Do you get charged?

[Bugsy]

Does your cardiologist charge you each time you call in your pro time? I've been home testing for 3 years now and never been charged for calling in my pro time until a few months ago. I'm not sure if it's the Dr's office or the insurance that has changed policy's but $25 each time I call it in is expensive! Especially since my insurance doesnt cover the cost of the test strips.

 

[AgilityDog]

Nope, but then, I'm self managing, as well as self testing. But I was never charged when I had to "rent" the machine and call in weekly - by the cardio, that is. Phillips charged me out the wazoo, $250 per month the last 6 months!
I never get charged if I call the cardio or nurse with a dosing issue, or other symptom, though of course, if the symptoms warrant, I may have to go in for a visit, and get charged for that!

 

[Bugsy]

I am self managing also. I havent had an issue since I began home testing. Of course they wont refill my prescription if I dont call in my pro time.

 

[ALCapshaw2]

Step 1 - Buy AL Lodwick's Dosing Guide ($5 from his website www.warfarinfo.com) or use the OnLine Dosing Calculator that has been posted by Ross.

Step 2 - If your Cardio / PCP gives you a hard time and still wants to charge, ASK if they charge the Diabetics who Self Test and Self Dose.

Step 3 - If your Cardio / PCP tells you that Home Testers are Not Accurate, ask WHY so many Coumadin Clinics / OTHER Doctors use them. Or Why MEDICARE endorses Home Testing.

It's going to take a Long Time before Home Testing / Dosing is fully embraced by the whole Medical Community .

 

[Bugsy]

Thanks for the info. Since I have been hometesting they have never had to adjust my dose.

 

[catwoman]

Bugsy:

Have you thought of getting your family doctor to handle your warfarin Rxes?

My family doctor -- not my cardio -- writes mine. I began home-testing almost 6 years ago. I was having my INRs done at his clinic, and then found out about home-testing. He had 2 other patients who home-tested, so he was receptive. At first, I did call in my INRs, then we realized I could do just as well as his office. So I adjust my doses and that's fine with my PCP; I've been going to him for 20-25 years, and he knows me well enough to know I can do this.
During office visits, we've dicussed how/when to adjust. In fact, during one office visit, a tech or nurse popped in to ask his advice on another patient's INR (3.1). Dr. Murphy asked what I thought. "What is the range and why is the patient on warfarin?" I asked. I was given reason (a-fib) and I said the range is normally 2.0-3.0 and I wouldn't change anything just for 0.1, just test again at the next regular time, I said.
Dr. Murphy agreed and told the tech/nurse as such.

Dr. Murphy writes all my regular Rxes (warfarin, alendronate, amoxi, ceph, acyclovir and generic Flonase) when I have my annual physical. Warfarin & generic Flonase are the only things I take daily; I take the alendronate once weekly; the others are as needed.

I changed cardios earlier this year, and have talked with my new doctor about my home-testing. He said I know as much -- if not more -- than some medical professionals.

 

[Bugsy]

Wow Catwoman sounds like you have a great family physician! I like mine but I hinted at doing the same as you and he didn't seem very receptive. Maybe I'll try again on my next visit.

 

[catwoman]

I think if you can demonstrate an understanding of the drug and when/how to make dosage changes, it certainly helps.

Al Capshaw advised purchasing the dosing algorithm chart from Al Lodwick. Here's a link to the algorithm chart:

http://www.warfarinfo.com/publications.htm

I gave my family doctor a photocopy of it so he would know what I was basing my dosages on. His clinic uses a different chart; I prefer Al's.

 

[Lisa in Katy]

My guess is that a consultant advised them on a way to make additional income. Are they charging you or just your insurance?

I don't home test, so the doctor's office has to call me with the lab results. I've never been charged.

 

[Bugsy]

The Cardiologist Office is billing the insurance company and the insurance company says it's not covered under my policy. The Cardiologist is sending me a bill.

 

[olefin]

No, my cardiologist has never charged anything. I'm sure QAS has to fax or call the results to him. Not sure he evens looks at the results. The last time I was in to see him he said I knew what to do and if I had a problem I couldn't handle, to call him.

At first, for a few times I wasn't calling QAS, until I found out that I must call them to follow Medicare guidelines. So I gave them the results that I had missed.

If I was you I would be finding a new doctor.

 

[Bugsy]

Yeah, I've been calling around this morning. It's turning out to be more difficult than I imagined. Some have actually told me they don't accept patients that home test and others don't know what I'm talking about. Most of the time I'm transferred to someone in billing and end up getting voice mail.

 

[Lynlw]

Yeah, I've been calling around this morning. It's turning out to be more difficult than I imagined. Some have actually told me they don't accept patients that home test and others don't know what I'm talking about. Most of the time I'm transferred to someone in billing and end up getting voice mail.

Maybe you can start a thread asking if any home testers that live in your area could recomend their doc.

 

[Lisa in Katy]

On your EOB, what is the exact reason they aren't paying and does it say it's your responsibility? If the provider is participating in your plan, he can't bill you unless the insurance company says he can.

 

[Bugsy]

I can't interpret the description. It says "PHYS REV INTEPR MEDICINE". When I spoke with the insurance company rep some of the words she used were "prosthetic and analysis".

 

[catwoman]

Bugsy:

(Just a thought)
Where did you get your home tester unit from? If you got it from QAS -- which is in Orlando, your home turf -- talk to someone at QAS. Shane or Lance Visnich (sp?) are starters, if they're still at QAS.

QAS may have lists of primary care physicians in the Orlando area to whom they've sold units and that you **might** be able to get phone numbers of so you can query those doctors.

Don't know if QAS would be able to divulge names/numbers of customers, but it's worth a try..........

 

[Bugsy]

Yes, I got it from QAS. That's a good idea I'll give it a try. Thanks!

 

[Lisa in Katy]

I think the description that you gave is for the procedure, not the payment.

Usually when you get an EOB from the insurance company, if they don't pay something it will be accompanied by a remark code. The code then should have a clear description at the bottom. For instance, here's one from mine. It's squeezed, but I can't get it to look right.

Billed Discount Not Covered Amt Apprvd Ded
TOTALS 90.00 32.95 0.00 57.05 57.05
UG*

Amount You Owe 57.05

*Remark Code UG: We Have Applied This Physician's Or Health Care Professional's Discounted Rate Towards Your Deductible. You Have Not Yet Exceeded Your Deductible Amount; Therefore No Benefits Are Payable.


So you can see that the insurance company didn't pay because it was applied to my deductible, but I am responsible for the payment. Your EOB should be very clear as to why they didn't pay and whether or not you are responsible.

 

[Eva]

............Maybe I'll try again on my next visit.

Last time I visited my cardio I told him that it does not make sense that I depend on him for the rest of my life to adjust my dose!!, and what do I do when I am travelling?!!, and that the adjustments are always either you decrease or increase the weekly dose by 5-10%. My cardio looked at me and right away he approved that I adjust my own dosage...just to give him a call if it goes above 4 and stays there or below 2 for more than a couple of days!.

 

[Guest]

No, my cardiologist has never charged anything. I'm sure QAS has to fax or call the results to him. Not sure he evens looks at the results. The last time I was in to see him he said I knew what to do and if I had a problem I couldn't handle, to call him.

At first, for a few times I wasn't calling QAS, until I found out that I must call them to follow Medicare guidelines. So I gave them the results that I had missed.

If I was you I would be finding a new doctor.

"Medicare" that is the deal. Several months ago, my coumadin clinic wanted me to start testing on a weekly basis, under the guise that home testers are much safer by testing weekly, and calling my INR results into QAS, who then would fax results to the clinic. The clinic in turn wanted to make money off of us home testers so they then bill Medicare for 'managing' my INR.

The catch here is I'm not on Medicare, that won't be for some time, and I told them I was not about to purchase more strips, pay out of pocket for them and wait for my insurance to reimburse me, test weekly, and use a third party when I can fax my results just the same as QAS. I already test bi-weekly and order all my strips at one time for the year based on this testing schedule.

After discussions with the head nurse that runs the clinic, she admitted that they were trying to recoup expense on home testers by billing medicare for services and reducing the call ins. She also relented that she did not want to inconvenience me, cause me more strip expense, and that I could call in my results as I had before. So, I still test bi-weekly and call in my results monthly. I've had stable INRs for quite some time, the only time I will need to call more frequently is if my INR gets out of whack.

It's a money making business no matter what.