mdINR service

[balloonshark]

Hi everyone! Before I went to my doctor's appt. last month I called medicare and they said that everything was covered for home INR testing because I have an artificial heart valve. Last month at my doctor visit I inquired about getting a home INR monitor. Last week I get a phone call from mdINR who said my doctor contacted them. They said that I would need to test once a week and that it would be a 80/20 copay through medicare and then they said it would be $26 per month. I'm not sure if that was the copay or an additional cost. They also said that if my bills were more than my income everything would be free. All I needed to do was sign a paper. So with that said I have a few questions please.

1. Do I have to test once a week when I normally would only get my INR checked once a month? I've been very lucky as my INR stays fairly level and has been that way for 25 years.

2. Do I have to use this mdINR service? It seems all they do is call the Dr. with my results. I did a little research and found out they are owned by Lincare and we do have a Lincare in town.

3. What are the costs involved if I have medicare and medicaid?

That's all the questions I can think of at the moment. If you can guide me in what to do or reassure me about mdINR I would appreciate it. I would rather keep the costs minimal so I don't waste medicare dollars.

Thanks,
shark

 

[dick0236]

Hi Shark. I am on a medicare "Advantage" plan, but not medicaid and I did self-test for about one+ years. The machine I had was on a "no-cost" lease from QAS, another company in the home testing business. I did pay 20% per test(about $7), but tested only every two weeks. Other companies do require weekly testing, but that is a company, not medicare policy. After my short time with home testing, I went back to my PCP office since I had a lot of problem with the QAS billing system. I would go back to home testing if I could buy the monitor/supplies outright with 80/20 medicare coverage, but so far, I do not think Medicare will do this. I also wonder about the future of self-testing, since the majority of warfarin users are non-valve patients and the newer ACT drugs(Plavix, etc) do not require testing. Once the market dries up, I wonder if the home testing for valve patients will survive...... at a reasonable cost.

 

[catwoman]

I am not on Medicare -- yet -- but I think the rules state that Medicare will cover NO MORE THAN 1 test per week, so my guess is that the vendors interpret that to mean you're going to test once weekly.

One question: If Medicare covers no more than one test per week, what happens if you have a testing error or have to test more frequently temporarily when starting/stopping meds or prior to a colonoscopy? I had to get my INR down to 2.5 before my colonoscopy 2 years ago, so I had one more test than normal that week. Had to test first to determine what it was, then calculate how much to adjust dosage to get down to 2.5. Tested night before the procedure and I was right on the nose at 2.5.

 

[catwoman]

I'm 4 years away from Medicare, so I don't have personal experience with it. I do know that Medicare's rules stipulate that it covers NO MORE THAN one test per week, so my guess is that vendors state that you're going to test once weekly, regardless of the type of mechanical valve. I would ask why you would need to test weekly if you've been going in for tests on a monthly schedule.

You're an AVer and have been testing once monthly. Unless there is an overriding reason for switching to, you could certainly continue as is.

I've been home-testing since November 2003 and would been extremely miffed to have to go to a lab or Dr's office for testing now. Guess I'm too set in my ways! Having my own tester has allowed me to stay on top of INR changes due to weather (this summer has been interesting, to say the least :thumbd and when I've had to get my INR down to 2.5 before a colonoscopy while still on warfarin. That required one extra test that week -- one to determine how much to adjust my dosage to get it down to the agreed-upon 2.5 and a 2nd one the night before the procedure.
How would only weekly testing per Medicare's rules allow for an occasional extra test for situations like this?
That's one question for you to ask.

 

[dick0236]

How would only weekly testing per Medicare's rules allow for an occasional extra test for situations like this?
That's one question for you to ask.

I had this happen a few times and messsed up a few tests as well, causing extra use of the strips QAS sent to me. I just didn't call the extra test in to QAS. They billed for every four tests regardless of the time between tests. They had no idea how many strips they had sent me. When I quit the service, I sent back almost a years supply of strips, because every couple months they would send more strips even tho I had not requested them.

 

[catwoman]

Dick:

What a headache!
Did they take the strips back? (I'll bet they tossed them.)

 

[balloonshark]

Hi Shark. I am on a medicare "Advantage" plan, but not medicaid and I did self-test for about one+ years. The machine I had was on a "no-cost" lease from QAS, another company in the home testing business. I did pay 20% per test(about $7), but tested only every two weeks. Other companies do require weekly testing, but that is a company, not medicare policy. After my short time with home testing, I went back to my PCP office since I had a lot of problem with the QAS billing system. I would go back to home testing if I could buy the monitor/supplies outright with 80/20 medicare coverage, but so far, I do not think Medicare will do this.

Hi Dick. Sorry to hear you had to quit home testing because of billing problems. I'm surprised to hear that the tests cost so much at $7 each. Was this to cover the test strip and the leasing of the machine? I also wish I could buy the machine outright and eliminate the middle man. I guess I have a lot of questions to ask and there is already a nurse calling my house wanting to come over and train me on how to use the machine. I find this odd because I have no idea what this is going to cost me or medicare.

P.S. That is a beautiful turtle you are holding .

I'm 4 years away from Medicare, so I don't have personal experience with it. I do know that Medicare's rules stipulate that it covers NO MORE THAN one test per week, so my guess is that vendors state that you're going to test once weekly, regardless of the type of mechanical valve. I would ask why you would need to test weekly if you've been going in for tests on a monthly schedule.

You're an AVer and have been testing once monthly. Unless there is an overriding reason for switching to, you could certainly continue as is.

I've been home-testing since November 2003 and would been extremely miffed to have to go to a lab or Dr's office for testing now. Guess I'm too set in my ways! Having my own tester has allowed me to stay on top of INR changes due to weather (this summer has been interesting, to say the least :thumbd and when I've had to get my INR down to 2.5 before a colonoscopy while still on warfarin. That required one extra test that week -- one to determine how much to adjust my dosage to get it down to the agreed-upon 2.5 and a 2nd one the night before the procedure.
How would only weekly testing per Medicare's rules allow for an occasional extra test for situations like this?
That's one question for you to ask.

Greetings catwoman. You are correct about medicare only covering one test per week. I will ask about testing less often and about what happens when the test doesn't work correctly. Both are excellent questions. Especially the one about messing up tests as this seems to happen a lot at my doctors office.

 

[catwoman]

Greetings catwoman. You are correct about medicare only covering one test per week. I will ask about testing less often and about what happens when the test doesn't work correctly. Both are excellent questions. Especially the one about messing up tests as this seems to happen a lot at my doctors office.

Shark:
I haven't had INRatio monitor problems with testing. It's been human error problems -- not getting enough blood for a sample once or twice. The INRatio is pretty much the same as the CoaguChek per testing procedures, more so than when I had my ProTime 3. I got a lot of bubble errors with the ProTime -- would hold my breath many times when I ran a test. Have never gotten a similar error message with the INRatio. I'm sure it's because of the difference in acquiring & applying the sample to the testing strip.
I have learned to get a REALLY BIG drop (no doubt TOO big) of blood for the INRatio test strip; if you get too small, you get an error or you don't get it completely in the well that draws the blood into the strip so you put another drop of blood on it and it co-mingles with the drop that is now coagulating and so your results are skewed. Been there, done that once or twice. Have learned to analyze my posture, whether I'm standing or sitting, what level the monitor is at, etc. I'm more apt to have problems doing it on my kitchen counter than on my bathroom vanity counter.
Then I don't skew test results and waste strips.
I'm not sure which route I'll go when I qualify for Medicare...

 

[dick0236]

Hi Dick. Sorry to hear you had to quit home testing because of billing problems. I'm surprised to hear that the tests cost so much at $7 each. Was this to cover the test strip and the leasing of the machine? .

The $7 was my 20% share. QAS also got about $28/test from my Medicare provider, for a total of $35/test. Now that I have gone back to my PCP office, he gets $71.98/test(allowable amount) and I pay Zero(0). That makes ABSOLUTELY NO SENSE:confused2::eek2::frown2:.

 

[balloonshark]

Shark:
I haven't had INRatio monitor problems with testing. It's been human error problems -- not getting enough blood for a sample once or twice. The INRatio is pretty much the same as the CoaguChek per testing procedures, more so than when I had my ProTime 3. I got a lot of bubble errors with the ProTime -- would hold my breath many times when I ran a test. Have never gotten a similar error message with the INRatio. I'm sure it's because of the difference in acquiring & applying the sample to the testing strip.
I have learned to get a REALLY BIG drop (no doubt TOO big) of blood for the INRatio test strip; if you get too small, you get an error or you don't get it completely in the well that draws the blood into the strip so you put another drop of blood on it and it co-mingles with the drop that is now coagulating and so your results are skewed. Been there, done that once or twice. Have learned to analyze my posture, whether I'm standing or sitting, what level the monitor is at, etc. I'm more apt to have problems doing it on my kitchen counter than on my bathroom vanity counter.
Then I don't skew test results and waste strips.
I'm not sure which route I'll go when I qualify for Medicare...

Good to hear that your newer machine works better than the old. Also, thanks for the tips on preventing errors. I will definitely try to find a place where I'm comfortable working with the machine for consistent results. I need to do the same thing when I solder as I tend to get nervous which causes my hands to shake. I'll find a way to make the process easier by creating a way to rest my hands on the table. I'm very glad you mentioned this .

The $7 was my 20% share. QAS also got about $28/test from my Medicare provider, for a total of $35/test. Now that I have gone back to my PCP office, he gets $71.98/test(allowable amount) and I pay Zero(0). That makes ABSOLUTELY NO SENSE:confused2::eek2::frown2:.

Thank you! I really need to ask about the costs involved after hearing about your costs. The last thing I need is a giant bill that I can't afford. I also agree about the home test costs versus the doctors cost making no sense. This is part of the reason our deficit is so large. A little common sense would go a long way in turning this country around.

 

[Protimenow]

Marsha -- thanks for the tip about the bathroom vanity - I'll give it a try. I, too, used the ProTime and the ProTime 3 -- I'm using my InRatio now and appreciate it much more. Strangely, although I don't use glasses for much else, I've found it somehow easier to get that drop of blood onto the InRatio strip when I have a bit of magnification for both eyes than when I'm guessing that I'm in the neighborhood. (I also have the capillary tubes, but haven't tried them).

At about $7 a strip, this sounds just a bit higher than you could get the strips for (I can't recommend eBay, because I am not sure if Forum rules allow recommendations from suppliers they won't authorize, so I won't make such a recommendation). If you had your own meter, and had to buy your strips, you may wind up paying about $7.

I test weekly - not that I necessarily have to -- in the past, I've gone much longer between tests. If I didn't have a good supply of strips, and my INR was very stable, I'd go two or more weeks between testing and save my strips. It certainly doesn't hurt to test weekly -- you may be able to detect fluctuations that you would miss if you test less frequently. As log as you don't get too compulsive about little changes in INR from test to test, you should be okay.

I agree with Dick -- encouraging the greed of a Medicare provider - who charges for the test and for the interpretation of the results and a consultation -- for what many of us are doing on our own -- makes no sense. Sure, the doctors have high overheads, etc., but $71.98 for a test that may cost him just a few bucks - and is probably done by an assistant anyway - doesn't sound like a particularly good use of medicare funds.

 

[balloonshark]

I test weekly - not that I necessarily have to -- in the past, I've gone much longer between tests. If I didn't have a good supply of strips, and my INR was very stable, I'd go two or more weeks between testing and save my strips. It certainly doesn't hurt to test weekly -- you may be able to detect fluctuations that you would miss if you test less frequently. As log as you don't get too compulsive about little changes in INR from test to test, you should be okay.

The only problem I have with testing weekly is I'm afraid that I will start chasing my level. I'm used to eating what I want and doing what I want and the level seems to stay the same. If I test more often I'm sure my habits will change and I don't like change . I'll also have sore fingers lol.

To all: I was able to find out a little more information today. I called billing and it looks like everything will be covered if I fill out a financial hardship form because I qualify for medicaid based on my income. This is a service in which they provide everything. I can stop the service anytime but I won't own the machine which I'm not happy about. I do have to test weekly and they should supply extra strips for screw ups.

I wish there was another way to do this so I could own the machine. I wouldn't mind paying part of the cost of the machine. The only plus I can see with the service is that if something happens to the machine it's on them (I think). Now I have another question to ask mdINR lol.

 

[Protimenow]

If you test weekly, and stay consistent with diet, activity and dosage, you shouldn't have to 'chase' your level. If you don't overreact to minor blips in your INR by changing dosages, you should be okay on weekly testing.

As for myself, I've been testing weekly for the past 9 or 10 months -- I had a lot of strips (including some 'expired' InRatio strips that are supposed to be good for up to a year after they expire) -- and testing is easy. I own my meter (which I bought on eBay).

With my stock of strips declining, I'm going to move to testing every other week (for the forseeable future) unless one of the tests appears to be way out of range - - THEN I'll probably make slight changes in dosing and test more frequently until I'm back in range.

Getting a machine on loan from Medicaid sounds like a good option. As long as you have your own meter (even if it's only on loan), and a supply of strips, it shouldn't matter who has the pink slip on the meter. (The prices for meters in eBay seem to have gone up in the last few months -- but they'll probably swing in the other direction before too long -- just don't get a CoaguChek other than the XS, or an InRatio, or a ProTime meter - the CoaguChek S and earlier meters are discontinued and you'll probably be unable to get strips for them).

 

[lance]

The only problem I have with testing weekly is I'm afraid that I will start chasing my level. I'm used to eating what I want and doing what I want and the level seems to stay the same. If I test more often I'm sure my habits will change and I don't like change . I'll also have sore fingers lol.

To all: I was able to find out a little more information today. I called billing and it looks like everything will be covered if I fill out a financial hardship form because I qualify for medicaid based on my income. This is a service in which they provide everything. I can stop the service anytime but I won't own the machine which I'm not happy about. I do have to test weekly and they should supply extra strips for screw ups.

I wish there was another way to do this so I could own the machine. I wouldn't mind paying part of the cost of the machine. The only plus I can see with the service is that if something happens to the machine it's on them (I think). Now I have another question to ask mdINR lol.

Good morning Shark.
Testing weekly shouldn't cause you to chase your level. Most changes in INR levels don't require a change in dose unless they are at the top or bottom of your range. I find it valuable to know which way my INR is trending up or down at such times.
Just because you know what your INR is on a weekly basis doesn't cause a change in habits or anything--you just have the information.
AND
I use the largest gauge lancette set to the deepest level and haven't experienced sore fingers in years. Just change fiingers for every test.
My monitor was bought outright and I pay for everything so I can't comment on your costs or insurance. Things are different in our two countries in this respect.
Happy testing.

 

[balloonshark]

If you test weekly, and stay consistent with diet, activity and dosage, you shouldn't have to 'chase' your level. If you don't overreact to minor blips in your INR by changing dosages, you should be okay on weekly testing.

My diet used to be fairly consistent but lately I've been eating more often with a family member which likes fast food. Your advice about overreacting to minor blips is good advice that I'll follow.

Good morning Shark.
Testing weekly shouldn't cause you to chase your level. Most changes in INR levels don't require a change in dose unless they are at the top or bottom of your range. I find it valuable to know which way my INR is trending up or down at such times.
Just because you know what your INR is on a weekly basis doesn't cause a change in habits or anything--you just have the information.
AND
I use the largest gauge lancette set to the deepest level and haven't experienced sore fingers in years. Just change fiingers for every test.
My monitor was bought outright and I pay for everything so I can't comment on your costs or insurance. Things are different in our two countries in this respect.
Happy testing.

Greetings Lance. It's good to hear from a couple people that small changes won't cause the doc to change my dose. In the past it seemed like any change the doc made resulted in a huge change in my INR level.

Cheers

 

[Protimenow]

It depends on the doc. Not all doctors or clinics are as careful with INR management as some of us, armed with good research and dosage charts, whose lives are actually on the line. (For example, in another thread, a doctor changed a dosage for TWO DAYS, and ordered a retest in THREE WEEKS. Sometimes we just have to listen to our doctors/clinics, but verify that the advice we get is good advice if something doesn't sound right.)

 

[dick0236]

It's good to hear from a couple people that small changes won't cause the doc to change my dose. In the past it seemed like any change the doc made resulted in a huge change in my INR level.
Cheers

Small changes, or no change at all, is the only way to manage INR, 97% of the time. It seems that in the last twenty years, since the "finger stick" became the test of choice, I have had a lot of trouble with younger doctors trying to overmanage my INR and keeping me on the "yo-yo". My experience is that INR clinics make better managers than most PCPs, or cardios. You will usually, but not always, be monitored by a nurse that does it all day long and has a much better feel for INR than almost all doctors. If you let your PCP manage your INR, and I currently do, you need to show an interest, and knowledge, of the need for maintaing an "in range" INR. Keep a good computer log, with notes, and share it to your doc periodically. Remember, most of the patients your PCP sees are Afib and/or elderly who have LITTLE OR NO clue about warfarin management. It is imperative, in my opinion, that my PCP and I are equally involved in my INR.

Due to our ever changing medical system, I have had to change PCP, or Cardio, or INR lab a dozen+ times in the past ten years. Most of the changes are due to ever changing "networks" or docs moving into, or out of, offices....but there have been three or four changes 'cause a doc took the "my way or the highway" attitude with me. Fortunately, I have one now that usually askes me "what should we do".....and I usually tell him the "we will leave it alone 'till the next test"......or "lets cut 1/2 dose and recheck in a couple weeks"........it also helps that I have been on the stuff two or three times longer than they have been MDs

 

[Protimenow]

If you're self-testing, keeping a record of INRs (and possibly prothrombin times), dosing, time and date of test, meter used for test (maybe not as important, but I keep this info), and comments is important -- especially for convincing a reluctant MD that you've got a good handle on your testing. In my case, I've been managing my dosing from the time of my first self-test, but it may also be useful for you to indicate WHO prescribes any dosage changes, so you can detect the source of any major spikes or drops.

I keep my records on a simple spreadsheet I developed. There are apps (I learned about something called MyINR, but I haven't checked into it) that can also keep this information. There are also sheets you can print out that will store this information. It's easy to track this stuff, and I strongly recommend doing so. (In my case, I started taking a pill a couple days ago that I think DROPPED my INR to 1.1 -- I'm making changes, but in my comments, I put a warning about that pill and what I think is the component that contained the high doses of K -- it'll be good info for the next time I think about taking something like it).

 

[balloonshark]

What you both said makes complete sense to me. My Dr. has been pretty lenient so I have faith he will work with me if my number is out of whack. I think testing more often will be better for the both of us now that I have read everyone's comments.

I'm also going to look for a chart to print so I can keep track of the date, my levels, what I ate the night before, etc. I normally would tell the nurse this info but now I will write it down so I can have a record. That sounds like a great idea since I will be testing more often.

The nurse from mdINR/lincare was here today to train me which took about 30 min. The machine she brought was the CoaguChek XS. After I test I have to call an automated toll free number, enter my PIN number and then my results. I can also order new supplies through that number as well. I was told to order new supplies when I have one strip left.

 

[Protimenow]

If you have a copy of Microsoft Office, you can create a simple spreadsheet in Excel. If not, you can download a chart from Alere or elsewhere. I think there's also a free program someone told me about called MyInr.

It should be fairly easy to find and set up something that will let you keep track of INR and other data.