HELP!!! How can I get home testing approved?

[JeannieF]

Hello everyone...I had AVR replacement 8 months ago. I keep asking the cardiologist who is now following me about home testing. He claims that my insurance absolutely WILL NOT approve it and won't fill out the paperwork for me to even try. I have 2 small children and have a hard time getting care for them so that I can go do blood work every week or more frequently when my INR is off. Have even missed appointments when kids are sick etc. Does anyone know how to go about getting home testing approved? Have any of you had such push-back from your physicians? I really want to have the capability to home test for a variety of reasons....any feedback would be really appreciated!!!!!!!!!

 

[ALCapshaw2]

ANY Doctor can write the needed prescription so you may want to ask your Primary Care Physician.

Contact QAS about supporting documentation that you could use to convince your Doc.

Then you and (s)he will have to convince your insurance company. Some are starting to come around.

Good Luck !

'AL Capshaw'

 

[lance]

Try and find a ...............

Try and find a ...............

clinic or hospital that uses home monitors. That's what I did several years ago. Once I found a hospital that used them my PCP changed his mind about home testing. Since then he has done a complete about face suggesting I could train my husband to use my "XS" and between the two of us keep his INR in range. I hope you find a PCP with an open mind.

 

[catwoman]

Jeannie:

What insurance carrier do you have?
How does the cardiologist know that your policy won't cover it?
Ask him if he has any patients who home-test. If he says no, sounds like he's opposed to the concept.

You'll need to investigate your insurance coverage, to see if it does cover home testing units for people with mechanical valves. Start with phone calls to the phone number listed on your insurance card for membership services, for what it's worth. Sometimes these folks don't know too much, or contradict each other. Also, search the carrier's website. You may find a policy statement that says you are covered. PRINT IT OUT, if you find one.
You have a mechanical valve. You are on chronic anticoagulation therapy. You have to care for 2 small children, which complicates medical appointments. These are valid reasons for an insurance company approving a home-tester. The more you miss appointments, the greater risk you have of being out of range and having a clot, stroke or bleed.

 

[SHerrin Hutt]

Pt

Pt

Hi Jennie
I got my PT machine in 2003 and my insurance co. paid for it and the supplies. QAS took care of everything. All the paper work. Humana was my primary insurance co. then. My husband retired in 2006 and my first machine died a couple of months ago and medicare paid for the second one.

 

[Blanche]

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=72

The above is a link to a document which contains the research and reasoning for Medicare's acceptance of INR Home Testing.

Perhaps your doctor will reconsider when she has documentation to show that the government, Medicare, covers in home testing for people with medcanical valves and people with a-fib?

If this does not sway your doctor, you probably might try finding a new doctor, as hard as that may be.

Regards,

Blanche

 

[ALCapshaw2]

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=72

The above is a link to a document which contains the research and reasoning for Medicare's acceptance of INR Home Testing.

Perhaps your doctor will reconsider when she has documentation to show that the government, Medicare, covers in home testing for people with medcanical valves and people with a-fib?

If this does not sway your doctor, you probably might try finding a new doctor, as hard as that may be.

Regards,

Blanche

This is a Very Interesting but LONG memo (14 pages) that gets off to a Slow Start citing the reasons skeptics were not in favor of Home Testing.

The Conclusions from multiple studies at multiple sites by different researchers ALL came to the Same Conclusion:

Of the 3 primary test sites,
(1) Physicians Offices, (80% of patients)
(2) Coumadin Clinics, (20% of patients)
(3) Home Testing, (not widely practiced in 2001 when the studies were conducted)

Physicians Offices had the WORST outcomes and greatest variability.

Coumadin Clinics had better results

Home Testing had the BEST results for a number of reasons including more frequent testing (therefore catching changes more quickly which required smaller and fewer dose changes).

The paragraph on Frequency of Testing (page 3) includes an interesting commentary on Anti-Coagulation RISKS vs. INR which (deductively) concludes that the 'safest range' is from 2.0 to 3.0 with a somewhat elevated risk of bleeding from 3.0 to 4.0 and a significantly greater risk of bleeding at 6.0. It also mentions that the risk of STROKE rises RAPIDLY for an INR Below 2.0

I recommend reading the memo for the detailed analysis of the individual studies.

'AL Capshaw'

 

[witzkeyman]

my cardio gave me a REAL hard time. I finally have the machine but it wasn't easy.

 

[Blanche]

Please tell us what kinds of things you did to get your doctor to approve home testing for you.

It took us more than 2 years to convince our internist. And, we already had the monitor and strips, which we got from the cardiologist. Our internist said Al could test weekly on the monitor, but he still had to go to the lab for a monthly blood draw. And, of course, he felt that the lab was the best for testing...

Well, 6 years later he opened his own Coumadin CLub in his two offices.
Actually, we have the very same INR monitor that he has...same monitor, same model, same everything. And we get our strips from the same place he gets his.

Regards,
Blanche