Revisiting Post of Home Monitoring

[SLV]

I am a Jude mechanical Valve patient since 2005 due to BAV congenital condition.

I use the Anticoagulation Clinic at the hospital- but the cost got astronomical. The fees are $250 a visit and is not billed as an office visit so goes to deductible. With high deductibles to keep premiums down it has been challenging. The CPT code seems to warrant being paid as an office visit with a copay but the insurance- and i have had First Choice, Blue Shield, and Blue cross all pay the same way, it goes to the deductible.

About 6 years ago I tried a home monitoring machine that insurance paid with a Roche machine ( I bought when my deductible was met) - but when my supples ran out, I found out they wanted me to test more frequently- they make their money on supplies. they wanted at the time twice a month. IWhen going to the clinic - I was lucky to get 6 weeks. The cost of the strips (i used Alere at the time) was just as bad as going to the clinic. I returned the machine as they said I did not really own it they billed insurance as a lease.

The billing for results is the other issue- that was problematic - the physician’s office did not do it - leaving the inr clinic to do it and they the did as a “courtesy”. In making my inquiry recently to revisit with a recommendation for a machine, they indicated they are changing their policy that will not make it cost effective for patients they told me.

I am stable so I don’t need to test frequently- The only time I run into trouble is with my Diverticulitis flare ups as the antibiotics wreck havoc with INR. I am still under age 65 when Medicare comes into play. Any advice and recommendation is appreciated

 

[dick0236]

Hi SLV. Welcome to this forum, it has a lot of good advice, help and support for valve patients.

I have home tested for several years with little problem............until recently. I had used Roche Patient Services(subsidiary of Roche Diagnostics) as my monitoring company with no issues or problems. Earlier this summer Roche sold their monitoring business to BioTel Heart. I am wondering if this could be a consolidation of monitoring companies since the market probably is shrinking due to the newer anti-coagulants that do not need testing. The decline of the brand name Coumadin sales has caused Bristol, Myers, Squib to stop production of the brand name drug Coumadin. My "gut" tells me that the market declines in sales of anti-coagulant drugs like Coumadin/Warfarin may be forcing changes in INR testing.

My PCP does offer INR(finger stick) testing thru their "in-house" lab and I am considering letting them do my INR. My Humana Advantage Medicare plan will cover this type of lab test at 100% in 2021.

 

[pellicle]

I am stable so I don’t need to test frequently ... That's what microadjusts are for.

I'm not sure what the question was ... but on the need to test "frequently", I test weekly and consider that while I'm more than 90% in range and only need occasional adjustments. I would caution about the "I'm so stable" because its to me like "I never have a car accident so I don't need to wear a seatbelt"

 

[pellicle]

...and I am considering letting them do my INR.

wow ... that's a change isn't it?

 

[dick0236]

wow ... that's a change isn't it?

Kinda........we'll see. I have become very uncomfortable with this new outfit, BioTel Heart. Nothing has been cast in stone, I'm just exploring alternatives.

 

[pellicle]

with this new outfit

when they say "its all about the customer" the really mean its all about the shareholders.

 

[Sheenas7]

I just started testing at home last April with the help and advise of many here. I would hate to go back to the doctor’s office. Hope that Bio Tel irons out their issues. Good luck to all of us.

 

[MdaPA]

My darling wife also uses Coaguchek (now it's Bio Tel Heart) for her INR monitoring meter and supplies. She also had issues reporting her INR results last week and again this morning (their IVR does not recognize her DOB). She was not able to speak with a live representative so she gave her results directly to her Cardio office who manages her INR. There is no value anyway of going through a "middle-man" to report results and sometimes it even causes delays or results not getting to her Cardio's office.

She did receive a fresh supply of strips and lancets a few weeks ago without having to request them so that's a good thing. We would get concerned if those delays start occurring, not when she doesn't get a bill. Not receiving a bill is a good thing, right? If/when she gets the catch-up bills and the out-of-pocket is not in-line with what she was paying with Coaguchek then we will challenge the bill(s).

 

[Sheenas7]

My darling wife also uses Coaguchek (now it's Bio Tel Heart) for her INR monitoring meter and supplies. She also had issues reporting her INR results last week and again this morning (their IVR does not recognize her DOB). She was not able to speak with a live representative so she gave her results directly to her Cardio office who manages her INR. There is no value anyway of going through a "middle-man" to report results and sometimes it even causes delays or results not getting to her Cardio's office.

She did receive a fresh supply of strips and lancets a few weeks ago without having to request them so that's a good thing. We would get concerned if those delays start occurring, not when she doesn't get a bill. Not receiving a bill is a good thing, right? If/when she gets the catch-up bills and the out-of-pocket is not in-line with what she was paying with Coaguchek then we will challenge the bill(s).

I had same experience again this morning. I did wait on the phone and finally got a representative who took down information to send to my doctor. I was in range so that was good as I don’t know how well they are reporting results based on their problems with DOB. I also received new strips without requesting them so that was good. Hope they get it together as it makes me uneasy. Billing I see my insurance paid Roche. How that irons out I don’t know. I have Medicare and Cigna. Hope their issues get resolved soon.

 

[SLV]

For those underage 65- how are the results from INR clinic or physician billed and paid? This was the crux of my question. In doing research to purchase a machine, I discovered the same problem I had before. It is the billing of managing the results which most often means a phone call. My Cardiologist office won’t do it- referring to the Anticoag unit for the phone call to me about my test results from the machine. The coag unit at the time several years ago explained it is not a billable service that insurance will cover so they did it as a courtesy. Now with the influx of those using the monitors - they told me they won’t manage the results without seeing me and do the test - thus a billable service for them but it makes using the machine invalid. I am doing some more calling around but this seems to be a trend. What I did discover after much inquiry with the anti coag unit - that i could use the services of one of their pharmacists that is placed in a medical clinic below their office. I am basically a stray patient using the pharmacist - but the cost was $130 cheaper. The monitoring companies i am looking at would be about the same cost now - except for the problem of a potential bill for the results. More checking to do - but it sure would be nice if the monitoring companies had an embedded pharmacist to review results that could include in the cost. Again this seems to be a problem for the under age 65 non Medicare with commercial insurance.

 

[pellicle]

@SLV why wouldn't you just buy one and pay for the strips yourself?

Get on board with your Dr and using a basic spreadsheet demonstrate that:

• you're in range most of the time
• managing it well
• clearly regularly taking your pills

if all the Dr has to do is review the report of well done then I'm sure they'll be fine. You could also impress your Cardio with the data, mine loves my data.

 

[kevanndo]

I have been testing my daughter at home weekly for the past 6 1/2 years since she got an On-X mitral valve when she was 9 years old. Originally, I rented the Coaguchek through a company and also got the strips from them. However, I quickly realized this was a money maker for them, and the insurance company was also being scammed out of a large sum of money weekly. After reading on this forum of the success of those who purchased their own machines and strips on Ebay, I've been doing that myself for the past 5 years. There was one month when my daughter's INR was uncontrollably erratic, going as high as 7.5. I thought there might be an issue with the strips, but then I came up with the clever idea of doing my own quality control experiment. I tested my own INR, and the result was 1.0, so I knew the issue was not with the strips.

 

[SLV]

@SLV why wouldn't you just buy one and pay for the strips yourself?

Get on board with your Dr and using a basic spreadsheet demonstrate that:

• you're in range most of the time
• managing it well
• clearly regularly taking your pills

if all the Dr has to do is review the report of well done then I'm sure they'll be fine. You could also impress your Cardio with the data, mine loves my data.

Good idea. I am getting a preauth for the purchase out of insurance but may just pay outright.

 

[pellicle]

I am getting a preauth for the purchase out of insurance but may just pay outright.

you can get them on eBay either new or used, bargains can be had, use paypal and be ruthless on returns of stuff

Eg
https://www.ebay.com/itm/ROCHE-COAG...NG-KIT-CARRYING-CASE-LANCETS-ETC/253353601821
the new model
https://www.ebay.com/itm/NEWEST-UPD...PT-INR-Meter-Monitor-Testing-Kit/252258734601
this is an Australian shop, consult currency conversions to understand US$ prices
https://www.medshop.com.au/collections/blood-coagulation-monitors
I understood Canada also sold them, and of course Mexico ...

PS: DO NOT buy the older S model, no strips are available now

 

[SLV]

Never thought about Canada. I am two hours away - of course borders are closed right now for non essential travel - but I will do some research! Tx

 

[Protimenow]

SLV - I agree with Pellicle and some of the others, and it looks like you've been ill informed about testing frequency and self-testing.

I've been self-testing and self managing since 2009 - before I was 65. I bought my own meter(s) and my own supplies (strips and lancing devices), and used information from this forum to get the hang of managing.

I rather ignorantly went for more than 3 years without testing - I couldn't afford a lab test, my dosing was stable (and not really the right way to do it), and I thought that I could 'feel' when my INR was too high or too low. I was probably lucky that there were no adverse effects - although, perhaps, keeping my diet and activities pretty consistent, my INR may have stayed in a safe range. I won't do THAT again.

Most of my monitors were bargains, and purchased on eBay. Strips and lancing devices also came from eBay. Unless your medical plan or doctor insists on having a company manage your dosing, you can probably test and manage on your own.

Many of us do.

 

[Ruby]

I’m Canadian, bought my first Coaguchek S in 2004, replaced it with Coaguchek XS two years later and have self tested weekly since then. Those machines were bought outright. The S from a pharmacy, the XS bought directly from Roche when S broke down while under warranty. Doesn’t Roche sell directly to the public? If not, why not. Is it a question of management?

 

[pellicle]

Doesn’t Roche sell directly to the public?

In Australia at least you buy from a reseller. Roche handles warranty.

 

[Protimenow]

'if not, why not?' I can only guess at the answers.

1. For some reason, these meters require a prescription - probably because the results are used for dosing of a medication that can be very dangerous if done poorly.
2. It's done through distributors, who can (presumably) do a better job of verifying prescriptions and handle the hassle of distribution of meters and supplies.
3. Roche doesn't want to upset its distributors by, in effect, competing with them.

Roche is also supposed to have had very tight control over the newer meter - the Vantus. I was told by Roche that the only way to get one was (because they left the service business) to subscribe to their INR reporting service. If a person left the service, they had to return the meter).

There's a large grey market for XS meters.

That's how I got mine. It's how many of us here have gotten our meters.

 

[Ruby]

Oh boy. Things have to be complicated don’t they? Grey market might be what happens to the returned monitors.