Pardon my rambling, but here goes.
First of all you need to be aware that your conference call is not with “the Board”. In likelihood this is a committee that goes by several names, namely “the Benefits Committee (better known as the benefits denial group.
I would suggest several scenarios. First off, make it clear that you are an informed and intelligent consumer of healthcare. You have independently done a large amount of research on the internet both the usual Goggle searches as well as using the National Library of Medicine via "PubMed” (
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed)
You have also had friends with knowledge of statistics and cooperative medical professionals give you advice. Now, having made this statement, you will ask them what their groups qualifications are in dealing with anticoagulation therapy. First, are any of you certified anticoagulation certified experts? Second, are any of you hematologists? Third, do any of you manage at least 30 anticoagulation patients in your medical practice? How much time in clinical practice per week do you have patient contact? I would suspect that they do not see patients more than 6 hours a week; the rest is in administrative function.
Then say, “I’m sure that you have reviewed the medical literature as I have. Would you be kind enough to send me your complete bibliography of articles that you have read about this subject, both the pro and con articles.
Have you looked at the Meta analysis performed by Cigna? Have you looked at any other Meta analysis? (
http://www.cigna.com/health/provide...ioncriteria_prothrombin_time_home_testing.pdf)
Aside from the medical facts regarding home testing, I suspect that a significant concern is the financial outlay for the device. I am curious, what do you pay to an outside lab to perform an INR? What is your in house Kaiser cost to perform the test? My friends with other insurances indicate that the labs charge between 25-50 for the test but get reimbursed in the range of 8-15. This latter figure is well within the range of the cost of home testing supplies. The only difference is the amortized cost of the machine itself. The literature is very clear that the risk of stroke or major bleeding complications is significantly less in home testing. If I were to have such a complication, what is the average hospital, clinical, rehabilitation costs of the complications? How does this compare to the cost of the machine?
If they bring up the question of accuracy, point out that the literature strongly supports the accuracy of home testing. However, there is a large body of literature that shows that even minor errors in the handling of ordinary laboratory samples can lead to large variations in the calculated INR.
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