Did I sell out? Not exactly

[Protimenow]

A few weeks ago, not sure that I'll be able to get strips before I ran out of my few remaining strips, I did something I really didn't want to do -- asked my cardiologist to write a prescription for a testing service. I didn't (and still don't) like that these clinics charge Medicare or insurance carriers a LOT of money for loaning me a meter and sending some overpriced strips. I was able to manage to get the money to buy strips, so my immediate need was met.

The insurer apparently wants me to test weekly - on the same day each week - and will report my INR results to my doctor.

I was contacted by the 'service' a few weeks after I asked for the prescription. I told the person who called me that I self test, and that I wouldn't take the service if it cost me any money out of pocket. (I'm pretty sure that it would). It's been four days, and I didn't get a call back - I don't expect a call.

FWIW - the 'weekly test' thing wouldn't have worked in the last week. I had to reduce my INR before having an ablation last week - for my own piece of mind, I self tested before going in for the procedure -- 1.5. I restarted my normal dose of INR and was going to test a few days later, to confirm that my INR had returned to range.

The first test failed -- I didn't apply blood to the strip (sometimes I miss a little). My second failed, too - plenty of blood, but I set the meter down a little harder than I wanted to - and this meter has a quirk where the batteries shift enough that I have to reset the time and date. The strip and the incision were wasted. (I fixed the problem with the meter by putting some folded paper towel between the batteries and back cover - this won't happen again.

I didn't like the results of the test - 1.9, but waited until the next day - 2.2. I'm sure that my next test will show an INR higher than 2.5.

The point is, during a one week period, I've used five strips SO FAR. I'll probably use another just to confirm that my INR is in range.

How would this 'service' handle six tests in an 8 day period - assuming that all tests were successful, this would be 8 weeks worth of strips. Would they send more? Would they need a good explanation why I needed more? Or would they happily send them, knowing that they can make a healthy profit for the additional strips?

In any case, I don't need a service. Although I almost sold out, I didn't. IF I do get a call back from the service, it'll probably be to confirm that I'll have a deductible. Even if I don't, I really don't need an InRange meter - my XS is just fine. I have enough strips to last a while.

And, in a way, I've stayed true to the idea that I don't want to stick Medicare or insurance with crazy charges that, for me, are unnecessary.

 

[RAS]

How would this 'service' handle six tests in an 8 day period

Good question! I'll answer based on using Remote INR (now owned by Royal Philips subsidiary Cardionet). I can't speak to other services, but of course it could vary.

I signed up for an every 2 week test schedule. I can test and report more often, but don't have to since I'm seldom out of range.

They bill per 4 reported tests:

• I don't report every test. (but must report at least every 2 weeks)
• I only report manually on the website rather than sync the device to the app (which would report every test in memory)
• They don't bill per strip.
• They don't bill for or know if you wasted a strip.
• I track all my tests and flag whether I reported a test or not so I can match it to claims/billing.
• If I am out of range, I'll test again in 1 week rather than my normal 2. In this scenario, it appears they allow one "free" reported test since the claim date will be on the 5th test rather than the 4th. I'm seldom out of range so don't have a lot of data to be 100% confident they will always do this.
• When I stopped my warfarin dose in preparation for a medical procedure a few years ago, I tested 4 times in 1 week and reported 2 of those.
• I was originally on auto ship which resulted in enough strips to test weekly about 70% of the time. I cancelled auto ship and now manually order strips when I get down to two boxes (12 strips).
• They have never prevented me from ordering new strips, but there is probably some minimum timeframe between orders. I just have never encountered it.

And, in a way, I've stayed true to the idea that I don't want to stick Medicare or insurance with crazy charges that, for me, are unnecessary

I'm not on Medicare yet, but will be later this year. I contacted Medicare and learned the following:

• The max billable cost is $71.64 per 4 reported tests. It could be less.
• Medicare is of course 80/20, Medicare/patient so patient cost would be .2*71.64= 14.33 per 4 reported tests. Medicare will pay the rest.
• Medigap and Advantage plans may cover some of that patient cost.
• Apparently there are other factors that affect the cost, but not sure what. They said the above is the max. The above cost matches the cost for "nationwide" region on the CMS website, but I see different costs for specific regions also listed. Maybe this provider is only under the nationwide region code. I don't know at this point.

 

[pellicle]

The insurer apparently wants me to test weekly - on the same day each week - and will report my INR results to my doctor.

seems pretty reasonable ... its what I do, and what I actually ask people I'm training to do. Nothing wrong in scientific pursuit in being regular and repeatable.

FWIW - the 'weekly test' thing wouldn't have worked in the last week. I had to reduce my INR before having an ablation last week - for my own piece of mind, I self tested before going in for the procedure

for reasons I can't comprehend people seem to think that you can't test more frequently and just pay for them with your own strips. The code chips are designed to be swappable so that's not even a question.

I would always encourage people to test more if they have a sound reason to do so. We aren't robots and there is no Gestapo monitoring how often you turn your machine on.

Just do it I say

 

[Protimenow]

I have a supply of strips and, if I go with them, I WILL supplement - and probably do this on my own meter.

I was called today - they apparently bill $95 a month for use of the meter and four strips - nothing out of pocket for me, but about $1000 a year for Medicare and my insurance. (Of course, Medicare is deducting a pretty large hunk from my Social Security and perhaps this should help be used for this stuff).

The only cost may come at the beginning of the year - Medicare has a $240 annual deductible - if I don't see a doctor at the beginning of the year and have the $240 billed to Medicare, the service will cost $19/month. Pellicle - the only thing that I have to do to keep the service happy is to test on the same day weekly (I do it on a Saturday - I think they want Monday). My doctor's office assured me that they won't mess with me as long as my INR stays in range (which it will)). If I go with this, I'll be able to try out an InRange - yet another meter in my armory. (I already have more meters than I need - and might be persuaded to get rid of one).

Thanks RAS for the information on your experience with a service. I suggest that, for your own safety, you test every week. Even if your INR is pretty constant from test to test.

 

[Chuck C]

Would they need a good explanation why I needed more?

Perhaps the conversation could go something like this:

Hi, this is Protimenow. Can you please send another batch of test strips? Why? Because:
-The dog ate my last batch
-My grandson fiddled with them and chewed them all up
-I accidently dropped the cylinder in the toilet and they all got wet
-they never arrived. I know my mailman also self tests and I'm pretty suspicious

Take your pick.

I would say just keep at least a 6 month supply available, so that there is never pressure to be forced to jump through all their hoops if you get low, due to the fear or running out.
If you do decide to use their service, in order to get free strips, if the excuses above don't work, you can always supplement with a few of your own that you order independently. If you needed an extra 10 strips per year, beyond what they provide, that works out to only about $50 per year. That's a very small price to pay to use up a few extra strips in order to prepare for a medical procedure.

 

[Protimenow]

Actually, I don't have grandchildren or dogs, but I WILL have a toilet once the remediation of my house from a flood in JULY is completed.

As I've already noted - I have a supply of strips that I will use to supplement their supply.

I won't really have to worry about asking them for strips (especially if they supply me with strips) until what remains of my 48 expires - July 2025.

 

[RAS]

I suggest that, for your own safety, you test every week. Even if your INR is pretty constant

Yeah I've thought of going back to weekly, but my results don't give me a reason to do so.
As I noted, if out of range, I do test within a week. My % in range is as follows since being on this schedule:

2024: 100% (so far)
2023: 96.3%
2022: 80.7% (A couple illnesses affected my INR that year for several weeks each)
2021: 92.3% (excludes tests week of no warfarin before a medical procedure and week after ramping back up)
2020: 100%

Average for this period 92.3%

The previous 3 years I tested on a 1 week schedule.
2019: 84.3%
2018: 71.3%
2017: 70.8%

Average for this period 75.3%

The lower in range % those 3 years was (I assume) due to working during those years with all the stress, business travel (inconsistent meals, sleep habits), occasional round the clock implementations, etc. I guess retirement has made my INR management easy.

 

[pellicle]

Yeah I've thought of going back to weekly, but my results don't give me a reason to do so.

personally with those results combined with no need to ever adjust I would tend to agree. My results are rather like this

which suggests that I benefit from weekly testing (plus Its just easier for me to test on Sunday, and if I do that every sunday I don't have to ask "did I test last sunday or not).

We each do what fits our needs and our approach.

Best Wishes

 

[Protimenow]

This is the final message from me on this matter - I think.
The company called me again a day or so ago. They were ready to sign me up.

I told them that I had run through 6 strips last week and asked how they handle orders for strips. I was told that I was allowed six (or was it four?) tests a month - and that if I need more strips, they'll charge me $50 for six. (Although I have a 35 or so left, I still wanted to know).

These people are charging my insurance $90 a month for loaning me a meter, sending me six strips a month, and reporting my INR to my doctor (who promised not to bother me as long as my INR was in range).

I declined. I have strips. I don't need this company.

 

[slipkid]

This is the final message from me on this matter - I think.
The company called me again a day or so ago. They were ready to sign me up.

I told them that I had run through 6 strips last week and asked how they handle orders for strips. I was told that I was allowed six (or was it four?) tests a month - and that if I need more strips, they'll charge me $50 for six. (Although I have a 35 or so left, I still wanted to know).

These people are charging my insurance $90 a month for loaning me a meter, sending me six strips a month, and reporting my INR to my doctor (who promised not to bother me as long as my INR was in range).

I declined. I have strips. I don't need this company.

$90/month is kind of in the ballpark what I experienced compared to the 3 different companies I've had.

First was about $118/month (RCS). That was with insurance but think their cost with was same without (?can't remember). Then of course that changed with insurance once my total deductible was reached (between $1200 and $1600 depending on the year & coverage I had as far as my insurance then paying a portion of the $118/month). But I had probs with them consistently billing me wrong (long story) which was a huge hassle for me.


2nd company was Roche when they used to have their own monitoring service. I can't recall their exact charge monthly but believe it was a little more, like $120/month. Also with insurance. At least they billed correctly though.


3rd company was the horrid Cardionet/Biotel Heart/Philips/whatever else they called themselves. Their monthly charge was an astronomical $880 which they submitted to my insurance company. Insurance then knocked that down to like $12 regardless of my deductible status (to my surprise - with deductible met was only like $1 a month!). But through a very long story I've already tried to explain in the thread specific to them, their billing was a complete mess and in the 3 years or so I was with them I was only billed correctly TWO TIMES. To start they took so long to bill my insurance that they got nothing (took over a year b4 they started billing my insurance then another year b4 they started billing me), and during all this they started resubmitting old bills incorrectly to insurance and all new bills also were submitted incorrectly also giving them nothing despite my multiple phone calls making them aware, at which point for the last year & half of dealing with them they started billing me directly at $880/month with an "$800 discount" for each bill (making it $80) hoping I would be stupid enough to just pay that rather than make them go through my insurance (had a lot of fun regarding that with multiple phone calls to BC/BS conferencing in Biotel/Cardionet/Philips trying to get them to understand & for us to figure out what the heck they were even doing).

All of this led me to believe the hassles of a monitoring service was not worth a penny though. I bought a meter myself last year, buy the supplies myself as well, and if I have a need I can ask my current (idiot) Dr how to adjust my dose (who honestly does not have a friggin' clue and doesn't even want me to let him know what the INR is) - which btw trying to ask him anything is a joke anyways since he does not followup with anything or respond to messages through the practice's web portal like he is supposed to anyway. But I digress...

 

[pellicle]

All of this led me to believe the hassles of a monitoring service was not worth a penny though.

Agreed

Ironically diabetics get test strips and meters supplied in Australia, but we don't. So I've been out of pocket since I started (2012). I hasten to add that it's cheaper than even parking trying to get a free blood test (and I'd happily pay to avoid the cumulative vein injuries anyway)

 

[MaryLM]

I've looked into several of these subscription places and it's just not worth the hassle and the costs when you can do self-testing on your own. They are all just middle men. I've ben self-monitoring on my own for over 5 years now. The meters and test strips are available online at reasonable prices. Originally had an XS and now using an INRange and report directly to my doctor. I test as much as I feel that I need to without any restrictions or hassles. I really see no reason at all to go with one of these subscription service places. I felt like they were trying to sell me a timeshare every time I talked to one of them. LOL

 

[Unicusp]

$90/month is kind of in the ballpark what I experienced compared to the 3 different companies I've had.

First was about $118/month (RCS). That was with insurance but think their cost with was same without (?can't remember). Then of course that changed with insurance once my total deductible was reached (between $1200 and $1600 depending on the year & coverage I had as far as my insurance then paying a portion of the $118/month). But I had probs with them consistently billing me wrong (long story) which was a huge hassle for me.


2nd company was Roche when they used to have their own monitoring service. I can't recall their exact charge monthly but believe it was a little more, like $120/month. Also with insurance. At least they billed correctly though.


3rd company was the horrid Cardionet/Biotel Heart/Philips/whatever else they called themselves. Their monthly charge was an astronomical $880 which they submitted to my insurance company. Insurance then knocked that down to like $12 regardless of my deductible status (to my surprise - with deductible met was only like $1 a month!). But through a very long story I've already tried to explain in the thread specific to them, their billing was a complete mess and in the 3 years or so I was with them I was only billed correctly TWO TIMES. To start they took so long to bill my insurance that they got nothing (took over a year b4 they started billing my insurance then another year b4 they started billing me), and during all this they started resubmitting old bills incorrectly to insurance and all new bills also were submitted incorrectly also giving them nothing despite my multiple phone calls making them aware, at which point for the last year & half of dealing with them they started billing me directly at $880/month with an "$800 discount" for each bill (making it $80) hoping I would be stupid enough to just pay that rather than make them go through my insurance (had a lot of fun regarding that with multiple phone calls to BC/BS conferencing in Biotel/Cardionet/Philips trying to get them to understand & for us to figure out what the heck they were even doing).

All of this led me to believe the hassles of a monitoring service was not worth a penny though. I bought a meter myself last year, buy the supplies myself as well, and if I have a need I can ask my current (idiot) Dr how to adjust my dose (who honestly does not have a friggin' clue and doesn't even want me to let him know what the INR is) - which btw trying to ask him anything is a joke anyways since he does not followup with anything or respond to messages through the practice's web portal like he is supposed to anyway. But I digress...

Your Doctor has no issues with writing the Rx for Warfarin without the INR test results? I'm in the process of dumping my useless service because they changed billing methods and amounts. I have not advised my PCP yet and ask if they want me to report INR to them.

 

[Protimenow]

Actually, my PCP writes the prescriptions for Warfarin. His office approves the renewal requests. In California, if I recall correctly, prescriptions have to be renewed annually.

My prescription usually comes with three refills - I can refill a few times during the year and end up with a large supply of warfarin. (For example, I get 4 mg, 1 mg, and 5 mg - from which I'm usually make up any dose that I need at the time). My current Part D drug plan has a zero deductible on warfarin - so I can be prepared for the Zombie Apocalypse (or, perhaps re-election of a former president) and know that I'll have enough warfarin to last for a LONG time. (Of course, I may not live long enough to need all the warfarin that I'm stockpiling).

 

[slipkid]

Your Doctor has no issues with writing the Rx for Warfarin without the INR test results? I'm in the process of dumping my useless service because they changed billing methods and amounts. I have not advised my PCP yet and ask if they want me to report INR to them.

Yes, my current waste of space "Dr" (he is a Nurse Practitioner) does not even want to know what my INR results are (he said something like unless my results are way out of range then there is no reason to contact him). I've painfully learned that anything taking 1 minute of his time outside of an office visit is not something he wishes to be involved with. It is damn near impossible to get him to follow up on things which require his attention so I have to basically fend for myself....

 

[pellicle]

like unless my results are way out of range then there is no reason to contact him)

Even then would he know what to do (any better than you)?

 

[slipkid]

Even then would he know what to do (any better than you)?

Good point. I suspect not.

 

[Protimenow]

When my old HMO REQUIRED me to go to an anticoagulation clinic, I had some long arguments with this idiot pharmacist about my dosing, and that I'd been self managing for years and didn't need him.

I finally agreed to go to the 'clinic,' where he tried to dictate my dosage - WITHOUT KNOWING, OR ASKING, WHY I TOOK WARFARIN. Idiot.

I never returned.

Screw the HMO - I know better what I was doing than this idiot, egocentric, self-proclaimed warfarin god.

 

[slipkid]

When my old HMO REQUIRED me to go to an anticoagulation clinic, I had some long arguments with this idiot pharmacist about my dosing, and that I'd been self managing for years and didn't need him.

I finally agreed to go to the 'clinic,' where he tried to dictate my dosage - WITHOUT KNOWING, OR ASKING, WHY I TOOK WARFARIN. Idiot.

I never returned.

Screw the HMO - I know better what I was doing than this idiot, egocentric, self-proclaimed warfarin god.

It's funny, that reminds me of my bro-in-law who was on warfarin and was forced to see a Dr regarding his dosage/INR etc when he was more than capable of doing it all himself. Although I don't recall the exact story the visit went something like the Dr advising him to modify his dosage by a specific amount to get into whatever the range was and my bro-in-law realized the amount the Dr told him to change to was wrong. And when he tried to point that out the Dr got mad and threw him (and my sister) out of his office!! I had a similar experience years ago with a pompous ass Dr who being wrong was not in his vocabulary and if anyone pointed it out he would threaten them and kick them out of the office (this happened not only to me but to the wife of a friend of mine).

I've come to expect Dr mistakes, misjudgements, inaccuracies, lack of expertise regarding whatever the case may be, but what I cannot tolerate is the pompous attitude of some who refuse to listen to anything a patient might be correcting them about and instead resort to just telling you to leave rather than discussing the issue.

 

[pellicle]

is the pompous attitude of some who refuse to listen to anything a patient might be correcting them about and instead resort to just telling you to leave rather than discussing the issue.

two angles:

1. I've seen many med students who are arrogant young twats who hated people who weren't wealthy and just saw being a medical specialist as a highway to the big silo of money to "Scrooge McDuck" swim around in
2. I can personally vouch for how hard it is to dissuade a dunning kruger who has strong convictions but is utterly wrong and lives in an information silo (QAnon-a-like) and only shares stories with their other Krugers. "I've done my research"

there are more in one than the other

humility is hard to maintain when you do know your stuff and confronted with people of fixed certainty but with little experience, no evidence nor scientific method to back it up. We are all human and all have our faults