Trying to figure out how to buy inr kit and supplies through insurance

[DachsieMom]

So I am a little ahead of myself since I just had surgery, but I know I want to do home testing and I have time on my hands before going back to work - so I want to figure this out now. With the surgery, I have met my ridiculous deductible and out of pocket maximum ($5k/$7k). This won't happen in future years, so it seemed to me I should buy the monitor and test strips this year. My insurance (Aetna) said they covered it at 100 percent since I have met these maximums. However, everyone I have called wants to put me in a program whereby they loan you the machine but charge hundreds every month to read your test. This doesn't help me, as next year I will pay entirely out of pocket until I hit the deductible (I know I will pay for strips next year, but I was at least hoping to get the machine covered). I am interested in the Coagucheck. Does anyone know where I could buy the meter and strips this year, but have Aetna cover it? (I know I need to wait 3 months per Aetna policy). Am I thinking of this correctly? Thanks.

 

[Boomanchu]

I'm just starting this process myself so I have been reading as many blogs as I can find and weighing what all the experienced folks are saying. It's tough as there seems to be a lot of different situations. It seems to me that the services may be ok if well insured but they may be pretty expensive for those that don't have superior coverage and high co pays/deductibles. I have to wait to see what my particular co pays are but I know I found "starter sets" for the cogucheck xs with 2 boxes of strips for less than $700 on ebay. I've heard some almost unbelievable prices for strips through the services and am just not sure what they will cost me. It seems to me that the services charge a bunch for what they provide and that's fine if they can keep customers but I know that I'm prepared to go it on my own if the numbers work.

 

[RobThatsMe]

From my experience obtaining my first home testing monitor, these are the steps that I had to go through.
I should add that the vendor that I purchased the monitor from was extremely helpful to me with the process,
and took care of and filed most of the paperwork.

If you have insurance, you need to check to see if your insurance covers "Durable Medical equipment/supplies.
You will then need to have your doctor support your decision to home test because he will have to write a prescription for it,
and may even have to drop a note to your insurance company backing up medical necessity.

I am sure some of the others will weigh in on some of the particulars they had to do to obtain theirs.

Rob

 

[dick0236]

My advice is to call the Roche self-testing office in Indianapolis, IN at 1-800-779-7616. They will give you the information you need.....either a "lend lease plan" or a direct purchase plan and can assist with questions regarding insurance. I have worked with this operation for about 1 1/2 years in a "lend lease plan" and have been very satisfied doing business with them. The office in Indianapolis is owned by
Roche Diagnostics(Coaguchek XS manufacturer) and not a third party program administrator. Hope this helps.

 

[camgough]

I am looking into this in Canada as well. My family doctor is not familiar with home testing, the local pharmacist was not familiar either. I called my insurance provider Manulife who sent me a form for my family doctor to fill out. I also followed up with my workplace Manulife liaison, and she asked for a cost estimate.

I have learned of the only pharmacist in my area who was trained by Coaguchek to sell the devices and train patients to use them.

If anyone has quick links to studies or other legitimate information showing the benefits of home testing I would appreciate it being posted here. I'm sure my family doctor and Manulife would be interested!

 

[Freddie]

Try these for Canadian information.........I had a heck of a time to try to convince my GP about home testing and had to do my homework for my doc. As it turned out, my Cardio had no problem with it and gave me the prescription I needed for the monitor. I'd like to think that my GP has excepted that I am a proud owner of a Coaguchek XS.

Hope this helps:

http://www.ismaap.org/
http://www.sciencedirect.com/science...49384808004908
https://www.cadth.ca/media/pdf/446_a...erapy_to_e.pdf

 

[T in YVR]

I am looking into this in Canada as well. My family doctor is not familiar with home testing, the local pharmacist was not familiar either. I called my insurance provider Manulife who sent me a form for my family doctor to fill out. I also followed up with my workplace Manulife liaison, and she asked for a cost estimate.

I have learned of the only pharmacist in my area who was trained by Coaguchek to sell the devices and train patients to use them.

If anyone has quick links to studies or other legitimate information showing the benefits of home testing I would appreciate it being posted here. I'm sure my family doctor and Manulife would be interested!

I too am Canadian and I home test. I checked with my coverage provider (Pacific Blue Cross) and my plan did not cover it. I shelled out the $500 for the unit, bought my strips (on eBay) and have never looked back. Yes, you need to buy it from a pharmacist who is certified and can train you on it (it's incredibly easy to use after 1 or 2 tries). I have been home testing for just over 1 year. I can't even begin to tell you how great it is. I do not have the links to hard data on the actual benefits that you asked about, but they are very obvious and straightforward. I could not imagine testing monthly and have no INR insight, especially if you live an active lifestyle, travel at all, eat lots of veggies, exercise regularly etc. I have enough slight variations that I would never want to be in the dark on something like this. Sure, it costs money to test weekly or bi-weekly, and for some people that is a barrier - I totally get that. But if you can afford it, do it. Peace of mind, proactive management of your health and well being, and an ability/freedom to live your life and not really worry about INR going in or out of range because you can catch it pretty easily/quickly (not to mention the reduced cost to the health care system from much fewer lab tests and doctor follow up).
T

 

[tom in MO]

DachsiesMom: Usually insurance companies want you to use their specified provider or you will pay even more. For example, I pay 90% (once deductible is filled) for in network medical suppliers but 75% for out of network. Also, if they told you to wait 3 months, they may not cover the purchase at all. I'd wait and do what Aetna says for this year. You may be given the meter free (like I was) and only have to pay for the strips. When I asked (after I received the meter) who owns it, I was told I do.

 

[bolligal]

completely disagree with Tom. I have a disdain from working with insurance companies, in general I think they just try to avoid costs any way possible, and the only way to reduce out of pocket costs is to aggressively push them to help you get what you need. You may have to wait 3 months to place your order, but there is a lot you can do right now to make sure this goes the way you want. I was in your situation 6 years ago with a high deductible plan, and I made sure I bought my equipment the same year I had my surgery to avoid paying for the meter our of pocket the following year. My experience was with BCBS, but from what you wrote the practices seem the same.

Steps:
1.) Confirm that this medical device is covered, write down the name/contact info of the person that told you it was covered, and ask for it in writing. I did this and they sent me a letter that told me I was pre-qualified and could order one in November (surgery was in August).
2.) Find a retailer that will sell you a device and bill insurance. From this forum, I was told to contact Alere (http://www.alere.com/ww/en.html), that was my first and only call to order an inRatio2 at home self-test moniter. They needed my insurance information, then they sent a fax to my insurance company asking for approval to buy/send me the device.
3.) Follow-up: After a couple of weeks, I had to call and follow up with the insurance company, as they were ignoring the request. This continued into December, but finally I got the insurance company to respond to Alere, and my device was ordered. Since it was the same calendar year, I avoided any out-of-pocket cost. They also sent me 12 test strips and lancets. The only thing I would have done differently if I did this again, would be to try and get more test strips, since the next time you will have to pay for them.

Side note: My inRatio2 is giving me ERR code 10, which when I called means unrecoverable error and it's out of warrenty, so I will be going down this painful process again. As I'm still on a high-deductible plan, I will likely do what T in YVR did and just get a cheaper one out of pocket and use my health savings account to pay for it without bothering to mess with insurance.

 

[DachsieMom]

Thank you very much. I called Roche and Alere, and neither would just sell me the machine - they, and other companies, all wanted me on the plan where they bill an exorbitant amount every 4 weeks for processing your results, but they loan you the machine and supplies. I assume they would take the machine back if I stopped using their service (in other words, can't use these types of services this year only, while I have met the deductible, and then discontinue when the new calendar year starts and assume they will let me keep the machine). I will try Alere again. I am interested in the coaguchek. Aetna has a policy stating the inr devices are covered, but they could not direct me to a provider that would sell it. I will ask for it in writing as you suggest.

 

[big_L]

I too have Aetna. I got so frustrated with this that I just bought my own meters and strips. Yes, I didn't want to spend my own money, but I found all the rules and structure to be maddening. I don't remember all the details. I did work through a Roche 'salesperson'.

 

[Boomanchu]

My insurance denied coverage for home testing so I checked ebay for a week until I saw one that wasn't getting much action, I think ending on a sunday didn't help tp drive up the bids. It was from someone that was denied then approved right after he purchased his own. A CoaguCheck XS, 48 strips and 200 lancets for $560. I will bring it with me to my INR check wed. at my cardiologists office to compare for accuracy.