Home testing options (?)

[slipkid]

Haven't been here in a while. Hope you all are well.

I'm back here today because I had to cancel my home self-testing service and am now looking for other options. I had been using a company called Remote Cardiac Services (RCS) but as I understand it they got swallowed up by "Lincare" at some point and have really gone downhill since then. I can no longer deal with their totally incompetent billing department, their ***-backwards billing system, their godawful customer service etc etc etc. Don't get me started or I will go on and on and on and on trying to explain how horrible this company is.

I had been using a Roche Coaguchek XS for the last 2 years or so which I will be returning to RCS/Lincare. I'd like to find another similar home meter system so that I can continue to check my INR weekly. Either just buying a unit/supplies outright myself, or enrolling in another service that gives me a unit and supplies to use.

Would like to know if anyone has useful experience in either buying a unit themselves (how? where? how much do the units and supplies cost? how to get any of that covered by insurance???) or of other service like this that provides the patient access to the needed supplies in exchange for a monthly fee covered by my insurance.

Any recommendations?

 

[dick0236]

I have used Coagucheck Patient Services for several years with no problems and I highly recommend them. It is a subsidiary of Roche Diagnostic. 1-800-780-0675 and they can answer any questions and help you get set up.

 

[slipkid]

I have used Coagucheck Patient Services for several years with no problems and I highly recommend them. It is a subsidiary of Roche Diagnostic. 1-800-780-0675 and they can answer any questions and help you get set up.

Thanks very much, I will check them out on my next day off (later this week). The fact that they are a subsidiary of the company that makes the device sounds like a good thing to me.

Let me ask though, since I want to try to avoid further hassles like what I am currently going through:

- Do they bill you correctly each month based on your actual insurance EOB?

- How ez is it to call them and actually speak with someone (rather than sitting on hold for 10-30 minutes only to speak with someone who is clueless that transfers you to someone else requiring another 10-30 minute wait who is just as clueless)?

 

[dick0236]

They bill me after four scheduled weekly tests for my 20%......about $20. They also bill my Medicare Advantage plan for the 80% balance. I receive the billings promptly with no problem.

They respond quickly and accurately the few times I've had to call. Strips are sent to me automatically every couple months.

Your experience with your current supplier sounds like my earlier experiences with Alere......I almost gave up on self-testing until I found Coaguchec Patient Services.

 

[pellicle]

Hi

firstly, I see that **** has given you good information pertinate to the Health "Care" systems in place in the US

but as you ask...

...
I had been using a Roche Coaguchek XS for the last 2 years or so ...

Would like to know if anyone has useful experience in either buying a unit themselves (how? where? how much do the units and supplies cost?

Units are units, so buy one on eBay for about $500. Right now Roche has introduced a new model with a colour screen and so older stock of the black and white LCD screen will likely be discounted. They are both XS systems so use the same strips.

If you look around online the strips are typically about AU$160 for a pack of 24, which works out to less than $7 per week. I spend about that on coffee beans for my morning coffee, so it should be something most can budget for.

I have noone pushing me around and I like that, I also like that I am solely responsible for my own health in this manner. A side effect of that is that I can call the shots on how stuff is done (like perioperative management of INR) and having built the knowledge to do this gives me confidence. From ignorance comes fear.

Worth pointing out is that during the last 5 years I've spent more than $1600 on tests (and will of course spend more), meaning that the "oh gosh, $500" is amortised to be about a quarter of the costs of the operation costs.

I can't tell you how much I've spent on eating in that time, but I suppose that if I didn't eat for 5 years I'd save a lot of money too.

HTH

 

[Agian]

From ignorance comes fear.
From courage comes knowledge.

 

[DachsieMom]

I use coaguchek patient services. I initially signed up with Alere but canceled after the sign-up process was botched. I am very happy with coaguchek. I pay 100 per month (4 tests).

 

[slipkid]

Thanks for all the replies. Very helpful.

I like the idea of having my own unit rather than "renting" one via a service like I was doing. But am hesitant to go the ebay route for something like that - also I would want to try to have my health insurance involved in paying for it & doubt they would authorize buying something from ebay.

Does Roche sell their units or just the "service"?

Also, does Roche require testing every week? Or would they abide by whatever my Dr. authorizes? I actually like testing every week but have been pretty stable and would be comfortable testing every other week (my Dr. thinks testing once a month is good enough but I feel that is too big of a window myself). And if Roche allows testing every other week is the cost less?

Sorry for all the questions. I will try to call Roche tomorrow actually, hope to have some time then.....

 

[pellicle]

I like the idea of having my own unit rather than "renting" one via a service like I was doing. But am hesitant to go the ebay route for something like that - also I would want to try to have my health insurance involved in paying for it & doubt they would authorize buying something from ebay.

well despite eBay having greater buyer protection than the usual US consumer gets there are also online sellers (who have long histories and are quire reliable) where you could go.

I just checked eBay USA and found a bunch of them for under $200 USD (of course auctions still in progress). Usually you can tell by looking at it if its been kept in its case.

All the "smarts" are in the strips and code chip and there are no chinese knockoffs around (for such a low selling item)

The $100 per month (for 4 tests) works out to be about 6 months worth if you're "rolling your own" (as we say in Australia)

However of course you must fit within the rules of your health insurance (which I've always thought was a funny name for what that actually is in the USA for anyone who is in chronic care as we warfarin patients are [or would be if I wasn't caring for myself])

 

[dick0236]

Thanks for all the replies. Very helpful.

I like the idea of having my own unit rather than "renting" one via a service like I was doing. But am hesitant to go the ebay route for something like that - also I would want to try to have my health insurance involved in paying for it & doubt they would authorize buying something from ebay.

Does Roche sell their units or just the "service"?

Also, does Roche require testing every week? Or would they abide by whatever my Dr. authorizes? I actually like testing every week but have been pretty stable and would be comfortable testing every other week (my Dr. thinks testing once a month is good enough but I feel that is too big of a window myself). And if Roche allows testing every other week is the cost less?

Sorry for all the questions. I will try to call Roche tomorrow actually, hope to have some time then.....

Several years ago I used an INRatio and strips that I bought on ebay with no problem. If the unit is new and unused there should be no problem. When the unit was pulled from the market due to strip problems I had to scrap my machine. I see the problem as being with product service, if needed, and I find the leasing program with Coagucheck Patient Services better serves my comfort level.

Roche(Coag Patient Services) used to allow for bi-weekly testing and my guess is they still do and the cost would be 50% less.

I also do not agree with your doc that "testing monthly is good enough". Remember that the majority of his/her patients are on warfarin for afib, etc. and not mechanical valves and less frequent testing seems OK for them. I actually have friends on warfarin for non-valve issues that test quarterly and I guess that is OK for them........but I've had my stroke and don't want another.....so I'll keep on testing weekly.

 

[LondonAndy]

As a Brit I am intrigued as to what these "home testing services" do. Here in the UK, if I had to pay for everything myself, a CoaguCheck XS (new from the manufacturer) costs £299 (About US$413), and a pot of 24 test strips costs £69.40 (US$95.60, or $3.98 each strip, again direct from manufacturer). Adjusting your Warfarin dose is not particularly complicated once you have had a little training, or is that what people want from the home service?

In reality I don't pay for supplies, but that is not the point - I am happy to say more about UK healthcare provision if people want, but that aside costs seem much lower here even at full price.

 

[slipkid]

I also do not agree with your doc that "testing monthly is good enough". Remember that the majority of his/her patients are on warfarin for afib, etc. and not mechanical valves and less frequent testing seems OK for them. I actually have friends on warfarin for non-valve issues that test quarterly and I guess that is OK for them........but I've had my stroke and don't want another.....so I'll keep on testing weekly.

Yeah, I hear ya, but I run into this all the time, not just with my Primary Care Physician. I work with a guy like me has an aortic valve replacement and he only gets tested once a month (via blood draw at a lab).

Every time my PCP goes on vacation (or moves between practices - I've had him for only 3 years and he is on his 3rd different practice now), another Dr. in his office then covers for him & they get my INR result, they have no idea it came from ME in the first place self-reporting through RCS, they call me to let me know what the result is (no clue that I already know), and tell me stay with same dose and retest in one month. Even when I used to use my cardiologist's office to manage my warfarin (which they were TERRIBLE at - see a different thread I posted in years ago), and my cardio doc was the one who TOLD ME about weekly testing and tried to set me up with Alere to do that, the person in their office (nurse practitioner) would still tell me to test again in one month with no clue that I was testing each week myself - and I even remember at one point telling that person that I selftest at home once a week and they gave me **** that I did not know what I was doing, that testing once a month was all they ever heard of, and I had to TELL THEM TO TALK TO THEIR BOSS AS HE WAS THE ONE WHO TOLD ME TO DO THIS AND SET ME UP IN THE FIRST PLACE TO USE THE SERVICE.

From past experience I was already pretty fedup with doctors in general but after my heart attack, open heart surgery, double bypass, & aortic valve replacement, my negative experiences with doctors & their staffs got ramped up about 1000 times as they demonstrated over and over and over again that they had not a clue what they were doing....

 

[pellicle]

Yeah, I hear ya, but I run into this all the time, not just with my Primary Care Physician. I work with a guy like me has an aortic valve replacement and he only gets tested once a month (via blood draw at a lab).

that's pretty common ... but while many never have any issues, its the reason why bleed and thromobsis stats are as they are ...

Every time my PCP goes on vacation (or moves between practices - I've had him for only 3 years and he is on his 3rd different practice now), another Dr. in his office then covers for him & they get my INR result, they have no idea it came from ME in the first place self-reporting through RCS, they call me to let me know what the result is (no clue that I already know), and tell me stay with same dose and retest in one month. ...

I put up with that circus for about 6 months, then went to self testing and self administration. Nobody showed me how, or trained me. I just started with "well I'm on this dose, and my INR went up, so I need to put dose down..." did some reading, made my own system and now I help others (who wish to be helped). Normally its only a few weeks and they're right on their own.

The first step into the pool is always the one you fear the most (while everyone in the pool is saying "come on in the waters fine")

 

[tom in MO]

I've had my supplies come from two places Alere and EdgePark. My insurance, BCBS, determines where I can go. I did not like Alere neither did BCBS who dumped them. EdgePark is better but not by much. Weird thing is Edgepark's stuff is actually shipped from Alere. My cardio's office has a service so I call in my results to them.

My cardio's nurse told me that the meter I received from Alere may be mine to keep, and it was. So I looked for strips on my own. They are cheaper on line, but for me, once my yearly deductible is paid (which it always is) it is cheaper on an annual basis for me to get the strips through my insurance. EdgePark gave me a new meter when I signed up. Both providers give you the meter for free and charge for the strips. I threw out a meter that was in my MIL house years after she died. Her service must have been the same because unlike the other medical equipment it didn't need to be returned.

Anybody know how long a meter is good for? It doesn't come with any recalibration or maintenance schedule.

 

[slipkid]

I've had my supplies come from two places Alere and EdgePark. My insurance, BCBS, determines where I can go. I did not like Alere neither did BCBS who dumped them. EdgePark is better but not by much. Weird thing is Edgepark's stuff is actually shipped from Alere. My cardio's office has a service so I call in my results to them.

Originally my cardiologist proposed weekly home testing to me and gave me a brochure to use Alere. I was than caught in a 4-5 week quagmire of BC/BS telling me that Alere was one of their in network providers with Alere originally saying so as well but then Alere telling me no that was not the case and they could not take my insurance. That is a huge long story (something about a "bluegap" technicality that was extremely difficult to finally get to the bottom of) that I think I already posted about up here somewhere, that illustrates how screwed up the USA healthcare system is.

Anyways, out of that a very good support person at BC/BS was able to find RCS for me who did take BC/BS and they used the Alere device. At which point my cardiologist balked at signing the paperwork for RCS though and sat on it for over a month because he was only familiar with Alere, and I had so many probs with my dosage management from the clueless fools that worked for the cardiologist that I was looking to escape from them anyway, and my PCP took over & got me started with RCS home testing....which leads me to ask you....at some point I thought Alere got OUT of the INR business. Their device was recalled (I was then switched to the Roche Coagcheck watchamacallit). Are you still using an INR meter/supplies from Alere????

 

[pellicle]

Anybody know how long a meter is good for? It doesn't come with any recalibration or maintenance schedule.

with respect to the Coagucheck XS I understood it was not needing any calibration as that was done in the chemistry of the strips (which have useby dates) and the accompanying code chip.

 

[tom in MO]

with respect to the Coagucheck XS I understood it was not needing any calibration as that was done in the chemistry of the strips (which have useby dates) and the accompanying code chip.

True but sometimes just because the calibration is external to an analytical device doesn't mean that the device that uses the "reagents" on the strip and calibration information on the chip, doesn't need some level of accuracy and precision related to the use of the strip/chip calibrators. Lots of analytical systems have two calibration levels, one related to the reagents (i.e. chip/strip) and one related to the instrument's function. Often it's not a calibration, but a calibration check.

Then what comes to mind, is that if all that is necessary for calibration is contained on the strip, what about maintenance? I replace the batteries. but there are no statements from the manufacturer concerning when, if ever, the device needs replacement. I've found a lot of information on-line concerning accuracy, comparison to laboratory tests, etc. but nothing on long-term use of the same meter.

 

[pellicle]

Well as I understand it, the machine just applies a current to "warm up" the reagents and that is likely to be a very simple reliable circuit. Then a timer circuit (also highly reliable olde schoole electronics) times the event. The code chip likely contains the requisite ISI scaling factors for each batch based in manufacturer sampling..

but nothing on long-term use of the same meter.

Anecdotal evidence from me is that after over 5 years is showing no changes worth mentioning when I do my periodic (around 6 month or so) INR comparison to a lab.

P.S. I observe a small pinhole in the strip which I anticipate is used for LED (perhaps IR) illumination to observe when particular movement ceases.