Remote INR taking over Coaguchek

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I've been self-testing since April 2009. I've gone through a handful of meters - Protime Classic, Protime 3, Hemosense (a piece of crap that was discontinued because of inaccurate tests -- relying on it gave me a stroke), CoaguChek S (discontinued), CoaguChek XS, Coag-Sense 1 and, now, Coag-Sense 2.

With one exception, I bought my meters on eBay - and, with the exception of a CoaguChek Pro, all worked as they were supposed to.

I've had no problem with bad strips (although I was careful to avoid the recalled CoaguChek XS strips), I didn't need a signed prescription to get a meter on eBay.

I self-manage -- I've found that, often, the dosing 'experts' don't know what they're doing. They use a dosing table, or they guess at any changes (after all, they're the experts). It's my own miserable life, and I'd rather take control of my own dosing.

This forum is a good resource for charts and accurate information about Warfarin management. Pellicle is an international treasure - he can give good dosing advice.

Now -- as far as meters go.

First - Scribe - the ProTime and Hemochron machines also calculated physical clotting.

Second - meters on eBay aren't always the overused, inaccurate meters that some may think they're buying -- some may be poor dead old grandpa's meter that he no longer needs and that Medicare already paid for. A few may come from hospitals or clinics that had to get rid of them for tax reasons. Some may be gray market. All are probably good.

Unlike consumer electronics, these are medical devices, and the manufacturers can't afford to ship products that may stop working, or become inaccurate. The meter manufacturers don't know whether their meters will be going to self-testers who run, maybe, 50 or 60 tests a years, or to clinics that may run the same amount in a day - 6 days a week. In either case, the meter must retain accuracy, and must always work.

Similarly, strips have to report values within range - if not, they'll be recalled and cause some embarrassment, not to mention liability, because of the defective strips. Bad strips are quickly removed from the market (unless, for some reason, they make their way into a gray market that just doesn't give a damn).

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I bought my CoaguChek XS 7 or 8 years ago for, if I recall correctly, about $50. If you keep an eye on eBay, you'll probably find one for below $200. The Coag-Sense was fairly inexpensive -- I've seen the original model for around $50 or so.

If you look around - and maybe wait - you'll probably find strips at a good price. One tip -- the per strip cost will probably be much lower for 24 or 48 CoaguChek XS strips than buying them 6 or 12 at a time.

I've seen Coag-Sense strips for as little as $2 or $3 a strip - still fresh, still unexpired.

---

With all that said, when I first got my Coag-Sense, I did a lot of testing, comparing all meters, and found that the Coag-Sense and CoaguChek XS were usually within .2 of each other - and the lab results were often the average of the two.

The last year or so, I've had an issue with the Coag-Sense meter that, apparently, nobody else has reported: my results are lower than lab, and lower than the CoaguChek XS. Above 2.5 or so, the difference may be as high as 1.0. I've had the same result with different batches of strips, and on different Coag-Sense meters. Scribe and others have reported very good correlations with lab results.

Perhaps there's something in my blood, or some factor, that the Coag-Sense just doesn't work well with. I'm now also using the CoaguChek XS in parallel with the Coag-Sense. I'm also doing lab testing every month or two (my HMO DEMANDS this).

Coag-Sense doesn't seem to care anymore -- I've contacted them a few times and, according to one of their techs 'if your INR is consistently 1.0 below the labs, then you know what your INR really is.' This is kind of like saying that 'if your clock is always ten minutes slow, just add ten minutes, and you know the correct time.'

The Coag-Sense should work well for most people. I used to be a strong supporter of the meter. BUT the reach of Roche is broad - International. There are millions of units in use globally. Strips will be available for many years. Roche has even come out with new meters that still use the XS strips. FWIW - although I often root for the underdog, perhaps the leader would be a better choice for most people.
 
FWIW - I have a Coag-Sense that is barely used (I got it used, but it had low mileage when I got it), for sale - inexpensively - if anyone wants it.

(I can use the money, and don't need a third Coag-Sense meter)
 
No bills (or EOBs) for me yet either.

Honestly I feel that Biotel Heart has no idea what they are actually doing and most likely will be going under at some point.
 
I've maligned the Coag-Sense meters as registering below the labs - and the CoaguChek XS for values above 2.5 or so.

Here's a new wrinkle:

I tested on Sunday - four days ago (the date doesn't really matter, does it?) and got a 3.5 from the Coag-Sense and a 4.1 from the CoaguChek XS.

In either case, I figured that INR was probably a bit high, and prepared to slightly reduce the dose by 0.5 mg.

Later that day - a few hours after home testing - I went in to the hospital with arrhythmias and shortness of breath. (I'm home and still have both). The hospital lab took an INR as soon as I got to E.R. - and the INR was 3.6 -- .1 higher than the Coag-Sense and .5 lower than the CoaguChek XS.

So, I'm still in a bit of a quandary: which is closest to the labs, or do the labs vary by more than a few tenths of a point or, perhaps, is the XS more accurate below, say, 3.0 and the Coag-Sense is more accurate above 3.0.

Ultimately, it may be a case of how much it really matters. An INR above around 2.5 on either meter puts you in range. An INR above 3.0 or so on the Coag-Sense may be around 4.0 on the XS -- still pretty close to range, and even a 4.0 isn't going to be life threatening.

As far as Coag-Sense strip costs, I still see them on eBay for around $2 each. (I don't know if they come with transfer tubes, so be careful when buying them - the transfer tubes are also available on eBay or the manufacturer and, most likely, from Wilburn Medical).
 
I bought a XS machine on eBay, haven't gotten yet. I go to my cardio for INR checks every two weeks and they use the same machine. Should I do a real lab every once in a while. I have a OnX valve and try to stay between 2-3.

Scot
 
I bought a XS machine on eBay, haven't gotten yet. I go to my cardio for INR checks every two weeks and they use the same machine. Should I do a real lab every once in a while. I have a OnX valve and try to stay between 2-3.

Scot
I posted this somewhere else already. I had 2 occasions to double check coagucheck when my test hit 2.0. (should be 2.5 to 3.5.). Hospital check same day showed 2.1 and another time 2.0. I feel secure in my coagucheck readings.
 
I went a LONG time without running lab readings to compare to the meter.

Labs are also, sometimes, not accurate, either.

My CoaguChek XS seems to be pretty close to the lab results - but my Coag-Sense seemed to be lower. On Sunday, in the hospital, the results were the other way around - the hospital got a 3.6, my Coag-Sense said 3.5, and the CoaguChek XS said 4.1. (FWIW - the CoaguChek XS is known to shoot a bit high as the INR increases).
 
I've maligned the Coag-Sense meters as registering below the labs - and the CoaguChek XS for values above 2.5 or so.

Here's a new wrinkle:

I tested on Sunday - four days ago (the date doesn't really matter, does it?) and got a 3.5 from the Coag-Sense and a 4.1 from the CoaguChek XS.

In either case, I figured that INR was probably a bit high, and prepared to slightly reduce the dose by 0.5 mg.

Later that day - a few hours after home testing - I went in to the hospital with arrhythmias and shortness of breath. (I'm home and still have both). The hospital lab took an INR as soon as I got to E.R. - and the INR was 3.6 -- .1 higher than the Coag-Sense and .5 lower than the CoaguChek XS.

So, I'm still in a bit of a quandary: which is closest to the labs, or do the labs vary by more than a few tenths of a point or, perhaps, is the XS more accurate below, say, 3.0 and the Coag-Sense is more accurate above 3.0.

Ultimately, it may be a case of how much it really matters. An INR above around 2.5 on either meter puts you in range. An INR above 3.0 or so on the Coag-Sense may be around 4.0 on the XS -- still pretty close to range, and even a 4.0 isn't going to be life threatening.

As far as Coag-Sense strip costs, I still see them on eBay for around $2 each. (I don't know if they come with transfer tubes, so be careful when buying them - the transfer tubes are also available on eBay or the manufacturer and, most likely, from Wilburn Medical).
Thank you for sharing that information. I got my CoaguCheck XS about 6 months ago. I don't know how reliable and accurate it is but one thing that I've learned is that we know our own bodies and in my case since I have Varicose veins, every time my veins pop out in my legs (specially the right leg) it's a sing for me that the INR is too high. I have to maintain 2.5-3.5 due to my valve replacements 10 years ago. I have learned that you don't want to have internal bleeding like I did and end up in the hospital. That last hospitalization really did a number on me. So look for signs in your body that can hint you whether you are on the high or low side.
 
Thank you for sharing that information. I got my CoaguCheck XS about 6 months ago. I don't know how reliable and accurate it is but one thing that I've learned is that we know our own bodies and in my case since I have Varicose veins, every time my veins pop out in my legs (specially the right leg) it's a sing for me that the INR is too high. I have to maintain 2.5-3.5 due to my valve replacements 10 years ago. I have learned that you don't want to have internal bleeding like I did and end up in the hospital. That last hospitalization really did a number on me. So look for signs in your body that can hint you whether you are on the high or low side.
Yours truly, Cyrus.
 
DachsieMom,
Roche is still the manufacturer of all CoaguChek machines.
It sounds as though you may be dealing with a 3rd party anticoagulation management vendor.
Have you contacted your insurance company to find out what business they are paying? An EOB for your insurance may give you some info if you check paid claims.

I have a CoaguChek that I bought new on eBay in 2014. I also buy my strips on eBay. I test every 7-10 days. Have been on warfarin since June 2003. Got my first INR monitor on Nov. 26, 2003. I have never had to report INRs to a 3rd party.
Where did you get your machine? And strips? And how do you report results? Please advise. The new year is starting and are faced with deductibles and so on and absolutely no way can afford more than what paying out of pocket now.
 
Man, this is ridiculous. I have yet to receive a bill from Biotel Heart going on like 7 MONTHS now since my last bill from Roche (when Biotel took over). I called them yet AGAIN about 2 weeks ago & was given the exact same B.S. answers which prove they haven't the slightest idea what is going on.

I've stressed in my phone calls that I need to know what they are going to be charging me and cannot just assume that I will be able to afford it but they will only say that "we don't see a bill for you in the system" and with one of the reps when I told them that I am hearing people are being charged like 5-7 times more than from Roche all she would say is that "yes it will be higher" but unable to tell me how much. I've never had so much trouble finding out a medical coverage cost in all of my life but this is much worse since they are going to back bill me potentially thousands of $$ which I cannot, do not want to, and WILL NOT pay.

Is anyone else is in this same situation with them? Who can we turn to for help when the bills come and they are shockingly high? Do I need to make them send me something in writing that I will not be liable for paying any more than I was paying Roche since they refuse or are unable to tell me what the charges are despite my asking multiple times? There has got to be some kind of legal protection regarding this - oh wait, I almost forgot, this is our great American healthcare system which puts the profits of the insurance companies, medical providers, and drug companies above that of the actual patients' needs or financial concerns.....
 
I have yet to receive a bill from Biotel Heart going on like 7 MONTHS now since my last bill from Roche (when Biotel took over).
My wife also has not received a bill since June 2020. Still not worried about it or calling them looking for it either.

I've stressed in my phone calls that I need to know what they are going to be charging me
As it appears you are going through your insurance company, call them and ask what your co-pay/out-of-pocket cost is for this service. They should have a negotiated rate for this service.

As previously mentioned in this post, you can always bypass the middleman and get your supplies else where (e.g. eBay, Wilburn Medical, etc).
 
I have yet to receive a bill from Biotel Heart going on like 7 MONTHS now since my last bill from Roche (when Biotel took over).

No need to worry about it as long as you can still get supplies shipped. They'll catch up billing eventually.

Biotel acquired the service from Roche effective 6/23/2020. Billing and A/R processes are difficult to convert. I worked in Finance and Financial Systems IT for 3.5 decades. We did a lot of acquisitions. Whether it be the financial business processes or the IT system conversions, it is not unusual for it to take a year or more to move billing/AR. In cases where only a portion of a company is acquired it is even more complicated. Often the selling company will continue to provide some of these back-end processes for a fee paid by the acquiring company until they get everything moved over. Doesn't look like that happened in this case. BioTel is less than 1% the size of Roche. Although they acquired just a small slice of Roche, they probably were not prepared for the complexity of converting the patients, billing, etc. from such a large company.

I assume you have insurance. The insurance contract between Roche and and your insurer will determine the price of the service. The coverage on your plan with your insurer will determine what portion they pay and you pay.

In my case, I signed up for the service last spring. The first shipment of strips was sent on 6/22 (1 day before the acquisition). My second shipment arrived in August.

The first invoice arrived from Roche in early July. I did not pay it because they charged me full price saying I was not covered by insurance. I contacted Roche to confirm they had the correct insurance info. A second invoice arrived in September (again for the 6/22 shipment). Same situation. I then contacted both Health Advocate and my insurer and they got Roche straightened out.

Soon after, the insurance claim for the first (6/22) shipment appeared with Roche as the Provider. The pre insurance discount price was $250 the after insurance discounted price was $113 (as expected based on estimates when I signed up), Still waiting for a corrected invoice from Roche.

In October the claim for the second shipment appeared and listed BioTel as the Provider. The pre insurance discount price was $880. The after insurance discounted price was $113. I owed the full $113 since I was well below my deductible. Insurance pays nothing in that situation. Late last year, I received the $113 invoice from BioTel.

The $880 is irrelevant. It simply reflects that BioTel has a higher "Chargemaster" price than Roche. The only thing that matters is what the patient owes based on the terms of the provider/insurer contract and your coverage. The acquisition and the higher Chargemaster price does not change that.

My assumption is that BioTel acquired the outstanding receivables for the Roche INR service as of 6/23 and A/R has not been converted yet. So until A/R is converted, they don't have the info needed to bill for shipments that were prior to acquisition. Maybe I'll get lucky and it falls through the cracks, but I doubt it. Your situation may be different.

By the way, if your insurer has Health Advocate I highly recommend you contact them if you are still concerned about this billing situation. They will probably be able to reach out to all the relevant entities and get an answer. My last 5 working years was at the company that owns Health Advocate. I never worked any Health Advocate projects, but did work closely with the development team that supported some call center applications used by Health Advocate agents. It's a good service if you have access to it.
 
I finally received a bill from Bio Tel. It is incorrect because they claim they did not have my supplemental insurance information. We are hopefully correcting this and they will correct my bill. I am waiting to see if It irons out now that they have all my insurance information.
 
I went through something like a 3 month ordeal with Allere when first tried to get a home unit as recommended by cardiologist at the time right after my surgery. Was a black hole of misinformation and coverage confusion insanity that took that long to figure out what was going on. Way too much to try to explain now. Then another 1-3 months to find a different company that would take my insurance, one that I had to discontinue because their billing system was such a total mess it was impossible to work with and never matched my EOBs. Thankfully Roche worked out pretty smoothly. I am concerned that Biotel will be live Allere & company #2 though. I don't have any faith in BC/BS in figuring any of this out & being my "advocate" at this point though. I went through something with them just last year that was a complete mess where they did not know what they were doing and gave me multiple wrong answers. I just do not have the time to deal with this crap anymore (was different when I was recovering from open heart surgery, as difficult as that was at least I didn't have to work 12/15 hour days on top of trying to straighten this stuff out).

Anyways, thx for the comments. At this point I give up. Will just wait & see what happens. Most likely I will kick the bucket by the time Biotel sends me a bill and therefore problem solved! Oh & I will probably lose my insurance soon anyways since I cannot take this current switch to nightshift that I am struggling with the past month, it is just too hard.
 
Others have already said this, and I've probably said it on this thread, but if you're self-testing anyway, why not try and convince your doctor to let you get your own meter and strips, and if they don't trust you to manage your dosing, let you call the results in to the doctor? It'll be a lot cheaper for you - and the insurance carrier.

My HMO demanded that I go to their clinic. I went there once. I convinced the pharmacist who thought he was the God of Anticoagulation Management that I was able to self test and self manage. I also point out to him, the one time he saw me that his dosing advice was INCORRECT - he didn't ask why I was on anticoagulants before giving me dosing advice.

I placate this 'expert' by getting a monthly (or less frequent) blood draw.
(I'm overdue for another blood draw - maybe this week?).

Self-test if you can. You may save money, avoid the hassle of greedy, incompetent providers and insurance companies, and give you the feeling that you've got more control of your anticoagulant management.
 
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(I'm overdue for another blood draw - maybe this week?).
pah ... or next week

Self-test if you can. You may save money, avoid the hassle of greedy, incompetent providers and insurance companies, and give you the feeling that you've got more control of your anticoagulant management.

and not just a feeling. If you document and review then actual experiential learning :)
 
Here's a couple weird things lately regarding "Biotel Heart" who took over my monitoring from Roche.

(1) I finally got an EOB from my insurance for my year 2020 Biotel charges about a month ago. However I still have not received a bill from Biotel for my portion.

(2) Calling in a test result last night Biotel's answering message system has changed. They no longer mention Biotel etc. They now call themselves "Philips" (or Phillips?). I assume they have been bought out/merged (??). Have no idea. My impressions of them as mentioned earlier in the thread were not great at all (unable to call in my INR for weeks after they took over because of problems with their system, not getting billed for 10 months, them not being able to answer anything when I asked when I would be billed or how much multiple times etc). Maybe Philips will or is getting their act together (?). Who is Philips anyway??
 
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