specify RENTAL rather than PURCHASE of DME.

That will give you a starting point. Probably a good idea to also talk to someone with your insurance carrier, too -- although they'll probably tell you they can't guarantee anything until they get a claim.

 

[COLLEEN S]

Well, I did everything all of you told me to do. I took board conversations, printed them out...dr didnt even look at them really. She saw I was determined to do this, and that I filled out all the patient info on the QAS forms, and she said "we like it when patients want to self test!" I mentioned self dosing and she said that they prefer to have you call in for dosages. Yeah, that will change.

 

[Ross]

Well, I did everything all of you told me to do. I took board conversations, printed them out...dr didnt even look at them really. She saw I was determined to do this, and that I filled out all the patient info on the QAS forms, and she said "we like it when patients want to self test!" I mentioned self dosing and she said that they prefer to have you call in for dosages. Yeah, that will change.

A gradual change. Lets put it this way. You call in, see what they tell you to do for the circumstance, then post their instructions and let us see if we'd suggest the same. I'm sure you will, but I don't want you to go solo until your 100% sure of what your doing.

 

[catwoman]

A gradual change. Lets put it this way. You call in, see what they tell you to do for the circumstance, then post their instructions and let us see if we'd suggest the same. I'm sure you will, but I don't want you to go solo until your 100% sure of what your doing.

I agree.
You're working with a new doctor and want to assure her that you do understand anticoagulation management by home-testing and being a compliant patient (calling in your INR tests). After demonstrating that you are doing things OK and your INRs are OK, they'll relax the reins.
Don't think of it as a stranglehold, but rather a learning tool. It does sound like you have found a good doctor. Let it work for you right now, rather than chafing at the neck.

 

[COLLEEN S]

Ross and Marsha,
I will be fully compliant and call in the INR's regularly. I'm usually a compliant patient until someone exposes their quackery. This doctor is, gratefully, so far, not. Plus, when they did the adjustment for my low (1.6) INR, they were right on the money. I will give them time to accept that I can do this. Thanks for your advice though, I always appreciate it.