Insurance and INR monitoring

[rnff2]

My cardiologist has sent my information to the only local company that supplies INR monitoring equipment to get me set up with home INR testing. Would you believe that my insurance says my local company that I would get the meter and supplies from is in my network but the company that supplies the supplies to the local company is out of network. So since the bills comes from the out of network supplier they told me it would cost upwards of $3000 plus the monthly fees and my insurance only pays 40%. If they were in network they would pay 90%. I can go on eBay and buy a complete set up for less than $800. Ridiculous!!!

So I'm waiting for the cardiologist office to call me back to see if we can find another company, although my insurance can't even tell me what companies they work with that would be available to me.

I spent 6 hours the past 2 days working on this and still have no answers...eBay is looking better and better.

Sorry...just needed to vent.

 

[dick0236]

For some reason, local medical supply distributors can't, or don't want to, get involved with home testing programs........may be some kind of liability issue?? You probably will need to work with one of the national INR programs if you want insurance coverage. I now use a program serviced by Coaguchek Patient Service in Indianapolis, IN and recommend them highly. They are "in network" for my insurer Humana. My cost is $20/mo for weekly testing.

 

[rnff2]

Dick...that's who I'm trying to work with now. I called them directly and asked if they could tell me if they take my insurance and she said that the cardiologist office needs to fill out the forms so they can review it and run it thru my insurance, because each situation is different. She was very helpful and answered all of my other questions but wouldn't you think if I tell them I have Aetna that they could tell me? Nope...so I'm waiting for a call back from my doctors office.
My insurance said they can't tell me if they use them either...ummm are you the insurer??? Shouldn't you know what companies you work with...nope.
Too bad my employer (a hospital) just switched from Humana to Allied/Aetna. Not too happy with the new insurance right now.
Also Aetna has a policy on home INR testing and it lists Coaguchek in its policy. If you Google Aetna INR testing the policy pops right up. I just don't get it.

Thanks for the info...hopefully it will work out with Coaguchek.

Question...do they act a a middle man between you and your doctor or do you report your results to your doctor? I'd really like to skip a middle man.

 

[DachsieMom]

I have recently been through this entire process with Aetna, so will try and help. I have no idea if your coverage is similar to mine, but I pay $101 per month for coaguchek. That is for 4 tests (1 per week).
As I switch to once every two weeks, the cost will go down. First- I went through tons of stress trying to figure it out. Got the billing codes, etc. Like you, very few at Aetna knew anything. Bottom line - try not to stress. Just call coaguchek and let them do it for you. They will get a prescription from your doctor, work with your insurer, and tell you the cost. Coaguchek bills for services - every 4 tests - but gives you the machine (new) and supplies for free. I called coaguchek, asked for the billing codes, and checked with Aetna for the cost. There will be an initial charge for training (like $125) and then the charge for services. Each week, I test, call it in to coaguchek, and they call or fax results to my doctor (strange, I know). I was told by coaguchek that I could stop at any time and the machine would be mine (which Is different than Alere). I know the cost is high, but for me home testing is so worth it. My arms were constantly bruised and I have very little time to run to a lab weekly. For whatever reason, my doctor's Coumadin clinic is not comfortable if I just bought strips off of Amazon and did my own testing and called them directly. No idea why, since I'm the one who calls in my results to Coaguchek! I think most of their patients must be on Medicare so pay less for home testing, and they would not seek alternative methods to get supplies. They have no patients who report their own results, and this is a large practice. Sorry for the rambling - hard to type on my iPad.

 

[DachsieMom]

I should add you can't home test with Aetna until 90 days after surgery.

 

[dick0236]

............. I just don't get it.

Question...do they act a a middle man between you and your doctor or do you report your results to your doctor? I'd really like to skip a middle man.

LOL.....sounds just like the health insurance industry I retired from 20 years ago.....it was screwed up then and apparently it hasn't gotten any better. Have your cardio fill out the prescription form and let Coaguchek do the rest. As I understand, you can't go on self-testing until 90 days post-op so Coaguchek will be able to establish whether or not they are in your network. Unfortunately, all plans written by an insurer will not have the same networks.

Answer....Self-testing was originally introduced by Medicare for mechanical valve patients using the third party reporting system.......probably due to lobbying efforts by the meter manufacurers. In the last several years most, but not all, health insurers have picked up the Medicare language as to how they cover self-testing. The protocol is "you test and call the third party with INR.......they call your doc with results,,,,,if you are out of range your doc will call you with instructions". It does seem cumbersome but I think insurers are finding self-testing costs to be much less than hospital admissions for INR accidents.

 

[almost_hectic]

I tried doing my own investigating with my insurer and I know how frustrating it is. I was trying to determine what home test equipment I would get if I went through my insurance because I only wanted to CoaguChek and nothing else. Got very little accomplished going this route. Problem is the insurance companies don't provide the actual equipment, they simply reimburse medical device suppliers who are under contract with the individual networks. So I tried to track down the information by contacting the device suppliers directly. Again got nowhere. The ONLY people who showed any interest at all in helping me was when I contacted CoaguChek directly. They made it so simple. Just drop that form off for your cardiologist and CoaguChek will take care of the rest. They verified my coverage, billed my insurance directly and my equipment was hand delivered to my home by a nurse they prearranged to teach me how to properly use the equipment. It was great! I lucked out because my Florida Blue insurance policy covers durable medical equipment at 100% so my device and all supplies are at no cost to me at all and I can reorder supplies as often as I like. The CoaguChek website you use to report your results is very easy to use as well. There's no real need to report your results directly to your doctors office unless you are out of range. Be aware though, just like the previous post mentioned, CoaguChek also requires that you have 90 days of prior PT INR results before you are eligible for your own equipment.

 

[rnff2]

Thank you all for the wealth of information.

I am going to get the Coaguchek paperwork to my cardiologist office tomorrow and get things started. I'm only 6 weeks post op and both the insurance and Coaguchek have said I have to be on coumadin for 3 months. The cardiologist's nurse that I'm working with says she can get around that but I'm not very optimistic that she can. The person at Coaguchek said to go ahead and have the doctor fill out everything and get it approved so when I hit the 3 month mark I will be all ready to go. At this rate it will probably take me till my 3 months to get everything in place anyway.

Thanks again!!! I will keep you posted if and when I get it figured out.

 

[rnff2]

I'm very thankful that the nurse at my cardiologists office is so great. I am dropping off paperwork work to her tomorrow for Coaguchek. Hopefully it works out, if not she said we would work together till we get it figured out.

Now we just to figure out why my INR was 2.7 on Monday and it's only 2.0 today. I feel like we are never going to get me to stay in my 2.5 - 3.5 range.

 

[dick0236]

Now we just to figure out why my INR was 2.7 on Monday and it's only 2.0 today. I feel like we are never going to get me to stay in my 2.5 - 3.5 range.

My INR went from 3.2 to 2.4 over the past week.........and I have no explanation.......it just happens sometimes. A single test can be influenced by a bunch of "outside" variables....maybe even a little "voodoo". Mine will probably be back in my range (2.5-3.5) next week.....but if it remains low, I'll give it a little boost of warfarin or lay off the salads a little. One of the good points of using a service is the records they keep for you. I have been in range 91% of the time over the past 6 months.....so these little blips, below or above my range, don't concern me. Only if I see a trend emerging do I adjust my dose....and then only a little. Don't like getting myself on a yo-yo by continuously adjusting warfariin.

BTW. since you are a nurse you may be able to have the "user training session" waived. They waived it for me since I had self-testing experience.......will save you +/- $100.

 

[pellicle]

Hi

I just wanted to reiterate this point

My INR went from 3.2 to 2.4 over the past week.........and I have no explanation.......it just happens sometimes...

and say "Yesit happens" .... that there is no reason to panic and one of the beauties of self testing is you get acquainted with these things. Compared to diabetics who test multiple times per day (at relatively regular intervals) we (should) test weekly and so there is much movement around which often goes unnoticed. Imagine checking in on the kids once per week?

A benefit to putting your INR data into a spreadsheet and watching the chart is that you learn "what's normal" and what's not.

 

[rnff2]

I'm realizing my INR is all over the place...no rhyme or reason for the ups and downs. But it's still early yet for me, I'm sure with time it will level out. Good thing is I've already learned not to stress over it and just adjust my dose as instructed and see what the next reading is.

Dick, that would be great if they would waive the teaching, its a simple test and meter from what I have seen. If not it will just add to the hundreds of thousands in bills that I already have for the year...thank goodness for insurance.

 

[pellicle]

Hi

I'm realizing my INR is all over the place...no rhyme or reason for the ups and downs..

quantify "all over the place" .. but I agree heartily about the 'no rhyme or reason" for the variance. A naive researcher may be tempted to attribute something to say eating a salad or drinking some booze (which they do here regularly) and thus forever more be "fixed" on the idea that doing X resulted in my INR going [UP | DOWN] as the case happened to be.

Here is my INR from 2015, there are a couple of "strange" events which I am unable to explain too, but I consider this "normal" when viewed in the context of my last 3 or so years.

You can see that it bumbles around between 3 and 2.2 most of the time. But there was an event on week 37. This is exactly why we measure weekly because that way we catch those events like in week 37 and adjust accordingly ... If I was measuring montly its quite likely the first thing I'd have known about was perhaps a bleed (if I were inclined towards them through other health issues, which I'm thankfully not).

Also ... the insurance is a double edged sword if you ask me.

I pay all my stuff out of pocket as its not covered in Australia anyway. A machine would be about $500 and the strips work out at $6 a test ... so no huge saving really. In fact I think that when you view it overall it may actually be a cost to the community doing it the way the insurance companies do it.

PS: the two red identified INR points are a reminder to me that I missed a dose a few days before my testing and to discount that point set in my analysis.

 

[rnff2]

Pedicule... "all over the place" means my graph looks like your week 37...up and down and little time spent in therapeutic range. But I'm advocating for myself and trying to keep my dose changes small and my dose as steady as possible and it's been better the past 2 weeks. Big changes in my dose make for big changes in INR.

 

[dick0236]

........... Big changes in my dose make for big changes in INR.

Remember that simple sentence!!

 

[pellicle]

Hi

Pedicule... "all over the place" means my graph looks like your week 37...up and down and little time spent in therapeutic range.

that's not good then

But I'm advocating for myself ...

I don't know what that means...

... and trying to keep my dose changes small and my dose as steady as possible and it's been better the past 2 weeks. Big changes in my dose make for big changes in INR.

but yes, big changes always result in big changes, as dick observes ... its simple. You'l notice if you read the axes on my graph that I don't usually make any changes and when I do they are very minor.

I take a very steady 7.5mg or 7.25 mg (which is actually an alternating 7 and 7.5) and yet big changes happened by themselves. Even still my response was not "big" and I only dropped my dose by about 1mg per day ... if you read the axes ... so something like 10% and I was actually monitoring every 3rd day from my "big INR change" ... so I could be sure I didn't over steer the change.

you'll have to let me know what you mean with "advocating for yourself" ... its meaning is left open to the imagination.

 

[rnff2]

Pedicule...Advocating for myself means I have taken a stand with the cardiologist and have discussed the dose changes they have been wanting to make and suggesting we make smaller gradual changes. For instance they wanted me to hold the coumadin for 2 days when I jumped up to 4.7. Previously I had a 4.3 and held for one day and went back on my regular dose and dropped to 1.7. So at 4.7 I suggested we only hold one day and then start at my lower alternating dose. I've been alternating 3 and 4 mg every other day, also at my suggestion, and have noticed levels are fluctuating less.

So since I'm finally learning how my INR and my dose are relating to one another I have taken it upon myself to speak up and make suggestions on what I feel may help get me or keep me in range. I don't think they, the cardiologists, look at the over all trends the way you do (or we do, because your a great teacher) and just dose off of the current INR, not taking into consideration what my trends are. So thank you for being a good teacher and sharing your graphs because they have helped me a lot even in the short time I have been on coumadin.

 

[pellicle]

Hi

Pedicule...Advocating for myself means I have taken a stand with the cardiologist and have discussed the dose changes they have been wanting to make and suggesting we make smaller gradual changes. .

excellent! I was hoping it meant that!! I am happy to make an ass out of myself, but don't like dragging U into it with the classic assUme problem

I have seen in so many cases people trampled by the pressures Doctors are under and don't voice up. I've helped my neighbour (who's been more like a 2nd mother because she's been my neighbour since I was born) with problems ranging from ACE drugs and misdiagnosis. Being in her 80's she's easily "white coat bluffed"

I'm very happy that my writings are helping people to manage themselves better and feel more confident in that.

One thing worth mentioning, is that in my "methods" I have a "trigger" to start what I call "AdHoc Monitoring" where I'll make mid week readings to observe the changes in INR if the INR goes out of my range eithe way. If by 3 days it has not started to return then I make my dose adjustments. Unless the INR is significantly out of range then I'll make a dose adjustment for the very next dose and still do the adhoc readings.

Best Wishes

 

[rnff2]

Pedicule...so this it what I'm advocating!

Today INR is 3.7. My range is 2.5-3.5. I'm supposed to take 4 MG today. Just got a call and was instructed to hold today's dose. Then continue alternating per my usual 3mg and 4mg dose tomorrow. I know the last time I held a dose I dropped like a rock. So I suggested 3.7 isn't that much out of range, how about we do 2 MG today and then start my alternating dose of 3MG tomorrow...cause I'm not that far out of range. Why risk dropping too low again. Would you believe they agreed?

I don't think they look at the overall big picture they treat it just as a number...I see it as a big picture, a process.

Thanks again everyone for your insite. It's got me on the right path...I think.

 

[pellicle]

Hi

....so this it what I'm advocating!

Today INR is 3.7. My range is 2.5-3.5. I'm supposed to take 4 MG today. Just got a call and was instructed to hold today's dose. Then continue alternating per my usual 3mg and 4mg dose tomorrow. I know the last time I held a dose I dropped like a rock. So I suggested 3.7 isn't that much out of range, how about we do 2 MG today and then start my alternating dose of 3MG tomorrow...cause I'm not that far out of range. Why risk dropping too low again. Would you believe they agreed?

that's just exemplary! I applaud both your decision and your logic and that your attitude won out and got you what you want.

One of the resons that I always talk "spread sheet and graph" is that it gives you historical data that not only assists and informs you but gives you evidence to present to those (who could be sued by you) to justify your reasons. This assists them in having confidence in your decisions and in giving them more information to work with.

Well done! I would call this win / win

Best Wishes

(and by the way pellicle has a meaning, I don't know about pedicule though)