Can I just buy my own machine and strips and manage my Coumadin on my own? My Cardiologist says I have to use a third party service in order to do home testing. I am just trying to find out how others do home monitoring, if everyone is forced to use a third party home monitoring company. Any info is greatly appreciated.
Hello JCC,
This thread seems to have deviated quite a bit from your initial question, but I'll offer an answer on how I am dealing with the home INR testing.
If you want the costs associated with the home testing to be covered by your health insurance, then I think you are indeed forced to use the 3rd party service, who then bills the health insurance company. I currently go through Philips, and they charge $280.00 per month. Blue Cross has a max allowable charge negotiated with them of "only" $173.43/month. So, until I hit my plan's deductible, I am paying the $173.43 each month. Your particular insurance plan may have a different negotiated rate. This will easily bust my max deductible for the year (12 x $173.43 = $2,048.16/year). I don't know about you, but this seems outrageous to me for the minimal service of supplying the test strips and passing along my weekly INR phoned-in value to my doctor. They maintain ownership of the meter - it is "on loan" to you. There is some benefit to their in-home test training, so it is probably a good idea to start out with one of these services until you are more experienced with home-testing. You said that you have already been home testing for 6 months, so you should already be fairly experienced.
How you deal with it long-term depends in large part on how flexible your doctor is. Ultimately, the doctor who prescribes your warfarin is responsible for seeing that you are managing your INR properly. I'm sure there are medical liability issues involved. He/she needs to be on board for whatever test strategy you work out.
The doctor I am using is very flexible, and he has indicated that he doesn't care if I go through the Philips service or not, just as long as he gets the data.
I have been home testing through Philips for about 16 months, and up till now I was OK with the high price Philips charged because I maxed out my deductible on the initial OHS and then some follow-on surgeries to address complications from the endocarditis that necessitated the valve replacement in the first place. So, for this past plan year I was going to pay my max deductible no matter what, and the incremental cost of the Philips insurance co-pay was not unreasonable. This will not be the case going forward, since hopefully all my surgeries are now behind me.
Several months ago, I purchased an Inratio-2 meter on Ebay, along with some test strips. Ignoring the meter initial cost, the test strips run about $5 each. So, I can test once a week for only 52 x $5 = $260/year instead of the roughly $2,048 going through Philips. Actually, my true costs are slightly less since once I bust my annual deductable I am only charged the co-pay. I have been making parallel tests each week on my Ebay purchased meter and my "official" Philips/Alere meter long enough to confirm that they generally agree to within about 0.1 in INR, and they also closely match the occasional lab test, so I know my "unofficial" meter is just fine.
My plan is to discontinue the official Philips/Alere service at the start of our new health plan year when my deductible resets, and continue weekly home testing using my own meter. I will go back to once a month (or even less frequent) lab draw but only use that as a monthly confirmation that my home meter is giving the same results as the lab. The lab charges a "retail" price of $51 for the INR blood test, but the insurance negotiated rate is only about $4. so I'm only responsible for the $4 until I hit my deductible limit, then over to a lesser co-pay amount. So, this ongoing monthly lab validation of my home test meter will only cost me 12 x $4 = $48/year.
This give me an out-of-pocket cost of $308/year to get the weekly home test plus a once-a-month meter validation check against the lab venous blood draw for a lot less money than continuing with only the "official" Philips home test service. By going this route, only the lab test costs ($48/year) are processed via my insurance, and my "unofficial" home test costs ($260/year) are outside the official insurance system.
I'm not advocating this approach for others, but just letting you know what I have elected to do for myself. My doctor is fine with this approach.
Also on the tangential issue that Protimenow and others have mentioned, my doctor is also a firm believer in taking the same exact dose of warfarin (or as close as possible) each day so that there is a uniformity of dose throughout the week. I break 1mg tablets in half and add 0.5 mg to my larger pills to get the daily dose uniform when necessary.
After hearing lots of horror stories about mis-managemant and uncooperative warfarin clinics, I consider myself fortunate to have an enlightened, competent and flexible doctor managing my ACT.
