BC/BS Health Select of TX & INR machines?

[catwoman]

Anyone here have Blue Cross-Blue Shield Health Select of Texas and have a PT/INR machine? Any problems with the insurance and home-testing supplies?

John (catman) has BC/BS HS of TX through Tarrant County College. He is considered a state employee, since TCC gets state funding (in addition to county $).
He hasn't finished up with pre-op tests -- has an arteriogram 3/15/07 -- but early indications are his MV can be repaired. John has pretty much decided on a mechanical if a repair doesn't pan out.
I have a ProTime 3 machine that I got in late November 2003 and it's working find. But ... if John DOES get a mechanical, he will push to get a machine through insurance (20% co-pay).

 

[dick0236]

I see from your signature that your husband is only 61 and not on Medicare so my answer might not apply to your situation. BCBS througout the US have some connection with each other and generally follow the same "play book". My medicare carrier is Anthem BC servicing KY. I submitted an Rx thru my PCP in early Feb., 2007. They approved home testin for six months with reevaluation of need at that time. I am supposed to receive the machine/supplies tomorrow, 3/1/07. I took about 3 weeks, start to finish, to get approval and machine. I understand that my "out of pocket cost" will be about $32/mo (20%). Anthem BC (Mecicare Advantage) will pay balance. About 6 years ago, Medicare approved and endorsed home testing for MV patients. I think any carrier would have a difficult time denying such service. They may try, but I always like a good fight. I sold/serviced group health insurance for 25 years. If you have your i's dotted and t's crossed insurance companies are not hard to deal with.

 

[LUVMyBirman]

No luck with my IL BCBS. They do cover home testing units for individuals with mecahical heart valves :clause: INR results must be within range for 3 months consistantly. I was on a roller coaster ride because of a medication that was not avaiable. INR was slighty out of range. Never mind I have been taking Coumadin for 8 years and home testing for 7. Denied.

Hope you have better luck with your BC!

 

[catwoman]

Yes, I knew about Medicare covering testing.
Several things I've gathered about Medicare & INR testing:
1. You MUST test weekly under Medicare -- not every 10 days, every 2 weeks.
2. I believe you MUST report your results to whoever (Raytel or other vendor). (Too much hand-holding for me.)
3. You don't own the testing machine. It goes back to vendor at your death.

Gina:
I've seen you post about the Catch 22 on getting BCBS ILL to cover INR machines. I've never understood why you must be IN RANGE during a 3-month period. Do fire alarms go off if you're 3.6 instead of at 3.5?
What if your PCP isn't upset at being a little over range?
It's obvious that, for the most part, insurance folks are imbeciles about anticoagulation management.