Starting over

[Harpoon]

This past fall I got a rather rude discharge from my primary care physician.
It's a long, crazy story and not worth repeating but one of the MANY things it has done is throw my INR monitoring out the window.

Fortunately, I know I'm still "in range," following my most recent visit with my cardiologist but I don't have a system for regular testing right now.
I do have a new PCP but she doesn't have the capabilities to do INR monitoring and she stately plainly that she doesn't know that much about it and would prefer not to have to help me manage it.

"Thank you, I appreciate your candor." is what I said roughly.

So I can get it done through my card, but that's an hour hike at least once a month.

There is one lab here that operates outside of the local hospital and I'm going to contact them about it. I can also go back to the blood draw method if absolutely neccesary, but I'd prefer not to for obvious reasons.

So I'm looking at re-visiting the home monitoring option again. Last time I suggested this my insurance just laughed at me. That was three years ago and I'm hoping times have changed.

And help, advice, books to throw at them would be more than helpful.

Bear in mind, I do have some medical training of my own and I've demonstrated through the years that I can be very proactive when it comes to maintaining my own health (inspite of what the office manager from my old PCP's office sasy!!!) so self-testing shouldn't be an issue that way.


Just looking for how to get started towards a direction of taking care of my own INR.

 

[hensylee]

Harpoon, we have lots who take theirs at home and they should be able to give you some pointers. Y'all come on in and give Harpoon your experiences in obtaining one of these time savers. He's a busy guy and needs to save time. Maybe Al Lodwick will be along to help out. He's our expert and he has his own website, too - listed under his posts.

 

[Ross]

First thing you gotta do is get a Doctors prescripition for it, then fill out all these forms and send them in and see what happens:

http://www.ptinratio.com/patient_how_to_get.asp

 

[Susan BAV]

I was only on Coumadin for three months post-op but there was an ongoing struggle between my local family doctor and my cardio, who is nearly three hours away, about who would manage it and how. I finally decided in favor of the cardio and then the local doctor's office (who had a witch of a nurse in his office then) wouldn't even do the draws so I had to drive half an hour to the nearest hospital for the draws and it took days to get results and I was never in range (maybe once) and yak,yak,yak...

Anyway, home testing sounds like a great idea!

 

[DrAllan]

Harpoon,

The process of getting home testing for you may be more complicated than most.

First, you need one of your physicians to agree to authorize (sort of write a prescription, but in reality signing a form authorizing you to get a machine. Your difficulty with this and your present set of physicians is that they also agree to monitor your INR results and subsequent therapy. For many on this site, this is observed more in the breach than in actuality. Regardless, the results need to be conveyed to the doctor when done. Sounds like your cardiologist is the one. Point out to him/her that there is an ICD code for billing for this monitoring. If you learn from this site how to self dose, then all you need to do is report the INR and the dosage for approval by the doctor. You might try working with your PCP and point out to here that you both can learn from this exercise and then she could manage and charge other patients as well. However, again be aware of the constant worry of physicians regarding malpractice and that since she has stated her lack of expertisemay not want to take on the responsibility.

Second, you need to decide which of the home devices you wish to get. This becomes important because the FDA does not allow you to get it directly. It has to be provided to you after you have had an approved training course and are certified as capable of doing home monitoring. This is often handled by the several companies that sell and distribute the devices and supplies. This site is sponsored by QAS, which seems to favor the Hemosense INRratio unit. Other companies such as Tapestry handle other devices such as the Roche unit, which is in limbo now because of strip manufacturing problems. These companies handle a good part of the paperwork between you and the insurance company.

It helps to be proactive with the insurance company regarding your eligibility. However, recognize that they can write their policies any way they want to excluding many procedures and devices. This may be your fight as it was three years ago. So being proactive you need a letter from your physician that basically states.

?My patient, Harpoon, requires home testing for anticoagulation management. He fulfills the Medicare requirements for this testing, mainly, a) he has a mechanical heart valve, b) he has been on warfarin therapy for greater than three months, c) he does not have easy or convenient access to a laboratory for drawing his blood, d) he frequently is away from his home base and would have difficulty finding and obtaining testing during these times. In addition, he has somewhat fragile veins and repeated weekly venipunctures represent a hardship to him. Finally, multiple published studies have shown that patients on self-management of anticoagulation therapy have fewer episodes of stroke or abnormal life threatening bleeding which in itself reduces total medical costs.

For the above reasons I believe that he is an excellent candidate for home INR testing.

 

[lance]

What about hospitals

What about hospitals

Hello Harpoon,

Initially I encountered difficulty with my PCP about home monitoring. All hospitals performing heart surgery have anti-coagulation clinics and would be knowledgeable about home testing. Many of them have web-sites. So I found a hospital compliant with home monitoring via the internet.

When my PCP learned training was available at a "big name" hospital he came on board. I've been testing myself for the past two years and hospital staff monitor my dosing. I perform the test, e-mail the result to the hospital and they respond the same day with dosing instructions--couldn't be simpler even when I was in Britain.

It's worked well for me. Maybe you could try that.

Best wishes and good luck.