Need Help - Claim Denied For Inr Kit

[temp69]

Hi there: My insurance just denied my claim for a coagu-check. I am trying to get either that one, or the HemoSense. Anyone have any studies, or data I can use to fight the decision and get them to pay?

THANKS!

 

[geebee]

I would try to find out why they denied the claim. Usually an insurance company wants to at least three of the following reasons for a home tester:

Mechanical Valve
Long term coumadin usage
Need for weekly testing
Frequent travel making access to labs difficult
Problem with venous testing (collapsed veins, etc.)

 

[RandyL]

Hi there: My insurance just denied my claim for a coagu-check. I am trying to get either that one, or the HemoSense. Anyone have any studies, or data I can use to fight the decision and get them to pay?

THANKS!

What insurance company do you have. I chose the IN-Ratio machine and it went right thru.

BTW I did have to have my PCP recommend or prescribe me to get one

 

[Karlynn]

I didn't think the Coagucheck was available for private use in the US right now. Or did that recently change again?

Some insurance companies want you to be on Coumadin for 3 months, or as along as a year, before agreeing to a home testing machine. Other insurance companies require that they see an out of the ordinary need, such as distance from lab, unstable INR or some such thing. If that's the case, and your doctor is agreeable, they can stretch the truth for you.

Don't give up. How did you apply for the machine, did you do it yourself or did you use a company like QAS as a go-between?

 

[jeffp]

Check the exact wording of your policy. Some specifically exclude certain types of equipment, others by general category. Most often home INR testers, being so unusual, aren't listed one way or the other. It does often involve a bit of a fight. You'll need to get the doc onboard with you. The hemosense.com site has a bunch of useful journal studies backing up the effectiveness of the units.

 

[Marty]

I think you need your cardiologist to write a letter for you to the insurance company. I'm not even a cardiologist ( just a radiologist) and I did write one for a friend a few years back. He got full coverage for his Coaguchek.

 

[Computec]

These home testing units come under the heading of "Durable Medical Equipment" and whether it's covered under your insurance depends on your policy.

Insurance companies aren't going to argue that the units are useless. They know better. They'll argue that "your policy doesn't cover it" or "you don't have a legitimate need" for one. (See Gina's post above!)

You can always threaten to have a stroke or a bleed but insurance companies are not altruistic. They'd be afraid to not provide the equipment to you if you WERE covered by the policy and THEN threatened to have a stroke or a bleed. That outcome would cost them a lot more than a few thousand dollars.

Jerry

 

[Karlynn]

Diabetic testing equipment falls under DME (durable medical equipment). It might be interesting to check and see if that is covered by your insurance. If it is, I think you have a case to push.

 

[Lynlw]

I remeber a very good letter someone wrote and posted here when they appealed the no, i believe, it might have even been jeff, i would search for it and use something simular for your appeal, beside the doc letter Lyn

 

[Marguerite53]

Not really related, but I had trouble with rehab being covered. The insurance company wanted a "letter of medical necessity" from my cardio. If you do not live near a clinic, or have a job that requires you to be unavailbable at the clinic's time.....maybe those are "reasons" which the insurance would accept. Best to be VERY friendly with the insurance, ask them why they wouldn't cover it. Then ask them how you could get them to cover it....what would there need to be in place to make it happen. Usually you can find a way through these things. Keep asking.....,sometimes even call back a few different times and speak to different customer service people.....they aren't all created equal....some are much more savvy.

Good luck!

Marguerite

 

[mtkayak]

My claim went right through but it took several weeks to get the machine. Did you go through QAS? They usually submit the claim for you. I remember my Cards nurse saying that you had to wait 90 days to make a claim for the machine. I guess they want to see that you will need it more than 3 months. My insurance (BCBS of Texas) have procedural codes they use to see if you qualify for it. Mechanical valves should qualify.