Am I nuts to want Home testing?

[MandyMV]

Hello,
I just got off the phone with my boyfriend's case manager who told me that we didn't have a shot of getting approved for a home testing monitor because he is abled bodied and can get into the local clinic to have his lab drawn so they don't see any need. However, I have extensively read this forum, journal articles etc that explain the benefits of home testing in lifelong coumadin patients so I got a little irate when they told me this. In addition it bothers me that he is going to a local clinic where we live to get blood drawn and then the sample is sent 2 hours away to the larger facility for the actual test...sometimes it is 24 hours until the blood is tested and then another 24 hours before we hear the results. Maybe scientifically that doesn't matter but it doesn't seem right to me.

In addition I didn't like the way they handled his drop in INR last week. It went from 3.7 to 1.2 in two weeks. I think it was because he started eating salads at lunch with broccoli and was an increase of Vitamin K over our diets previously. They told him to eat whatever and didn't say to call them if he makes any changes it would be seen in the INR testing. When they got the 1.2 reading they just upped the dose to 7.5mg 4days and 5 the other 3 with another test in two weeks. OK but now he stopped eating the salads and he can't go in for a check on his INR until next week. If we had a home monitor I could at least test this week to make sure it didn't go up too far with increased dose. I am at my wits end with his doctors!

I will keep fighting the insurance company and his doctors or else he will just get one for Christmas!! I guess I needed to vent but would also love any advice anyone has in how they got their devices.
Cheers,
Theresa

 

[AgilityDog]

My cardiologist recommended home testing at my first post-op appointment, and called in the Rx to Raytel.com. My insurance covers it b/c I have an artificial valve.
Check your BF's insurance coverage. Mine specifically states it covers home testing for artificial valvers, though my co-pay is a tad steep at $50/4 tests.
If the insurance won't cover it, buy the machine anyway-- now, not at Xmas. Raytel sells outright, though you may need the dr. to write a scrip. If he won't, then have him watch the video posted under Home Monitoring. Or change doctors. He needs educated. Your case manager is living in a cave.

 

[MandyMV]

Hi Laurie,
Thanks for the encouragement. I just talked to the case manager we had at the hospital (big city nurse vs. small town nurse) and she told me they have had success with other patients with Raytel...they seem to know what to say to our insurance guys. We are now working on tracking down our doctor (our PCM who knows nothing of this world) to get the paperwork filled out. My BF unfortunately has an employer who dictates who his PCM is (as well as the rest of his care which is how we got here in the first place) so I guess I will just have to educate everyone. I just started watching the Discovery channel CME course-very interesting maybe I will email his doc the link

Oh and I wouldn't wait for Christmas-he just wouldn't get something else!
Thanks again,
Theresa

 

[Bina]

Hello and welcome.
Until you get the home machine sorted out, it is best if your BF tries to keep his intake of greens a bit more steady. I was lucky that my GP saw the pamphlet and agreed it was a good idea. I disliked shipping my blood samples out to a lab also.

 

[Ross]

If he keeps having problems with INR, send him to the anticoag forum. We'll get him straightened around. Diet plays a very small role in INR management.

 

[Blanche]

Raytel is the best

Raytel is the best

Theresa:
I highly recommend Raytel Cardiac for their service and professional manner.

In 2001 we bought a ProTime Monitor from QAS. The ProTime was the only monitor approved for home use then.
THe ProTime monitor was wonderful, but the batteries are enclosed within the unit. When the batteries died, we plugged in the monitor...What a pain. So, we decided to buy the INRatio monitor in August 2007.
The INRatio monitor cost us $1.500. Supplies are $84. for 12 strips.
I ordered the INRatio monitor on a Wednesday and received it on Friday, two days later. I charged it to my Visa card.

In America only 1%of the people eligible for home testing have their own anticoagulation monitor. In germany 45% have monitors. Doctors are not used to this and they fight it continually.

You should tell your insurance company that Medicare provides anticoagulation monitors to Medicare patients who have medhanical valves.

My husband had his valve replaced in 1990. For 10 years, we was just fine with testing at the lab once a month. Then, in 2000, with no warning he had two strokes one week apart. He was hospitalized for nearly 6 weeks. If we had a monitor and tested weekly, it is very likely that he would not have had those strokes....that changed our lives drastically. His strokes happened because his INR was way too low. He was scheduled to test at the Lab one day after his stroke.

I have never regretted buying the anticoagulation monitors and would recommend them to anyone who is on oral anticoagulation. By the way, I developed A-fib 3 years ago, so I too must test.

My advice would be to get the machine as soon as possible. Christmas is a long way away.


Blanche

 

[Philip B]

Home Monitoring & Insurance Companies

Home Monitoring & Insurance Companies

My wife and I fought running battle with our insurance company to get my monitor paid for. After initial refusals from the company I purchased my own machine and shifted the fight to seeking reimbursement.

After about a five month war the insurance company gave up and reimbursed us. We're still fighting the company for reimbursement for supplies.

Was it worth all of the stress and hassle? Absoultely!

Probably the hardest issue to deal with was making the decision to simply pay for the monitor without knowing if we would ever get reimbursement. There are a lot of other things I would rather spend that kind of money on.

One of my students and her parents are presently pursuing getting a home monitor. Today, I asked her how that was going and she indicated that her insurance company has stalled the process. Those who comment about insurance companies typically resisting paying for home monitors are probably right. Such resistance doesn't seem to be based upon logic.

Keep fighting. You might just win!

-Philip

 

[TomD]

Home testing

Home testing

I just ordered the INRATIO home tester which on the web site is on sale for $1,495. If you think about a lifetime of testing it's worth it even if insurance does not pay. Inratio people said they would submit all the insurance stuff but then I would have to wait 4-6 weeks while its being processed so we decided to byte the bullet and just order it and fight the insurance reimbursement ourselves.

Prior to this and prior to my surgery I was on coumadin for atrial fibrillation. I worked out a deal with my doctor and the lab (Quest Diagnostics) that I could come in whenever I wanted to and the lab would fax me the results the same day. I managed my own coumadin levels based on what I got from the lab. This might be an alternative to buying your own tester.

 

[lance]

Absolutely not "nuts"

Absolutely not "nuts"

Actually you're the exact opposite--using your brain for its intended purpose--thinking.
Are medical supplies tax deductible in the US?

 

[Lisa in Katy]

I have another question on this topic. I have a new job and after a few phone calls to the new insurance company (United), I'm not sure if the machine will be covered - none of the people I talked to knew what it was! So, I am thinking of setting up my healthcare spending account for $2,000 (the max) to cover the cost of the equipment plus supplies. Is anyone familiar with HSA? Would I have to run it through the insurance company before reimbursement? My fear is that they would end up covering it and I would be out the money in my HSA. I only have 30 days to complete benefits enrollment (actually about 21 now), so don't have time for the insurance company to run it through their process.

Thanks.

 

[TomD]

INRATIO home testor

INRATIO home testor

I received my INRATIO home tester on Friday and my first test showed my INR at 3.8. That did not surprise me because I have been reading just how much Amiodarone can effect your INR. So I took zero warfarin Friday night and measured it again this after noon. The result was 2.9. I am now going to test again early next week at my doctors office to make sure there is an acceptable correlation. Once that's done I am done with the doctor tests and waiting for their nurse to call me with a new dosage recommendation. It's easy to do yourself by just logging your warfarin levels and INR level in Excel and using common sense to make the adjustments. The interesting thing is that had I followed the nurses last orders which I got last Tuesday it would have put me way up around 5.0. When you take Amiodarone you need to reduce your warfarin level. What I found on the web is the following:

DAILY AMIODAONE/PCT TO REDUCE WARFININ LEVEL
100/25%
200/30%
300/35%
400/40%
600/45%
800/51%

I am currently taking 800 mg per day of Amiodarone so I have cut my average warfarin level to 2.5 from my old pre surgery level of 5.0 and I think it will work out fine using the home tester.

 

[Philip B]

Comparison INR

Comparison INR

Hi Tom,

Just a thought about your plan to do the comparison thing with the lab your doctor uses...

Don't be surprised if there is some difference in the results between what your machine says and what the lab says. I tried the comparison thing a couple of times before I realized how much the lab results can vary. There seems to be a lot of factors that can impact the lab results. Numerous posts here address the issue of differences. I finally just gave up and started trusting the machine.

I've thought about wasting a test strip by testing someone who isn't on Coumadin. If the test were to indicate an INR in the neighborhood of 1.0, it would confirm the accuracy of the machine. It's easier to simply trust the machine than find a willing test subject for the finger stick thing.

-Philip

 

[catwoman]

I have another question on this topic. I have a new job and after a few phone calls to the new insurance company (United), I'm not sure if the machine will be covered - none of the people I talked to knew what it was! So, I am thinking of setting up my healthcare spending account for $2,000 (the max) to cover the cost of the equipment plus supplies. Is anyone familiar with HSA? Would I have to run it through the insurance company before reimbursement? My fear is that they would end up covering it and I would be out the money in my HSA. I only have 30 days to complete benefits enrollment (actually about 21 now), so don't have time for the insurance company to run it through their process.

Thanks.

Lisa:
If you're talking about United HealthCare, it should be covered, depending on how UHC set up the policy with your new employer. UHC covered my machine in late 2003 at 100%. However, I would be surprised if you find that coverage in 2008.
You're talking to insurance employees who don't have an inkling of anything. Go up the food chain and ask about durable medical equipment for home anticoagulation self-testing. Ask if Raytel, QAS, etc. are in network.
You may have to pay an annual deductible first, then get the INR tester covered @ 70 or 80%.
UHC would not cover my testing supplies. Said that the policy specified ONLY diabetics' testing supplies.

Not sure what an HSA is. I have an FSA (flexible spending account) for reimbursement of medical expenses (Dr./hospital bills, Rxes, eyeglasses, OTC drugs/first aid supplies, INR testing supplies, etc.).Sounds like a HSA is the same as a FSA (flexible spending account).
An FSA -- or the equivalent -- is an ideal way to save on your taxes and yet get reimbursement for medical expenses. I've had one since 2004. I am surprised that many of my co-workers do not, and they complain about our (new) $250 annual deductible and other medical expenses.

I increased my FSA this year to include my deductible and co-pay on a new INR testing machine.

Hope this answers your questions. And, good luck!

 

[Ross]

Hi Tom,

Just a thought about your plan to do the comparison thing with the lab your doctor uses...

Don't be surprised if there is some difference in the results between what your machine says and what the lab says. I tried the comparison thing a couple of times before I realized how much the lab results can vary. There seems to be a lot of factors that can impact the lab results. Numerous posts here address the issue of differences. I finally just gave up and started trusting the machine.

I've thought about wasting a test strip by testing someone who isn't on Coumadin. If the test were to indicate an INR in the neighborhood of 1.0, it would confirm the accuracy of the machine. It's easier to simply trust the machine than find a willing test subject for the finger stick thing.

-Philip

Personally I think everyone should stop trying to check with labs readings. Your machine has the reagents to give you a good result when you test. Labs reagents are different and will always cause a different and sometimes unacceptable reading. If you doubt the accuracy of your meter, test someone NOT on Coumadin and it should be between .9 to 1.2

 

[Karlynn]

Personally I think everyone should stop trying to check with labs readings. Your machine has the reagents to give you a good result when you test. Labs reagents are different and will always cause a different and sometimes unacceptable reading. If you doubt the accuracy of your meter, test someone NOT on Coumadin and it should be between .9 to 1.2

I agree. I really wish doctors would get away from the idea that the lab is the definitive benchmark. If home testing machines were unreliable then the studies that indicate people who home test have fewer incidences and more stable INR's would say the opposite.

 

[Guest]

I have another question on this topic. I have a new job and after a few phone calls to the new insurance company (United), I'm not sure if the machine will be covered - none of the people I talked to knew what it was! So, I am thinking of setting up my healthcare spending account for $2,000 (the max) to cover the cost of the equipment plus supplies. Is anyone familiar with HSA? Would I have to run it through the insurance company before reimbursement? My fear is that they would end up covering it and I would be out the money in my HSA. I only have 30 days to complete benefits enrollment (actually about 21 now), so don't have time for the insurance company to run it through their process.

Thanks.

Lisa, call United and ask for a nurse case manager, similar to who you need to contact for any pre-authorizations or hospital admissions. A nurse reviewed my paperwork and gave the ok. My monitor was covered but each company/government institution has different benefits. My out of pocket was $650 or so. If the provider is out of network, appeal it, appealing saved me $1,000. Of course this was my monitor, and 6 containers of strips.

 

[njean]

The INRatio monitor cost us $1.500. Supplies are $84. for 12 strips.

Blanche

Wow, Blanche! That's pretty cheap! I pay $170 for 12. After I bill the insurance, they reimburse me w/$136.

And I'm in total agreement w/everyone on lab testing! If I had continued w/my lab, I would have probably ended up dead by now! Being able to home test is a real convenience & a life saver!

 

[tobagotwo]

It may be a bit late for this year, but do keep in mind that the machine and its supplies are usable as costs in a medical pretax deduction.

This means you are automatically getting a percentage off equal to the percentage of federal taxes you pay. So if you wind up paying about 28% in income tax, you're effectively getting a 28% discount off the cost, because the money isn't being taxed. Not so much for many retirees, but certainly worthwhile in some way for anyone who pays US income taxes.

I would only accept clinic or lab testing if I had absolutely no other choice.


Best wishes,

 

[Guest]

I usually do not read this forum but a member asked me to look at this thread. I think that if you can operate a computer then you can monitor and dose your own warfarin.

Some of the things that I learned in 10+ years of managing warfarin full time:

It is hard to eat enough salads to maken the INR come down to the point of causing a clot. You can make the INR jump around a little but the INR is not a good predictor of adverse events in the short term.

Few people truly change their diet. They eat a few salads for a few days and the INR decreased slightly. The the warfarin dose is increased and they go back to eating what they like. Then the INR goes up and the warfarin gets reduced (usually too much) and then they get a low INR. If somebody had a slightlky low INR because they were eating more salads, I'd give them one extra pill that day and have them come back in a month. Probably 95% of the time the INR was back in range because they had given up on salads.

The information you posted about about adjusting the warfarin dose according to the amount of amiodarone is accurate.

A few years ago a hospital lab employee neglected to plug in the correct sensitivity level for the test material being used. This resulted in over 900 wrong INRs coming out of that lab. I have forgotten whether it was 3 or 5 people who died as a result of this. I have never seen a report of anyone being killed by self-testing and adjusting their warfarin. It is really the lab test that is the most risky.

Roche also has the CoaguChek-XS approved for home use. (I have been paid by them to consult on several projects. I believe that it is important to disclose my possible conflicts of interest.) You might check the price of this.

Remember that everything is allowed to have a certain amount of tolerance in its accuracy. This means EVERYTHING whether you are talking speedometer, blood clotting or politicians "promises". The last time that I looked, the acceptable tolerance on the INRatio tester was + or - 0.3 INR units. So if you get a 3.8 the actual reading is expected to be somewhere between 3.5 and 4.1. This is why you cannot get too worried about an INR that is slightly out of range.

I now teach 6-hour-long seminars on warfarin management. I have trained about 2,000 health-care professionals including physicians how to manage warfarin.

 

[Karlynn]

Thank you Al! This is why we respect you so much!