first case of amputation due to non compliance with an on x aortic valve

[Chuck C]

Will insurance cover test strips?

Personally, I don't know. I buy mine on Ebay. A pack of 24 runs about $ 130- a little more than $ 5 each. I plan to see if I can get reimbursement from insurance soon, but I am not holding my breath, as I did not go through my insurance company to get my Coaguchek.

There is an advantage to getting your own- you own it. Apparently, when the insurance provides it they still own the device. This came up about a month ago. I stopped reporting to the Covid Clinic my weekly results when I discovered that they were billing my insurance company $500 each time I gave them my results. That cost ultimately gets passed to all the members of my cost sharing group and I could not in good conscience keep letting them do this, so I stopped giving them my weekly results. They said that unless I kept reporting they would be forced to inform the insurance company and that my Coaguchek would need to be sent back to them. That was funny. Because I own it, no one can take it away from me.

 

[pellicle]

Will insurance cover test strips?

it depends ... but at $6 per test whats the big deal? What does a coffee cost around your area?

 

[MarkZ]

it depends ... but at $6 per test whats the big deal? What does a coffee cost around your area?

$6 (plus the up front cost) is a lot of money to a lot of people. That’s my point. As long as doctors collude with insurance companies to pork poor people, the rural thing matters.

 

[pellicle]

$6 (plus the up front cost) is a lot of money to a lot of people

I personally find that hard to believe, but if you say so. In which case they should choose a tissue prosthetic ... not sure how they'll afford all the other stuff that goes with heart surgery.

the rural thing matters.

sure does, you'll have to travel long ways to get all the yearly post operative scans done ... I'm betting that costs more than $6

I've had my Coaguchek for nearly 10 years now, the cost of it per test is now less than a buck (and they are new here at AU$500).

The thing is that there are work arounds for every problem, if you want to solve it.

BTW ... you didn't answer how much a coffee costs there.

 

[MarkZ]

I personally find that hard to believe, but if you say so. In which case they should choose a tissue prosthetic ... not sure how they'll afford all the other stuff that goes with heart surgery.



sure does, you'll have to travel long ways to get all the yearly post operative scans done ... I'm betting that costs more than $6

I've had my Coaguchek for nearly 10 years now, the cost of it per test is now less than a buck (and they are new here at AU$500).

The thing is that there are work arounds for every problem, if you want to solve it.

BTW ... you didn't answer how much a coffee costs there.

You don’t have to believe it if you don’t want to. There are a lot of people suffering. There are people who can’t afford a coke. Literally. There are people who get a ticket for a seat belt violation for example and have to choose between spending 3 days in jail or just living with a warrant for their arrest, because they can’t afford to pay the ticket. These aren’t random examples, I’ve personally lived it, so I’m pulling these examples out of my life history. Fortunately I do quite well for myself now and can afford coffees and coagucheks all day long, but I remember where I came from. The struggle is real, as they say.

And I don’t agree with you that people should base their health decisions on what they can afford. It’s entirely feasible for a person in poverty to get a mechanical valve and then follow the rules to get their free coaguchek and test strips. All I’m saying is that when they impose excessive rules for reasons that aren’t entirely clear, it can be burdensome to people in poverty and doesn’t exactly facilitate patients making the best decisions. As easy as it is for you and I to take warfarin correctly, the undeniable fact is that it’s not easy for some people and I wouldn’t discount poverty and lack of access as one of the reasons for it.

 

[Al3x]

A quick semi-related question. Are there any risks with accuracy if picking up a second hand machine? I was looking at some on eBay but I'm wondering if I should just pay full price and buy new for peace of mind.

 

[pellicle]

A quick semi-related question. Are there any risks with accuracy if picking up a second hand machine?

not really, they either work or they don't. All of the "smarts" is in the strip and its chemistry. The machine is simply a counter ... If I was you and I was buying on eBay I'd time it for getting a blod draw at the same time as getting the machine and if needed some strips. You could then compare and see.

Its often the case that there are a few decimal points out in the INR readings. This happens both from the nature of the chemistry and ones "repeatable steps" in timing the whole thing.

I started out seeing 0.3 INR difference and now see around 0.1 difference.

The key is to remember that this difference is not clinically significant (meaning it would not result in your changing what you would do in response.

Reach out if you get one and feel like a bit of a guide on managing INR when you start.

 

[pellicle]

There are a lot of people suffering. There are people who can’t afford a coke
...
And I don’t agree with you that people should base their health decisions on what they can afford.

I confess I don't understand what you're saying. It doesn't matter, so don't bother explaining it more.

 

[Al3x]

not really, they either work or they don't. All of the "smarts" is in the strip and its chemistry. The machine is simply a counter ... If I was you and I was buying on eBay I'd time it for getting a blod draw at the same time as getting the machine and if needed some strips. You could then compare and see.

Its often the case that there are a few decimal points out in the INR readings. This happens both from the nature of the chemistry and ones "repeatable steps" in timing the whole thing.

I started out seeing 0.3 INR difference and now see around 0.1 difference.

The key is to remember that this difference is not clinically significant (meaning it would not result in your changing what you would do in response.

Reach out if you get one and feel like a bit of a guide on managing INR when you start.

Cheers. I appreciate it. I'm still pre-op at the moment but will definitely take you up on that when the time comes.

 

[pellicle]

Cheers. I appreciate it. I'm still pre-op at the moment but will definitely take you up on that when the time comes.

reach out any time

being pre-op gives you time to get your head around things. My advice is to not spend too much time thinking about what might happen but instead in adapting to knowing that "things are changing" (as indeed life often does to us) and preparing for "dealing with and managing what does happen when it happens"

Its all we can really do. Some quotes from past philosophers which have helped me.

Marcus Aurelius:

I like also Epictetus

Best Wishes

 

[ashadds]

I'm unfamiliar with the US system, but I've seen quite a few Americans order one on eBay (new and used) and my Australian supplier may well shop to the USA too.

Strips also available on eBay and there are no fakes on the market. From what others have said their insured our of pocket costs are what I pay without insurance.

One has been sent from New Zealand to Thailand (that top to @Warrick ) to a low income fella who is a forum members here (the OP of this thread)
https://www.valvereplacement.org/threads/how-scared-should-i-be.888016/post-905509
He is now ticking along fine and I got him in range in 2 goes, been in range since.

why was his INR low in that thread despite raising the dosage ?

 

[pellicle]

why was his INR low in that thread despite raising the dosage ?

Because it needs to be the dose it needs, not some number one likes or is attached to.
Some require 2mg, others 20. He takes 10mg to be in range

Nobody was at the helm who understood that apparently. He was only being managed by a GP as I understand it.

 

[Zoltania]

You don’t have to believe it if you don’t want to. There are a lot of people suffering. There are people who can’t afford a coke. Literally. There are people who get a ticket for a seat belt violation for example and have to choose between spending 3 days in jail or just living with a warrant for their arrest, because they can’t afford to pay the ticket. These aren’t random examples, I’ve personally lived it, so I’m pulling these examples out of my life history. Fortunately I do quite well for myself now and can afford coffees and coagucheks all day long, but I remember where I came from. The struggle is real, as they say.

The SF author John Scalzi, who has made a similar journey from poverty to being well-off, wrote an essay called "Being Poor" which describes this struggle vividly.

 

[pellicle]

who has made a similar journey from poverty to being well-off,

walked that road myself ... one thing I learned was the you have to want to get out. Nobody helps you until you start helping yourself. The same also goes with educating yourself ... something I also did with an amount of hard work and sacrifice.

 

[MarkZ]

Good lessons for sure. It’s possible it’s a little different in the US where wealth disparities are so incredibly high and socioeconomic mobility is a bit more restricted due to cronyism (let alone the racial component to it). Help can be really important here, but I digress.

Many of us have been fighting against health disparities that impact medical care, of which poverty is a MAJOR cause, which is a really common problem in the US that has led to professional societies establishing task forces devoted to it, regulatory agencies setting their sights on it, and healthcare accreditation groups having committees with health disparities as their core mission. I know this because I’m on all three. So when I talk about healthcare needing to make improvements to address inequities, and not tailoring surgical guidance based on income for example, I’m admittedly coming at this from a very what’s-going-on-in-the-US-right-now slant.

 

[pellicle]

So when I talk about healthcare needing to make improvements to address inequities, and n

As you may note, I'm Australian. Whenever I've commented about the differences between our health care and the USA it upsets an American an member here. Since I can do little to help that disparitie I see no point in raising it further.

We all have to make choices that we may not like to have to make. However for myself I've always seen that understanding my budget has helped me in planning. Planning not only what I can do, but planning what I need to do to get where I want.

It's been decades since I was mattress on a floor in really cheap housing, yet even then I was putting everything into changing my situation.

 

[MarkZ]

Whenever I've commented about the differences between our health care and the USA it upsets an American an member here.

Understood. But it's not really "upset" as much as acknowledging that things can be different in different countries. As I admitted, I'm coming from a very US-centric perspective and I know literally nothing about Australia's socioeconomic landscape, healthcare system, or anything else. YMMV basically.

 

[tom in MO]

A quick semi-related question. Are there any risks with accuracy if picking up a second hand machine? I was looking at some on eBay but I'm wondering if I should just pay full price and buy new for peace of mind.

There is always a risk buying second hand anything. When I switched providers for my testing supplies I got a free new meter even though the old one worked.

 

[pellicle]

But it's not really "upset" a

With the guy I mean it's stamp his feet red in the face upset.

Anyway, its refreshing to have a conversation.

Best Wishes

 

[Dodgy Ticker]

Thanks for talking me off the ledge. I was losing it there for a bit.

My pleasure....