Roche Diagnostics Out of Network

[jpattillo]

My cardiologist ordered a home test kit from Roche Diagnostics. However, I received a call from them saying they are out of my BCBS of Alabama network and that I would have to cover 50%. Has anyone had this problem before? Also, is anyone using the kit but not reporting results to the testing company? It seems ridiculous for me to pay the company to just pass on a number to the cardiologist when I could just as easily call the nurse and leave her a message. No need for a middleman here....

 

[Protimenow]

Yes, the thing with Alere or Philips DOES seem pretty ridiculous - and outrageous. If you're able to do your own test, you should be able to pick up the phone and call the results in to clinic, doctor, or self-manage (if you're capable and your doctor allows this). From what I've heard, the expensive programs where they send you the meter and strips and require you to call in have a larger deductible than the cost of getting your own machine and strips.

Personally, I own my own meters - and all but one (that Alere sent me), have been bought on eBay. The only meter that I had trouble with was one that was described to be As Is, cost me $1, and that I bought primarily for the charger. I got strips on eBay, from Alere, and from a medical supply company.

You might check with BCBS to see if they'll cover a meter that you buy, and strips that you buy, and see if they have a provider IN NETWORK that they can refer you to. It doesn't seem like you'll have any problems getting a prescription for meter and strips from you doctor, and other companies that are in network may make it easier and less expensive to get your own meter and strips, call your doctor with your INR, and get self-testing without having our insurance dollars subsidize greedy companies.

 

[AgilityDog]

UHC required me to use Phillips. Y'all know how I feel about Phillip$$$$. I used them for 2 years, and it cost me the equivalent of about 3 machines.

I then bought my own meter and buy my own strips on-line. For a while I called my cardio's nurse (the anti-coag manager) weekly, but after a while we agreed I could self-manage, calling only as needed.

I bring copies of my INR charts to the cardio every time I see him. I think I've called 3 times for a consult with the nurse re dosage in 4 years.

 

[Protimenow]

The way Laurie described it is the way it seems to work for many of us. We get our own machines, our own strips, and do our own testing. There are good resources regarding dosing and, if you don't get nuts making changes to your dosing, your likelihood of staying in range is pretty good (in fact, there are papers that say self-testers do a better job of staying in range than clinics or doctors who manage this stuff).

I keep a spreadsheet with my dosage, INRs, the machine I use for the testing, anything unusual that could effect the tests, etc., and if necessary I am happy to show this to my doctor when I need a refill of Warfarin. I test weekly and encourage others to also do weekly tests. For the cost of the strips, I think it makes good sense to know your INR every week.

As noted before, you can buy meter and strips on line -- if you're comfortable with eBay (as I am), you can get meter and strips that way, or you can use a medical supply company and your doctor's prescription. You may even find a BCBS approved vendor who can even help with the paperwork.

 

[wcasey5]

You could try edgepark to see if they are in network. I just ended my relationship with phillips as they totally screwed me by changing billing codes so my strips were not covered. I specified that I wanted to purchase my machine, so now I just call my cardio once a month with my INR, and I test every 2 weeks or so.

 

[jpattillo]

So what should I expect to pay on EBay? I'm seeing new kits well over $1,000.

 

[AgilityDog]

$950 on Amazon right now. To anyone. for the machine.

BUT if you have a very friendly doctor, or a doctor in the family, you can get one for less via one of many medical supply companies on line, by having the doctor purchase it, and you reimburse the doctor. However, MOST of the medical supply companies won't sell the machines to the public, even though there is no legal obstacle to doing so to my knowledge.

Strips run about $225 for 48 strips.

A travel case runs maybe $35

lancets are $5 at Walmart for 100, use at least size 26, or Size 21 gauge if you can get it

lancing devices are another $5 and last forever.

 

[tom in MO]

My BCBS has Alere as the provider; maybe you BCBS has a different provider and your cardioligist doesn't know it. Since my deductible is up, the machine and first years strips (1/week maximum testing rate as prescribed by doctor) are fully covered. The whole thing was set up by the coumadin clinic at the hospital. I found that BCBS customer service knew almost nothing useful. The staff at the coumadin clinic and Alere gave me the answers I should have gotten from BCBS.

 

[Protimenow]

I'm stuck with a coumadin clinic and they FORBADE me from doing self testing. They told me that if I was self testing, that they would cancel my service. THEY were more comfortable with monthly testing in the lab than my weekly testing with a meter. (My INR was 1.8 on my meter and 1.75 at the lab last week, and they advised me to increase the dose that I was already going to do -- the only value to this clinic, for me, is blood draws that confirm my meter's readings).

On eBay, the price for meters has a wide variance in values. One member here got a CoaguChek XS last week for under $200. I've seen them considerably lower - and often much higher.

As far as I know, all three of the most commonly available meters - CoaguChek XS, InRatio (and InRatio 2), and Protime (and Protime 3) - are functional and accurate. The InRatio and CoaguChek XS are easier to use (and easier to get a blood sample for) than the ProTime meters. All three will have strips available for many years. (Avoid the CoaguChek S - it's been discontinued by Roche). The cost for the strips is fairly equal regardless of the meter (ProTime costs about $145 for 25 strips, probably the most expensive; CoaguChek XS and InRatio are around $200 or less for 48 strips).

Getting the best price on eBay may be a matter of checking eBay regularly - the best prices DO occasionally show up and are often snapped up pretty quickly.

If you know someone in Canada, it's been written that the CoaguChek XS is being sold for $500 -- but I don't know what else may be required to get the meter.

One more thing -- for some weird reason, the Feds want you to have a prescription to buy a meter and strips. Not all sellers require a doctor's prescription and may still sell you meter and strips without one. Most eBay vendors probably don't require a prescription for ordering the meter or strips.

 

[Scott]

Hi all. I am using Edgpark. with the coagucheck. I was told I had to use the very expensive strips they sell and I could not use more strips or test without calling them. Anyway, I just purchased 48 strips from Amazon- Medical Department Store. 204.00 And they came usps in about 5 days. My wife had to sign for them. I was afraid they would have a short expiration date but decided to give them a try. The date is 12 months from now, June, 2013. I haven't tried one yet but I will let everyone know if there is a problem. It's too bad to have to go outside rules and insurance, but at least it's due-able.

 

[mecretired]

I purchased my Coaguchek XS thru ebay about a year ago for $800 and this included 48 test strips. I have since purchased 48 more test strips for $200 on ebay. I have had no problems with the meter or the strips. Roche wanted to charge me $2400 just for the meter. I told my cardiologist after the fact and he was OK with it. The coumadin clinic--not so much. I test weekly--however, the coumadin clinic will not take any inr results from me. They will only take them directly from Roche or a lab. So I just play it by ear--I lab test occasionally so the coumadin clinic stays in the loop. But I feel soooo much more in control of me by weekly testing with my own machine. Having my own meter has made a huge difference in how I feel about the whole warfarin/inr thing. I feel more "normal".

 

[wcasey5]

I thought I was stuck with a coumadin clinic until I spoke with my cardio. He approved my machine and take my results. The coumadin clinic was charging me $45 per month for a copay (should have been 9% of the $71 per visit, but of course they use billing codes that piss off the patient rather than the insurance company), and they refused to allow me to do home testing. That's when I said screw them and went to my cardio. If my cardio starts to give me static, I lined up my PCP to do coumadin management. This health care system is expensive enough without extorting more money out of me than is needed.

 

[jpattillo]

I just had a great break through with this. I explained the problem to my cario's nurse. She called the rep from a different company and the rep went to bat for me (with the incentive of picking up more business from my cardio). Apparently home INR companies are often willing to waive the co-pay if you ask. For a lifetime customer like me (who can take my business to another company if I want) they are apparently willing to do this. So it should cost me $0 each time I test. I'm still not sure about my share of the device itself. However, I will not own it but rather "rent" it. Hopefully they will waive any co-pay on this as well.

 

[Madsometimes]

I find it really shocking that Roche are charging people $2400 for coaguchek xs. I bought direct from Roche in the UK and paid £299. Normally, we get ripped off over here, paying more for cars, branded clothes and electronics. Maybe people in the US get charged more because Roche knows their insurance will cover it, whereas in the UK the NHS doesn't fund the cost of meters so patients pay the full cost. For many people, £299 is a lot of money.

I'm fairly sure the coaguchek is cheap to manufacture, and Roche makes plenty on consumables. I would have thought it would make financial sense to reduce the cost of the meter, so that more people buy it, and then make money on the strips.

 

[Protimenow]

It IS shocking. There seem to be enough people on warfarin that the companies can still make a bundle on the consumables. But, of course, society is all about making as much money as possible when you can get away with it. Roche and others may also be aware that, some day, there may be a GOOD medication that will make warfarin unnecessary - and INR testing unnecessary - so the need for a meter will go bye bye. Perhaps they're looking to milk the cash cow as long as they can, because they know that the cow's days are numbered.

 

[Bina]

I find it really shocking that Roche are charging people $2400 for coaguchek xs. I bought direct from Roche in the UK and paid £299. Normally, we get ripped off over here, paying more for cars, branded clothes and electronics. Maybe people in the US get charged more because Roche knows their insurance will cover it, whereas in the UK the NHS doesn't fund the cost of meters so patients pay the full cost. For many people, £299 is a lot of money.

I'm fairly sure the coaguchek is cheap to manufacture, and Roche makes plenty on consumables. I would have thought it would make financial sense to reduce the cost of the meter, so that more people buy it, and then make money on the strips.

I don't think that it is fair to blame the Roche manufacturer for the extreme prices in the United States. It is the multi level, pyramid
type of price fixing through insurance companies and suppliers that has driven the price to those heights. Everywhere else, like in Canada,
the UK, Australia, etc. the price is pretty much the same at $500 and it is accessible to the patient with a simple prescription.
My monitor has worked perfectly for 5 years, I couldn't love it more ;-)

 

[Madsometimes]

I didn't even need a prescription. I just ordered it on the website, put in my credit card, and a few days later it arrived in the post, just like ordering books fom Amazon. I get my strips on prescription, because they are heavily subsidised that way. Unfortunately, the meters are not available on prescription.

I will admit to not understanding the US healthcare system. On anticoagulation it seems to put barriers in people's way. Of course, there are some haematologists here that are anti home testing too, but luckily mine is not.

I am very envious of the short waits for treatment in the US. I found out that I had flutter in January, and finally have an ablation date for mid July. Waiting lists are supposed to be capped at 18 weeks, but you wait to see the consultant, wait for tests and then wait for treatment.

 

[Protimenow]

I don't understand why a prescription is needed for the meters or the strips, either. I don't see the harm that would be done if a person knows his or her INR --whether or not he takes warfarin. I can't imagine a person buying an expensive meter just out of curiosity.

As long as the doctors control prescriptions for warfarin, I don't see much potential for harm. (OTOH, it IS possible to get Warfarin from other countries - but I can't imagine people who don't NEED warfarin actually wanting to mess with their anticoagulation).

 

[jpattillo]

The US healthcare system is working for me. I'm getting the home kit and won't have to pay a deductible, all because of competition in an open market. It's the threat of my taking my business elsewhere that has kept the price down for me.

 

[wcasey5]

I had to wait from August to the following March to have my AVR. In Canada, my mom's neighbor started at the same time and got his AVR in half the time. Some things are a shorter wait, some are longer. ALL of it in the U.S. is horrendiously bureaucratic and much more expensive. But that goes with the culture, The NHS or Canada's health system would never work here, just as the American system would never work there.