Coaguchek XS is not a glucose meter

[tommy]

Has anyone had trouble with insurance claim agents getting confused? My claim for payment of the XS was initially denied because "glucose meters are a pharmacy claim". I was told that the claim would have to be re-filed with the pharmacy.

I've had phone calls before from case managers that reviewed my claims for orders of Coaguchek test strips. They called to see if I needed help managing my diabetes. Now that's one disease that I don't have.

In both situations, I had to dig in to help them find their confusion. If they had made even a brief review of my claims history, the confusion would have never gotten started. It just goes to show me that we must pay attention to the details and advocate for ourselves.

I'm looking forward to seeing the revised EOB in writing "no charge to patient".

Okay, and why are glucose meters a pharmacy item and anticoagulant meters are a durable medical item?

 

[Protimenow]

There are probably a few reasons why glucose meters are a pharmacy item and Prothrombin test meters aren't.

The first, of course, is that you can buy a glucose meter over the counter at pharmacies for as little as $6 or $8. The test strips are less than a buck apiece (probably way less). Pharmacies stock these things. Millions of people use them.

Prothrombin test meters are a different animal. They're much more expensive. Pharmacies don't stock them. They don't stock the strips/cuvettes. For most people, you have to get a doctor's prescription and buy it from a company that handles the equipment.

It's kind of like a Chevy Malibu being a dealer item and a Peterbilt Truck being something you have to go to a specialty dealer to buy.

Your insurance carrier's ignorance of the fact that there could be more than one kind of meter (and I'm not even including the cholesterol meters that some pharmacies carry) shows how infrequently they get requests for PT Meters. Plus - as far as being a durable medical item - if a blood glucose meter should fail, you just throw it away and buy a new one - the PT meters are expected to last for YEARS. (Medical facilities that use these meters may amortize the price over many years, deducting a portion each year until the total cost is deducted).

 

[Bina]

Tommy, I had told my insurance company to get on Google and look it up if they didn't believe me.
Warfarin/Coumadin prescriptions and ACT testing go hand in hand. It's just the home monitor aspect of ACT that is somewhat slow to catch on in North America.

 

[Luana]

Once upon a time all blood glucose monitors and testing supplies were considered durable medical equipment by insurance companies and Medicare. Only in the past few years have some, and now more, insurance companies started to cover them under pharmacy items. It has nothing to do with the fact that they are sold in pharmacies.

One would think the word "coag" in the Coagcheck might clue someone in to the fact that this machine is not dealing with glucose but coagulation, but never trust an insurance company to have much in the way of common sense.

 

[Philip B]

Insurance Issues

Insurance Issues

Yeah, I had issues with my insurance company insisting that my test strips needed to be coded like glucose test strips through a pharmacy. Of course, my local pharmacy couldn't do that. I never did win the battle over test strips with my insurance company. I did manage to get the company to pay for one 12 pack, but they reversed that decision when I tried to get the company to pay for another one. I even tried to get the company to let me present my case for its board of directors, but they rejected that idea.

-Philip

 

[lance]

Hi Bina,
The cost of my XS strips has just increased. Pharmacy blamed the HST. However I don't understand why INR strips are taxed while glucose strips aren't. Sounds discriminatory to me.

 

[yotphix]

Lance,
If the need of ACT can be described as a physical disability, or if the medical condition requiring it could be then you are absolutely correct. The Charter of Rights prohibits discrimination on the basis of a physical disability. HST on medical supplies at all is absolute foolishness. Complain.

 

[tommy]

Insurance said that they straightened this out a month ago. Yesteday they said that the check was cut last week to the provider. The check is in the mail. EOB has been corrected. BTW....... the insurance discount is about 70%. Done!

 

[lance]

Tommy
That's done and well done. Congratulations!

 

[lance]

Hmmm Physical disability--that's a good one. It's a grey area for sure.
I don't feel disabled that's why I had the valve replaced. I hate ACT therapy but that's not important--it keeps me alive. So it's hard to decide. I don't think disability enters the picture. OHIP has provided INR lab testing facilities at no cost to the user so why would they pay for POC home monitoring. It's a good one alright especially considering POC costs are tax deductible. It's the same philosophy--home testing. Maybe I'll have a word with my MP.

Lance,
If the need of ACT can be described as a physical disability, or if the medical condition requiring it could be then you are absolutely correct. The Charter of Rights prohibits discrimination on the basis of a physical disability. HST on medical supplies at all is absolute foolishness. Complain.

 

[tommy]

Oops, the insurance discount was 40% not 70%.

 

[Protimenow]

I wonder what kind of discounts you can get if you tell the supplier that you don't HAVE insurance.