Remote INR taking over Coaguchek

[pellicle]

It's important to understand they bill this as a Service. They don't bill for the device, strips, or lancets.

out of interest, how much does this service charge?

 

[RAS]

out of interest, how much does this service charge?

The answer to that here in the US is it depends on what a given health insurance plan negotiated with the service provider and then the specific structure of the chosen plan that determines how much the patient pays and how much the insurer pays.

The negotiated service rate, In-network, out of network, coinsurance, copays, deductibles, out of pocket max are factors affecting what a given service will cost a patient at a point in time. It can vary quite a bit. In my case at last year rates $113 every two months. This year for some reason BioTel has not submitted even one claim so I don't know if there is a cost change. It's all my cost since I am below my deductible. If I go above my deductible then I pay 50% thereafter. If I go above my out of pocket max, then I pay $0.

 

[skier]

The service I use (Biotel Remote INR) provides 3 methods to report
1. Entry on website (this is what I use)
2. Phone call (used once, but prefer the website)
3. Bluetooth connection from the device to a mobile App (I don't use this - see below*)

The service will then report it to your Provider.



It's important to understand they bill this as a Service. They don't bill for the device, strips, or lancets.

Biotel and another service I looked into, bill every 4th Reported result. They require at least 1 test every two weeks or they will not allow you to stay in the program.
Two weeks is the frequency I signed up for. However occasionally I test more often, but don't report it. That minimizes the cost.
*That is the reason I don't use the Bluetooth reporting method since that will automatically send every test to Biotel that had not been previously transmitted.

When I signed up, I was on their auto ship process. They shipped strips out far more often than I used them - about 70% more strips than I needed to maintain an every two weeks schedule. I shut off the auto ship because eventually strips would have expired before needed. I order strips via the website often enough to ensure I have sufficient supply (usually a couple boxes) on hand to test more frequently if needed.

So in summary, the lowest cost way to handle the INR service is to sign up for an every two week schedule and report only on that schedule.
You will be able to test more often, but I don't know if you would quite get to a weekly test under that scenario. If you sign up for a weekly test schedule, then obviously they will ship enough strips for at least that frequency and probably more, but not likely to be enough for daily testing.

I know you can order more strips even when on auto ship (I tested that and they shipped them), but don't know how often you could do that. Fortunately I have been in range 93% of the time since I started using the service in 2021 and only needed to test more than every two weeks a few of times.

Thanks so much for the detailed response. That's exactly the info I needed! Great to hear I'll likely be able to test more often than I report to the service to save cost.

I'm also wondering if there will be a cost from my health care provider, as the anti-coag nurse adjusts my dose after testing at the clinic. Does the remote monitoring service adjust your dosage, or does your doctor/clinic?

 

[mecretired]

Cardionet charges me on$880 per month. Medicare pays $51.27 and my insurance pays $12.82. Since they accept Medicare I’m not responsible for the balance. They do charge my cardiologist’s Coumadin clinic $20 per month. Medicare pays $6.44 and my insurance pays $1.60. Again I’m not responsible for the balance. I test weekly and report weekly online.

 

[RAS]

will be a cost from my health care provider

No additional charge from the provider.

Does the remote monitoring service adjust your dosage, or does your doctor/clinic?

The service does not manage the dose. They contact the provider with the results. I manage my dose, but the provider is required to contact the patient. So I get a call which sometimes is just a vm. They are ok as long as I let them know of any dose changes (which is rare). Sometimes there will be a new nurse and I get more direction than I want.

 

[RAS]

Cardionet charges me on$880 per month. Medicare pays $51.27 and my insurance pays $12.82. Since they accept Medicare I’m not responsible for the balance. They do charge my cardiologist’s Coumadin clinic $20 per month. Medicare pays $6.44 and my insurance pays $1.60.

Thanks for the detail.
The $880 and the $20 are not relevant. These are "Chargemaster" or "list" prices. For some reason they include it on the EOB - probably just to make us think we are getting a great deal. My EOB shows the same $880. No Coumadin clinic is involved in my case.

The only thing that counts is the contract/negotiated price between the insurer and the provider. I infer from your post that is $72.13 (51.27+12.82+6.44+1.6) compared to my $113 per 4 tests.

So that tells us Medicare has a much better rate for this service than my ACA plan provider. Which is as I expected. It also is an example of the variation in rates for the same service depending on insurance. I would guess there are even more significant rate variations out there for Biotel/Cardionet.

 

[pellicle]

. In my case at last year rates $113 every two month

That was the case I was asking about.

Thanks

 

[KLS39]

Question about at-home testing through an insurance-covered service:

Does the testing device automatically report back to the service, or do you need to enter the value on a website or manually report it some other way?

I'm wondering if I can use a device provided by the service to test my INR more frequently than the service prescribes. So, if they say test once a week, would there be a problem if I test every day, for example, assuming I pay for the strips?

When I got my Coagsense I was set up with mdINR. I am supposed to have my supplies automatically shipped to me, but it seems I am always calling to order them. I go through them a little quicker than they expect when I test for a second time a week rather than the once a week. I put my result in an app and they call they provider. I do not put the result in if I test a second time unless the cardiologist is the one who asked me to test again. I pay a flat amount for the monthly service whether or not I get more supplies.

 

[Protimenow]

Yeah, I'm aware that some Roche Coaguchek XS models are for Professional use only, but there was a Coaguchek XS model approved for home use in 2007. Here is the FDA record.

The current system for home use is the Vantas which is what I received from the INR monitoring service (no up front cost). The Roche Vantas system approved in 2018 succeeds the XS home use model. FDA states in their decision summary "The CoaguChek Vantus System is intended for single patient self-testing only for adults, age 22 years and older." Here is the FDA record for that system.

And yet, the Vantas system is difficult to find for sale direct to consumer at medical device suppliers, pharmacies, etc.

The professional model of the XS system is still available from various suppliers. Wilburn Medical for example sells XS (for professional use), but not Vantas and steers home users to the CoaguSense device.

I don't think the FDA is the reason direct purchase of Coaguchek devices and supplies is so difficult here.

Pell, I'm curious can you buy your Coaguchek test strips from official/approved Medical supply distributers in Australia or do you buy from eBay?

I'm new to this thread - or at least, I haven't read it for a few months.

I spoke to Roche a few years ago when I complained about the difference in values reported by the CoaguCheck XS and the Coag-Sense meters. At the time, I had complete faith in the Coag-Sense. I don't now.

For me, the results were usually higher than the lab (and the XS). Coag-Sense changed presidents a few years ago. Support sucked. I get no mail returned. When I spoke to a tech person and reported that my INR was about 1.0 higher than the lab, I was told that I can subtract 1 from my Coag-Sense readings to get the accurate value.

Occasionally, the Coag-Sense is closer to the lab than the CoaguChek XS - I'm using the XS almost exclusively - as long as my INR is reported in range, I'm okay with the value.

Now - in regards to the Vantus:

Roche told me that the Vantus was used exclusively by their monitoring service. The only owner of the Vantus is the monitoring service. They are not available for purchase ANYWHERE. When a person stops using their monitoring service, the meter must be returned to them.

It's surprising that, given this, anyone on eBay can be selling it.

Plus, if I recall, it may not give the prothrombin time - just the recorded INR.

 

[Protimenow]

A few more things:

I have been self-testing and managing since April 2010. My first meter was a Protime meter. I got it used on eBay for $35. I couldn't buy the test strips - a doctor friend ordered them for me. I had to keep them in the refrigerator.
I moved from there to the Protime 3 - same strips. It was a bit more compact, and looked less clunky.

I moved to the InRatio - again, bought on eBay. It was much easier to use. The strips didn't require refrigeration. I thought it was accurate -- that is, until I had a stroke because it was telling me that my INR was in the mid-2s, and the hospital showed INR of around 1.6. I didn't take them to court, or reported this to the FDA, but should have.

After that, I tested with whatever meter I could get - CoaguChek S, CoaguChek XS, CoagSense and CoagSense 2. I haven't gotten my hands on the newer CoaguChek meters - but they use the same chips. The difference is features and cosmetics.

I haven't been as diligent about weekly testing that I should be - or that I told others on this forum to do religiously.

I have 24 strips that I probably won't use up before they expire.

And - reading some of the insurance nightmare stories, I'm glad that I own my own meter, self test and self manage.

I'm now on Medicare. My doctors don't know a thing about meters covered by Medicare. I'm waiting until Roche discontinues the XS and I can request the newer model before pushing for a meter that Medicare pays for.

Other than the CoagSense PT2 meter that CoagSense sent me, all my other meters came from eBay.
Most of the strips have been purchased on eBay.

I was sent a bad batch of Coag-Sense strips, but the seller told me to send them back for a refund.

Buy strips from a vendor with a good rating on eBay. Make sure that they have a good expiration date.

And as far as 'how long will the meter last'? I suspect that they'll last as long as strips are made for them. Consider this: the XS was made for testing in clinical settings - they may be used for hundreds of tests a month. It may take 3 years before they're fully amortized, then removed from service - dumped or sold to liquidators. If you figure that the meters in a clinical setting may have done, conservatively, 3600 (or so) tests, and compare that to the 52 (more or less) tests we do each year, it should be clear that these meters are built to last, they're built for a LOT of testing, and they are built with built-in quality controls to detect problems.

 

[RAS]

I moved to the InRatio - again, bought on eBay. It was much easier to use. The strips didn't require refrigeration. I thought it was accurate -- that is, until I had a stroke because it was telling me that my INR was in the mid-2s, and the hospital showed INR of around 1.6. I didn't take them to court, or reported this to the FDA, but should have

Wow! Somehow I lucked out. I used the InRatio (purchased through insurance) for 10 years without any significant issues. My understanding from the recall info and the class action lawsuit was that it was reporting inaccurate on the low side rather than high. My experience was that my out of range results were high 2.5x more than low. I don't know if it was inaccurate or not since I didn't compare to any other device.

n regards to the Vantus:

Plus, if I recall, it may not give the prothrombin time - just the recorded INR.

That is correct.

 

[pellicle]

Good morning

I haven't been as diligent about weekly testing that I should be - or that I told others on this forum to do religiously.

well I understand that, if one sees numbers that are good one could be tempted to test less. I still use my seatbelt analogy and put it on every drive. I don't test every drive, but I do test every Saturday, and enter that into my sheet. Its a small thing but having "habits" or "rituals" in life are important for beings like humans ...

I have 24 strips that I probably won't use up before they expire.

Well in such situations I usually plan an experiment to test an idea I have.

 

[RAS]

In my case at last year rates $113

That was the case I was asking about.

Thanks

Update: BioTel/CardioNet finally submitted a claim for 2022. The new cost is $96.08 - about 15% lower than last year. Since these provider-insurance contracts tend to be multiyear, I'm expecting I can plan on that cost until I'm on Medicare in a couple years.

 

[pellicle]

Hi and thanks

Update: BioTel/CardioNet finally submitted a claim for 2022. The new cost is $96.08 - about 15% lower than last year. Since these provider-insurance contracts tend to be multiyear, I'm expecting I can plan on that cost until I'm on Medicare in a couple years.

if you don't mind me asking, is there a reason you don't just by strips and self manage? I mean I know a few Americans on the forum who do just that ... seems to be not only cheaper but have better results.

 

[RAS]

is there a reason you don't just by strips and self manage?

We covered that earlier in this thread: Post 170
Also another thread: Post 5

 

[Keefo]

Yeah that's correct. I'd be happy to buy via Rx from a pharmacy or medical distributor here in the US even if not covered by insurance as I did in the past, but for some reason Roche is no longer allowing that. One other fact to note is US Federal law restricts sale of medical devices like an INR meter and test strips to physician ordered sales only. In other words an Rx is required.



That seems correct. I think it came out in 2019, while Vantas was 2018. By the way Inrange is for patient use outside the US. Vantas is for patient use in the US. The only functional difference I am aware of is the Inrange can report INR, seconds (prothrombin time) or something called %Quick while the Vantus is limited to reporting only INR.

Any idea why there is a restriction to GP only sales?

I'm in Australia and have been using a Roche INR test machine for over 10 years now, never had it calibrated and every time I verify my results via a blood test, it's bang on, exact same as the machine.

The only issue for me is the cost. It's about $10 per strip, once per week, which doesn't sound much, but over a year, it adds up. And after 10 years, don't get me started!!

But if there is a genuine reason as to why there are restrictions on this machine, suddenly, I'm concerned!

 

[Protimenow]

I think the reason why the doctor is supposed to prescribe the meters and strips is because to deal with the results, you have to use a medication (warfarin) that can be dangerous if the person using it doesn't know what he or she is doing. The INR can change quite a bit if too much or too little is taken. There are those in the system who are attempting to protect us from ourselves.

OTOH - diabetics can test their blood sugar levels with inexpensive meters and inexpensive strips. People who suspect that they may have blood sugar issues can easily buy both over the counter.

You still need prescriptions for Insulin, or medications that are made for people with Type 2 diabetes. You need prescriptions for warfarin.

The big difference is that the FDA trusts you to self-test, and even make insulin dosing decisions, but we're apparently all too stupid or careless to do our own tests -- even if you report the results to a doctor for dosing advice.

And $10 a week may seem like a lot? when you consider that you're spreading that $520 out over a year, but it's a hell of a lot less expensive than care for a stroke.

 

[pellicle]

We covered that earlier in this thread: Post 170
Also another thread: Post 5

Sorry, been doing quite a few other things, thanks for the references.

 

[pellicle]

Good Morning

The only issue for me is the cost. It's about $10 per strip, once per week, which doesn't sound much, but over a year, it adds up. And after 10 years, don't get me started

I use medshop in Australia

So about $170 (including shipping) for 24 strips (or rounded up about what you said, but it adds up ;-)

Oh, and welcome aboard.

 

[RAS]

if there is a genuine reason as to why there are restrictions on this machine, suddenly, I'm concerned!

The US FDA Rx requirement applies to all INR devices I am aware of.

The restriction by Roche to not allow direct sales to patients is their business decision. There is no reason for concern that it has anything to do with reliability of the device. I speculate they refuse to sell direct to US patients as a way to mitigate risk by requiring direct involvement of a healthcare professional. I don't know about Australia or other countries, but the US is rather litigious.