I am a too frequent tester ...

[AgilityDog]

I do not want to hijack this thread, but I do have a question for those getting this "home test" service who are on medicare. QAS has billed my Anthem Medicare Advantage $280 for my last four completed tests . Anthem approved $113.79 and payed 80%, $91.03. My 20% share is $22.76 that has not been billed to me by QAS yet. Is this close to what Medicare approves/pays for your service.

I am on a QAS program where QAS provides my machine, strips, lancets etc. and I am recquired to call my results in to QAS.

Ye Bloody Gods! These outrageous charges, plus a $3000 annual deductible, is why I bought my own blessed machine. No way on G*d's green earth does it cost nearly $300/month to run 4 strips and make a phone call or send a fax.

When Phillips started charging me that, and wouldn't fix it back to the $50/month I got my own machine. My strips cost me about $250/year, which I could run through insurance if I wanted to. That's a lot less than the $600/year it cost me my first 18 months under the $50/month program, and WAY the hell less than the $3360/year I would have paid when Phillips took over Raytel and changed the billing on me.

 

[Doug]

Dick, I'm on Medicare, use QAS but I have AR Blue Cross Medi-Pak.
Each month for 4 test QAS billed $280, Medicare allowed $118.82, of which they pay 80%, $95.06. Med-Pak paid the 20%, $23.76.

My cardiologist charged just under $14.00 per test, he uses an InRatio. The reason I wanted my own machine is it is an 80 mile round trip to his office. I almost forgot to add, I am testing once a week and my cardiologist only wants a call if my INR stays too low (or high) for a period of time. I am thinking of going to every two weeks after I am sure I am pretty stable.

 

[Taysgrama]

My cardio has me testing once a month not weekly with the exception of last 2 weeks since I was off coumadin for 3 days for my surgery. I was 1.8 when I tested first and up to 3.8 when I tested on Monday. They want me to retest next Monday then will probably go back to once a month. Should I be testing bi-weekly or weekly just to make sure I am closer to my range? I usually run pretty close to my range of 2.5 to 3.5.

On a side note: I own my InRatio and I stopped reporting to QAS after I changed cardiologists last year. They have their own Pro-Time clinic and they prefer me to call my results in instead of getting a fax from QAS. I sure hope this does not make it harder to get my strips when I need to reorrder them.

 

[dick0236]

When I went to my docs lab , I tested once per month. Now that I home test, I test biweekly. Medicare has publiched a paper where they suggest "once per week" for mechanical valve recipients.

I you are buying your strips from QAS, there should be no problem with continuing to order from QAS.

 

[Ross]

Dick ask Anthem to send you a detailed explaination of benefits summary concerning the payment of those claims. Medicare isn't paying anything near that and I'm sure Anthem has a write off amount. Your supposed to pay 20% of the MEDICARE APPROVED AMOUNT, not the billed amount.

 

[dick0236]

Your supposed to pay 20% of the MEDICARE APPROVED AMOUNT, not the billed amount.

Ross, I am supposidly being billed 20% of the MEDICARE APPROVED AMOUNT although QAS hasn't billed me since last Sept. I was wondering if that was happening to others. I have even called the lack of billing to QAS's attention and have not gotten a response. I am wondering if QAS is billing other patients for the 20% that is not being paid by an insurance company?

 

[Ross]

JFYI---I just went through this with my HMO. They started having me pay my co payment for oxygen on delivery. The charge, $32.64 for 16 bottles of oxylite cylinders. OK, when the things were processed through billing, it was only $13.94 for 16 bottles. Now me, I wanted to know why there was a large descrepency between the two. They billed $204.00 for 16. Now 20% of $204 is NOT $32.64! I started digging for answers.
Make a long story short, they bill $204.00, Medicare paid $55.77 leaving a balance of $148.23, then there is a Medicare write off of $134.09 leaving $13.94 for me to pay. I don't know where they came up with the $32.64. It's like they pulled that number out of the air to charge me. At any rate, it was wrong. I bet the same thing is happening to you.

 

[lance]

Good morning Karl,
I have been testing weekly for years. Maybe it is too often, but I really don't care--I'm very stable. Costs of home testing not covered by universal health care so we pay for everything and wouldn't have it any other way--freedom and independence. I feel really sorry for patients who must depend on labs and wait for up to 3 days for their results most of home have no understanding of how warfarin works. That could be a blessing. Actually I shudder to think of the implications. You do what you think best for you. It's your health.

 

[olefin]

Dick, you checked with QAS and they haven't billed you, so I say forget it.

My wife has insurance from where I worked, this year they changed the policy and added a co-pay. Her doctor's office bills her for the co-pay about a month later.

 

[ShezaGirlie]

I am wondering if QAS is billing other patients for the 20% that is not being paid by an insurance company?

Just for you Dick, I accessed my insurance company info and had a look at the benefits paid to QAS and came up with:
Monthly Charges for $280.00
Plan Pays $118.82
Excluded Amount $161.18
You Pay $0.00
"This amount billed exceeds the normal amount of charges for this type of service. You are not responsible for excess charges."

What a deal, huh...

 

[dick0236]

To Olefin and Shezagirlie, thanks for the reply. It does show that QAS is consistently billing $280/4tests and most insurance companies are approving +/- $115. With a Medicare Advantage Plan like mine, I know that I should be paying 20%(+/- $23). Since they haven't billed me since last September, I am afraid of what my bill will be by the time they get around to sending it to me.....at least I know it will be about $6 x two tests/mo. x #months since last bill. If its too big, I'll take out a second mortgage on our house, ha-ha

 

[jax]

Too frequent of a tester. Sounds like someone wants to get out of doing some work. I also test once a week with my machine karl and i won't have it any other way. I was nice and steady for a month after getting my machine, but the husband has been sick for a couple of weeks and although i haven't caught it like he had it i wonder if i don't have a little bit of what he had. My inr the last 2 weeks has been above my range. 3.8 and 3.7 after dropping 4 mgs and eating salad. Although i am not worried about these numbers I am puzzled why with the decrease in warfarin and eating things with vitamin k it hasn't come down at all. We will see what it is on friday when i test. If i was still going to the lab for testing i wouldn't have a clue that i was high and would still be taking the higher dose had my time for testing not come up yet. Having your own machine gives you the control over it and someone had to prescribe you to test once a week so do what you need to and she will just have to do the work she is trying to get out of.

 

[realkarl]

Sounds like someone wants to get out of doing some work.

Thanks, Jackie. I agree, so this morning I wrote them a more detailed answer to why I am testing weekly, where I asked them if they would prefer I report in only every 4 weeks, or if I am out of range, rather than call in every week. I also explained that one reason I am always within range - is minor adjustments to dark greens, if a test shows I am on the low or high side of my range and possibly on the way out of range. It has always worked so far, and yesterday I was 2.5 - [range 2.0 - 3.0]

EDIT: I am glad I wrote them: I received a prompt reply stating that testing and reporting weekly was perfectly OK, many patients did so, and not a problem for them.

Karl.

 

[jax]

Glad you got a response karl. Hopefully something will be said to this nurse that doesn't want to do the paperwork.

 

[catwoman]

EDIT: I am glad I wrote them: I received a prompt reply stating that testing and reporting weekly was perfectly OK, many patients did so, and not a problem for them.

Karl.

However, it was -- for a nurse.......................................

 

[Gail in Ca]

The easiest way to deal with insurance problems is to have your cardio or gp say it's 'medically necessary'. This always works for me and my hmo-type plan.