?? In network vendor ??

[CATDOG]

Has anybody in the USA (Northeast) found an IN-Network (Blue Cross insurance) DME Vendor that will sell either the Coaguchek XS or the InRatio2 device and test strips directly to a patient?
I have an Rx, but have not found a local in-network vendor that will even sell it, let alone work with the insurance. The pharmacies say they can't bill DME or they can only buy from their contracted supplier. The DME stores say it is pharmaceutics. The hospital medical supplier won't sell to patients.
I have asked BC/BS to look up one monitoring company just for the heck of it, and they are not In-Network. (In-Network I pay 10% and have already used up my deductible, out of network 60% with $600 deductible, which is not pocket change to me with machine costing nearly $2K and the strips costing $315 on the website of a medical supplier that I know is on contract with local hospitals and companies.)
I really do NOT want the extra expense and hassles of a monitoring company (cost same as DME %s) Why should I pay to email them just to have them fax my doc? My doc is already set up with the local hospital's electronic chart system, and says we can send that info back and forth through that. (Which I think is way better than having to answer a call at work in front of co-workers.)
I just want to try to use the insurance I am paying for before giving up and trying eBay or some unknown website without an address.

 

[TheGymGuy]

I think you will be better off and it will be cheaper to go eBay route. I did that and it saved me loads.

 

[Protimenow]

I've managed to do my own testing since 2009, without insurance, and have used eBay as my primary source for meters and, usually, for test strips and lancets/lancing devices. I've been able to do it for your reported out of network deductibles and, in some cases, pretty close to your In Network deductibles.

If you consider the probability that your meter will probably last you for many years (it takes the manufacturers, by law, quite a few years to discontinue the supplies for meters that they've stopped making), the actual costs, per week or per month, can drop significantly.

Buying strips on eBay, for me, is usually the least expensive way to get them. I haven't had to deal with issues about a prescription for the strips -- if you have a question about whether or not a vendor will sell to you without a prescription, just ask. There's a spot on the eBay listing that lets you as the vendor a question.

If you're looking to buy a meter, it may be good to check on a return or non-DOA policy if the meter is used, and it probably wouldn't hurt to look at vendor feedback.

I've been capable of doing my own INR management. I hit a rough spot last year, when I was out of strips and couldn't (at that time) afford new ones, so my testing dropped from weekly to every two weeks -- plus, I relied on a meter that I didn't realize was reporting higher than actual numbers. Using the dosage charts available here - and other sources - it's not difficult to manage your dosing - as long as you don't make any major changes all at once. If you do your own testing, I urge you to create a spreadsheet that records test dates, INR and Prothrombin time (if your meter gives you one), and other factors that may be relevant (diet changes, new medications, etc.).

Personally, if I had to choose between CoaguChek XS and InRatio (or InRatio 2), I'd go with the CoaguChek XS. Although there's not much that has been written about the Coag-Sense meter (which I now have TWO of and may be interested in selling my 'spare'), this meter seems to either be accurate or a bit low -- for my own needs, I'd rather have a meter that was .2 or .3 below actual labs than one that was .2 or .3 higher than actual, so that I can stay out of the 'stroke zone.' The Coag-Sense strips are priced comparably to the InRatio and CoaguChek XS strips.

Just be sure that you don't buy a CoaguChek S -- it's obsolete, no longer supported by Roche, and you CAN'T GET STRIPS FOR IT.

If you DO buy on eBay, it'll be interesting to learn what you bought.

 

[marc_kowal]

I have BlueCross also and Allere, which rents you the INRatio 2, is no longer consider in-network. I pay $99 for 15 test strips and a portion of that money goes towards the quarterly rental fee. Whatever the insurance company is willing to pay, is sent to me via check and then I forward a check to Allere. Yes, there is a slight fee they charge to report your INR to the cardiologist, and I don't think the 2 minute phone call to an automated system is a hassle.

Good luck and let us know how it turns out.

 

[CATDOG]

I bought Inratio2, but don't have it yet. I decided on that one because my cardio's office is trying to set up a coagulation clinic and have been starting to test out that brand. I am hoping down the line that he might more helpful in getting strips, but so far they wouldn't even consider getting a meter for me to buy, although he thinks I am a good candidate and says he would get one himself if he were going to be on warfarin for the rest of his life.

Like you I'm more comfortable nearer the higher end of my range than the lower end. My mom has had 2 or 3 TIAs and 2 mild strokes, and I fear I'll take after her eventually anyway (though she has re-cooped from all except for loss of muscle strength in one leg and one slightly droopy eyelid). I'm more afraid of a stroke than I am of bleeding to death.

 

[CATDOG]

I bought Inratio2, but don't have it yet. I decided on that one because my cardio's office is trying to set up a coagulation clinic and have been starting to test out that brand. I am hoping down the line that he might more helpful in getting strips, but so far they wouldn't even consider getting a meter for me to buy, although he thinks I am a good candidate and says he would get one himself if he were going to be on warfarin for the rest of his life.

Like you I'm more comfortable nearer the higher end of my range than the lower end. My mom has had 2 or 3 TIAs and 2 mild strokes, and I fear I'll take after her eventually anyway (though she has re-cooped from all except for loss of muscle strength in one leg and one slightly droopy eyelid). I'm more afraid of a stroke than I am of bleeding to death.

 

[dick0236]

I bought Inratio2, but don't have it yet........ I am hoping down the line that he might more helpful in getting strips............ I'm more afraid of a stroke than I am of bleeding to death.

I assume that you purchased strips with the meter. After messing around with insurance a few times in the past, I purchased an Inratio2 from ebay, along with strips in Oct 2012. I have recently purchased additional strips, again from ebay, for about $4 each. Personally, it has been far less hectic and stressful in not having to deal with Alere, insurance company and doctor. The ebay seller I purchased from both times was "sales_cc" and I have been very satisfied with the service of that seller.

I agree with your "stroke vs bleeding" statement. I have had both, and I'll take the bleeding every time. The old saying that floats around here is...."it is easier to replace blood cells than brain cells".

 

[Protimenow]

I've had pretty good experience with vendors on eBay.

Probably unlike most others on this forum, I have more than one meter technology. (After having a TIA because I trusted a meter that reported values that were higher than a competent medical lab, I've become very interested in finding an 'accurate' meter). In my personal experience with the InRatio, I've seen that it appears to report INR values that are actually HIGHER than the lab values. You may want to take this into account when running your tests using the InRatio, and shoot for the middle or high end of your range, just to be safe. If you have blood draws, it's interesting to do a test using your meter slightly before or after your blood draw so that you can compare the values of meter vs lab. In my experience, the InRatio gives a result that seems to be .3-.6 (or more) higher than the labs. One of the people on this forum even came up with a mathematical formula for converting the InRatio values to lab values.

In keeping with what Dick just wrote (it's easier to replace blood cells than brain cells), you should consider aiming towards the higher end of your range, just to keep out of the danger zone (usually below 2.0).

If possible, maintaining a record (I use a spreadsheet) of your INR, dose, time and date of testing, type of test (lab or meter, for example), and any comments (change in diet or activity, for example), will be a useful historical record. It may also be helpful if you change doctors and have to convince a new one that you're able to self test.

Good luck with your new meter.

 

[dick0236]

.........In my personal experience with the InRatio, I've seen that it appears to report INR values that are actually HIGHER than the lab values. .

My experience seems to be the opposite of yours. While I test weekly(Inratio2) at home, I go to my doc monthly for test with Coag XS. I am usually less(-.1 to -.2) than their meter(Coag XS). Back in Jan 2013....my Inratio2 tested 4.0, their Coag XS tested 4.5 and the vein draw sent to the lab was 4.7. I guess I've learned to not sweat INR too much and anything from the lower 2's to higher 3's is pretty much OK....with my goal to be +/-3.

 

[CATDOG]

Thanks for the tips. Blood cells vs brain cells, I like that phrase. I may have to use it with the doc because she (her nurse) has told me to keep the same dose and test in 3 wks when I'm 1.8! I need to re-emphasize my opinion on this. At the time I had to just bluntly say I was not comfortable with that, and I was trying to eat more veggies and I thought she should allow for that. I was trying to increase gradually, and she should expect some change. I was very annoyed that she was counting out the # of half pills I would need for the last Rx, and I had to stress that the insurance would not let me fill an Rx early, that she was leaving no room for adjustment, and it might be a big hassle if I ran out at a bad time. Enough of that rant.
I have been keeping a spreadsheet, though I'm thinking of rearranging my Sunday-Saturday columns to make the week start right after the test since I usually go on the same day of the week. Then have a total dose column at the end of the week, and a column for comments. Except maybe I'd rather test on Saturdays once I've gotten through the calibration stage instead of giving myself something else to do in the morning when I'm already trying to leave earlier enough to get to the lab before work. I might look at that app somebody mentioned in another post. A spreadsheet is rearrangeable, and if I do change the day again, I can just slide the columns around again then.

It shipped and should be here tomorrow!
Do I need an Rx for lancets? I wonder where I can get them on a Sunday. wallyworld pharmacy?

 

[CATDOG]

Oops, not quite so easy to flip the columns around. I forgot I'll have to shift half the week up a row to the previous week.
Maybe I'll just start a new "sheet" whenever I switch test days to have new regular day.

 

[CATDOG]

Oops, not quite so easy to flip the columns around. I forgot I'll have to shift half the week up a row to the previous week.
Maybe I'll just start a new "sheet" whenever I switch test days to have new regular day.

 

[Protimenow]

I never worried about a specific day of the week -- I enter the DATE of the test on my spreadsheet.

In many cases, over the years, my test days have changed. This is to accommodate for an earlier retest. (For example, if I happen to have an INR that is BELOW range, and I take an extra dose, I like to check in a day or two or three to make sure that my INR is back in range. So -- if I get a 1.9 on a Sunday and take an extra dose right away, I might test on MONDAY, to see if my INR has gone up. I may not test until the FOLLOWING Monday. If I was locked in to a specific day, this would be pretty hard to manage).

I am using a basic spreadsheet, with the fields that I've defined or added when I started recording my INRs.

(It sounds like your clinic doesn't know what it's doing -- I would NOT be happy with a 1.8. I probably wouldn't consider bridging with Lovenox because of a single result of 1.8, but I certainly would increase my dose right away and test the next day or so. I would NOT be comfortable with a clinic that told me that a 1.8 was okay, and to retest in a few more weeks.)

 

[Protimenow]

Dick:

It's interesting to see that your lab actually reported values that were higher than an InRatio and CoaguChek XS. (This kind of makes me wonder about the lab). I know that we both agree that we feel a lot safer with INRs at the high end (or even slightly above) of our range than an INR down near 2.0.

Your notes just help to confirm that INR testing is really not a science and not one that we can totally rely on - whether it's done at a lab (usually somewhat reliable) or with a meter.

 

[dick0236]

Do I need an Rx for lancets? I wonder where I can get them on a Sunday. wallyworld pharmacy?

I doubt that an Rx is needed to purchase them locally. I could not find one that I thought would produce a big enough blood droplet at my local pharmacies.....they seem to carry lancets designed for diabetic testing. I get mine on ebay, without Rx, and the recent cost was about $50 for 200($.25 ea). The one I use is "Unistik 2 Extra".

 

[CATDOG]

Easy-peasy

Easy-peasy

So my meter came and all I've got to say is "easy-peasy". I'll cross-check the results next week with the lab, but my first impression was "hit the Staples EASY button."
We all need to make a stink about this being so hard to get. The insurance companies SHOULD be on our side, since this is less expensive than the lab charges. They aren't yet -- as many of us discouraged end-users have discovered, but if they really analyzed the charges they should start changing their minds.

 

[Protimenow]

I don't think that there should such tight controls on the meters or the supplies. These meters provide INFORMATION, in the same way that blood glucose monitors, blood pressure meters, or even the heart rate app on my phone do. Although Warfarin, if mismanaged, can be a dangerous medication - so can Insulin. The warfarin is tightly controlled, and can't be easily obtained without a prescription.

I don't see much reason for making it so damned hard to get these meters and supplies except to think about the lobbies that want to protect the income that the medical establishment receives for running this relatively inexpensive test in their offices; or the enormous amount of money that the 'services' get for sending out a meter and strips and letting a doctor know what the 'client's' reported INR is. If a high income flow, generated by these meters and strips wasn't being protected, I see few reasons why these should be so tightly controlled.

The other argument, though, is that some people are not capable of running a proper test. They may have issues with getting a good drop of blood. They may not be able to get the blood onto the strip in the time allotted, they may not understand the procedure involved, etc. Additionally, some people may try to manage their anticoagulation but be incapable of doing it correctly. Doctors seem to be fairly good at determining who these non-candidates are. They can control how many pills they prescribe.

I believe that these meters should be readily available. Supplies should be readily available. Letting the patient do self-testing - and, if necessary, reporting to doctors or clinics, can help to keep the patient's INR in range. Changing the frequency of testing from the ridiculous monthly or every two month schedule that some doctors and clinics use, and having everyone do weekly tests will sell more supplies. The meter manufacturers should fully support this. Having more meters out there -- one per patient, rather than one in a doctor's office or clinic that may do 50 or more tests a week, will help sell a LOT more meters.

The economies of scale should kick in - reducing the price of meters and strips. More people on warfarin will be in range more of the time.

I feel that the FDA should allow the purchase of meters and strips without prescription so that the public health benefits of allowing self-testing by people on anticoagulants should happen -- and should happen right away.

(Now, excuse me while I step off my soapbox)

 

[CATDOG]

First double-check with the lab: spot on. Both readings were "2.5".

 

[AgilityDog]

Walgreens and CVS both will order you size 21 gauge lancets (the big sticker) for your finger sticker.
Size 26 and 31 are too small for me.

I paid about $10 for a box of 200. That will do me for several YEARS.

Oh, and I use Amazon dot com for my Inratio strips, and you can buy the machine through them as well. At least, I DID.
I pay about $200 for a box of 48 (which yes, you can use after the expiration date. They work just fine).

Philips/Alere was costing me co-pays of $260 per MONTH, for me to call them and them to fax my doctor. Idgits.

 

[pellicle]

First double-check with the lab: spot on. Both readings were "2.5".

Excellent. Welcome to self testing