How do I get mom started with home testing?

[watson524]

Hi all,

Been a while since I wrote but mom's ticker is still going strong, she's developed other health issues but we're plugging along. I took her warfarin management away from her GP after a discussion with her cardio. He has always supported a finger stick while her GP insisted on blood draws and given her other health issues, the cardio was like this is nuts. He was going to have her use pradaxa off label but the cost was outrageous and since she's been on warfarin for 35 years and done well with it, I asked him to get her hooked up with an anti coag clinic through a big local hospital system that uses the finger sticks. No problem. So now she goes there and then they give her her dosing right on the spot (tho she's very level). I told them when I started I wanted to get her a kit for home since she will eventually not be able to get out (she's in a wheelchair now) and they said they have patients that do that and then the company reports it to them as the doctor and they give us the dose so I want to start that process but how do I do it to get a monitor (Coagucheck XS - they use the pro version at the clinic)? I understand medicare part B pays for it but do I call Coagucheck? Do I call medicare? I'm assuming I'll need an Rx for it which wouldn't be an issue as her cardiologist is very understanding of our situation but I have no idea how to start.

thanks in advance!

 

[jwinter]

Not gotten mine yet and not medicare but I spoke with primary care provider and he said he would write the script for it when I see him Tuesday..

 

[dick0236]

I use the CoaguchekXS and am enrolled in a plan thru Coaguchek Patient Services in Indianapolis, IN....1-800-852-8766. They provide the meter, strips, lancets etc without cost to the patient and charge about $25/test. Medicare pays 80%($20) and I pay 20%($5). It requires an Rx from your Doc and pre-approval from Medicare. Give them a call and they can get you started. I have used a couple of different programs over the years and Coaguchek Patient Services is the best I have ever used and I recommend them highly.

 

[DachsieMom]

Love coaguchek patient services! Except I am not on Medicare so I pay $100 per month.

 

[watson524]

I use the CoaguchekXS and am enrolled in a plan thru Coaguchek Patient Services in Indianapolis, IN....1-800-852-8766. They provide the meter, strips, lancets etc without cost to the patient and charge about $25/test. Medicare pays 80%($20) and I pay 20%($5). It requires an Rx from your Doc and pre-approval from Medicare. Give them a call and they can get you started. I have used a couple of different programs over the years and Coaguchek Patient Services is the best I have ever used and I recommend them highly.

Thanks ****!! That's extremely helpful. The place she goes to says once a month assuming she's in range 3 tests in a row but told me that some services require 2x / month at least. Is that how Coaguchek is? I assume I could just buy more strips on my own if I wanted to test say weekly and just not report half of them.

 

[dick0236]

Thanks ****!! That's extremely helpful. The place she goes to says once a month assuming she's in range 3 tests in a row but told me that some services require 2x / month at least. Is that how Coaguchek is? I assume I could just buy more strips on my own if I wanted to test say weekly and just not report half of them.

​I think, after reading your moms bio, she may not qualify for Medicare coverage for self testing INR. I think the coverage is limited to Mechanical Valve Patients, but you should check that with Coaguchek Patient Service. They do permit testing 2X/mo but I doubt they would sell you additional strips so you could test and not report the results.......but that's for them to answer. The other way is to use ebay to purchase a meter and necessary supplies.

 

[watson524]

Huh I didn't think to ask Mark at Roche when I talked to them. He's going to send me the information packet to get started. If I went on eBay and got things, I don't know if her clinic would just let me call in the results and do the dosing that way (I know her doctors wouldn't want me self dosing, even tho last I checked I'm not an *****). If they would, that'd be a good option. If medicare will pay for the test from Roche, I assume I could buy extra strips on my own (ebay) and just use those as needed or does the meter somehow say "whoa you're testing too much" because it's tied to Roche directly?

 

[dick0236]

.......assume I could buy extra strips on my own (ebay) and just use those as needed or does the meter somehow say "whoa you're testing too much" because it's tied to Roche directly?

The meter would not identify the number of tests being done......however, there is a "chip" for each batch of 6 strips and you would have to remember to have the correct chip in the meter for the strip being used. Should be doable.....but a bit of a hassle. Bigger question right now is if Medicare will approve self-testing for a non-mechanical valve patient. It has been a few years since I first looked into self-testing and the newer rules may be different from the old ones.....I hope so, "cause home self testing is a lot more convenient than going into a lab. Good luck

 

[DachsieMom]

Your doctor writes a prescription for how often to test. In my case, it is once per week. I receive 6 strips per month from Coagucheck - allows for a mess up or two! (And you will have many at first...). I am billed every fourth test, so if you test less often maybe you are billed less often- ie every 8 weeks if you test every two weeks? Coagucheck did not require weekly testing. Alere did (at least when I called last year). I test weekly anyway, but I liked the flexibility of coaguchek. Not sure if medicaire allows home testing for tissue valve, but coaguchek should know.

 

[watson524]

I found this article that shows that she should be covered even with the native valve http://www.prnewswire.com/news-rele...onitoring-clotting-time-at-home-57026082.html so that's good news. I'll see what the info packet says and then get the doctor to fill out the paperwork he needs to. I'm going to "suggest" bi weekly testing to him and her cardio is much more apt to just do whatever I want there.

The Roche guy said you get billed every 4th test so that must be the standard regardless of test interval

 

[dick0236]

I found this article that shows that she should be covered even with the native valve http://www.prnewswire.com/news-rele...sers to have the convenience of home testing.

 

[pellicle]

... I'm going to "suggest" bi weekly testing to him and her cardio is much more apt to just do whatever I want there.

The Roche guy said you get billed every 4th test so that must be the standard regardless of test interval

I'm curious what that will be ... as I just pay everything myself with my own money it works out at $6 per test (with the cost of the machine not included, but as I've done over 300 tests on this machine its not going to be expensive either)

 

[George in Denver]

Sorry to hijack this thread. Switching to self-monitoring after 4 months of trips to a hospital-based INR clinic. I’ve been studying the many threads on home monitoring and Pellicle’s blog posts on the subject (about to dive into his videos)—all very helpful. I’m so grateful for all of this support from the community. A few questions:

1) I need to buy (self pay) a second Coaguchek XS because I’m often at a second residence for my work, and I’d like to leave the extra machine and some supplies there. Alere has quoted me a price of US $2495. Several people here have mentioned buying a machine off eBay. Is there a reliable eBay seller that anyone might recommend (even via PM)? I’d be afraid of getting a used or defective machine, or one without a warranty. And do you need a doctor’s order to purchase from an eBay seller?

2) If I want to purchase additional supplies beyond those I can get through my insurance, is there a reliable seller? And do you need a doctor’s order to purchase supplies in the US?

3) The home monitoring service that’s covered under my insurance is Alere. I know from many posts here that Alere is not as good as Coaguchek Home Monitoring, which is not in my insurance network. Am I making a big mistake (in terms of my own safety) in using Alere for home monitoring, rather than self-paying for CHM? I can pester Alere to send supplies when I run out if that’s the only problem.

Thanks for any insights on any of these questions.

 

[dick0236]

........... A few questions:


1. I would not be afraid of buying a meter from a rated supplier on ebay so long as it was new and the strips do not have expired, or soon to expire, "use by" dates. I believe ebay also stands by the products being sold thru their site. You do not need a doctor Rx when going thru ebay. Not sure a warranty would be offered thru a "private sale".

2. Strips thru a USA medical supply distributor would probably require a doctor Rx. You might find a foreign distributor on the Internet that does not require an Rx. Strips thru ebay would not require an Rx.

3. Unfortunately, many of us (me included) have had bad product and service experiences with Alere and prefer to not use them. Unfortunately, if they are your "network supplier" you will be stuck with them.

BTW, welcome to the forum.

 

[pellicle]

Hi

Sorry to hijack this thread....Pellicle’s blog posts on the subject (about to dive into his videos)—all very helpful. I’m so grateful for all of this support from the community.

very glad to hear they are helpful. The video is short (like a minute) and it really needs the context of the blog post to flesh out its "assumptions" and "premises" Key points are:

• be repeatable
• be consistent
• stay within the guidelines
• note that the rubber band is wound down the finger, to essentially (gently) push blood back below the start point giving you more
• be quick without feeling panic and stay within the 15 seconds rule

I recommend practicing onto a bit of paper a few times ... costs less than a strip

A few questions:

1) I need to buy (self pay) a second Coaguchek XS because I’m often at a second residence for my work, and I’d like to leave the extra machine and some supplies there.

basically the machine is robust, and there are no "cheap copies" of it that I've ever seen. The real important stuff is in the chemistry of the strips; The machine is nowhere near as complex as a CD player or a Phone ... yet you would buy and use cheap ones of those?

Unlike that only one is available and I have never heard of Roche dumping defective units on the market (unlike some other consumer products) to get rid of them

So basically if its new and in packaging its good to go

Alere has quoted me a price of US $2495

Wehh llll ... God Bless Capitalism is all I can say (wow, that is nearly 8 times over street price)

2) If I want to purchase additional supplies beyond those I can get through my insurance, is there a reliable seller? And do you need a doctor’s order to purchase supplies in the US?

again, if it comes in packaging (and must have the little key chip) then it'll be fine. Just check expire dates because that could be the reason that a bunch are cheap. I would imagine that the only reason for needing a Dr's script is to attempt to get them on insurance (and thus generate 10 times more in you being billed the same as a co-pay and someone else being billed like $50 a strip)

 

[George in Denver]

Thanks for the replies. Called Coaguchek yesterday, and they quoted a price even higher than the price from Alere. Will do my due diligence and buy off the web. Will report back with any useful findings.

 

[JaneF]

Hello Everyone,

i am 6 weeks post-op and have just returned to work pat-time today. I work for a manufacturing company 10 miles outside of a small town. I start work at 6:30 am and my doctor wants my INR checked between 8 am - 10 am, so I will have to leave work, drive 10 miles to town to test, then drive back to work. I have finally gone from testing twice per week to testing every 10 days. My doctor has not mentioned self testing, I learned about that on the forum and am intrigued and think it would make my life much easier.

Should i I check with my insurance company first to see if it would be covered, before discussing with my doctor as I do not have another actual follow up for 4 months?

This forum has been a wealth of knowledge and I only wish I had found it much earlier in my journey. Thank you in advance for any help you can offer.

Jane

 

[dick0236]

Should i I check with my insurance company first to see if it would be covered, before discussing with my doctor as I do not have another actual follow up for 4 months?


Jane

Hi Jane and welcome to the forum.....from another Kentuckian. I had my surgery a little down the road from yours at the UK Hospital. Most insurers, but not all, in KY only cover home INR testing thru a third party service company. If you want to go that route, call one of them and they will help you. I use Coaguchek Patient Service @ 800-780-0675......and I highly recommend them. The other alternative is to buy your meter(+/- $400) and strips(+/- 6 ea) on ebay. You will not have insurer coverage for this. Many docs in KY are still reluctant to allow home testing??.

 

[LondonAndy]

I have posted about this before on other threads, and am not sure how useful a UK Health Regulator's report would be in the US or elsewhere, but in case helpful here are some points in favour of home testing that found it is SAFER than clinics, giving greatly reduced risk of strokes etc. such that this has become recommended best practice in England.

• Comparable quality of results from patient tests compared with laboratory tests
• Reduced number of visits to hospital
• Increased time in therapeutic range (43.2% to 80.8% for self-testing compared with 22.3% to 72.0% for standard care)
• Increased cost effectiveness
• Improved outcomes for self-management over self-testing (para 6.6)
• Less time spent testing (5.3 minutes per test compared with typical 158 minutes)
• 42% reduction in the risk of thromboembolic events compared with standard care
• Risk of death reduced by 32% through self-management

Full report at: http://www.nice.org.uk/guidance/DG14

The report was published in September 2014, and obviously depends on a patient's ability to use the machine, but a normal, able-bodied person will find it easy - very similar to the finger-prick machines used by diabetics, but a larger drop of blood needed.

My personal experience is that I test weekly, and over the last 12 months I have been over 90% in therapeutic range. It only dropped that low because I found a change in INR of 1.2 in only 3 days quite recently, whereas for months my readings were only up or down 0.1 or 0.2. This has happened before, and I therefore do not share the view of many clinics that, if stable, a patient can go a month or longer between blood draws to test.

I prepared a summary of the report (one page in medical speak to sell the advantages to my doctor, one page is translated into English for us non-medical bods) in order to seek to persuade him to allow me to manage my INR this way, and if anyone would like a copy do click here to get it if you want to try persuading your doc/insurance rep. As it happens my doctor was fully supportive and I never needed to go through the document.

(Here in England the policy is generally that the patient buys the meter, and then the doctor prescribes the test strips. I email my results every month or so (at times they ask for it) to my anti-coagulation clinic, and officially they then advise what change I should make to my dose, if any. In practice I manage this myself, just as I do my insulin dose for diabetes. I also go to the clinic once every 6 months or so to calibrate my machine against theirs.

To me it is worth it just for the convenience of testing when and where I want, and avoiding the repeated damage to veins of blood draws. The fact it enables better medical outcomes is a bonus!

 

[DachsieMom]

I think most insurers may make you wait 3 months to start home testing, but you can still get it set up now. Even if your doctor doesn't like it, you could always go yo the lab once per month and home test in between. I have been home testing about 2 years and love it. I pay quite a bit through my insurer, but it's worth it to me. I use Coagucheck patient services. They are excellent.