Dr. prescription for INR Machine.. Now What??

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TXGal

Well-known member
Joined
Feb 11, 2009
Messages
197
Location
Texas
Ok, so I'm finally going to try my hardest to get my own INR machine for home. My cardiologist wrote me a prescription for one.. now what?? How do I find out if my insurance will cover this? What do I sent them?

Also, once you have one & you get the results of your test, how do you know how to adjust your coumadin.. or do you call the results in to your PT clinic and then have them adjust?

I'm just so frustrated with my clinic and never being regulated.. I want to check more regularly at home and adjust myself if at all possible.

Thanks for any advice in advance!
 
I probably can't give you the best advice -- but I'll try to say what I'm doing, and what I've read that others on the forum are doing:

I don't have insurance. For the past few years, I've been using meters that I bought on eBay (aside from the one that was sent to me as a gift). The eBay meters have worked fine for me, and the results correlated well with a hospital blood draw. I started with the ProTime and ProTime 3 meters -- the strips take more blood than CoaguChek or InRatio, but I've found the meters to be quite accurate, and there may have been fewer wasted strips with the ProTime than with the InRatio. I'm currently using an InRatio, primarily, although I've used the obsolete, discontinued CoaguChek S last month to verify that the InRatio results were in the same ballpark. Although many here are afraid of buying a meter on eBay - and I'm not suggesting that you buy your machine using this approach, and I think the Forum also does not endorse purchase from any company other than one licensed and approved to sell or rent the machines - I've had an excellent experience going this route.

As far as getting your machine -- there are companies that can provide you with the machine and strips - Alere and Philips come to mind (and there are probably others). They'll provide you with the machine and supplies, probably set you up on a testing schedule, and set up a system that enables you to call in your results to a special phone number. They'll probably also report the results to the doctor, and the doctor will make dosing recommendations. You may find a clinic that allows you to self-test and that can give you (mis)advice about what to do with your dosing. These vendors may also be able to help you navigate through the insurance maze. They do it all the time, and their advice should be very helpful. (You could also call your insurance company and just ask -- they're probably getting somewhat famiiliar with these meters and may be beginning to realize that the have nothing to do with blood glucose)

There are many options, and I'm sure others will give more information than I have here.

(For myself, I manage my dosing. I have my own meter and usually test weekly. My dose usually stays stable, and my INR rarely fluctuates much, but if necessary I may make minor changes to my dosing. The dosing charts available from various sources are also valuable for determining the best dosing and management decisions.)
 
most likely you'll need to go through some DME provider like Alere or Philips, or maybe a place locally. I'd do a google for "durable medical equipment, mycity, mystate". When you contact whichever company you decide on, they'll give you the necessary forms to have your doctor fill out. A script on a 3x5 piece of paper isn't going to cut it, I bet.

I just read in the home ACT monitoring forum that someone bought their Coaguchek XS for approximately 600 bucks from some "pharmacy". I feel pretty bad about going through Alere after reading how much I could've saved since my insurance company paid 2,600 bucks. Don't get me wrong, Alere's service and signup process is pretty easy, but wow that's a ton of money.
 
Duff, in Canada and Australia the Coaguchek XS is $500. at Roche approved pharmacies.
Kristen, it is probably best to call your own insurance company and ask what steps you need to take. Good Luck !
 
Kristen:

You can probably get names of authorized vendors at the websites for INRatio and CoaguChek. The authorized vendors will usually handle all paperwork needed from the doctor, filling the forms with your insurance carrier, etc. Local medical supply houses probably do not carry INR testing machines. At least, that's what I found out when I was trying to purchase testing strips for my ProTime 3.
I got both my monitors from a business that did everything. When I got the 2nd one -- from the same vendor -- my doctor had to fill out forms all over again.

Best to check your DME coverage and see what percentage it covers and if that percentage is a true figure or "usual and customary cost." The latter means it covers less than the actual percentage.
Also determine that your policy will cover a tester. Some insurance companies try to say that it's a "convenience," and not necessary. I have Aetna insurance and I found an Aetna document online stating the policy to cover INR home testers.

I love my INRatio. I paid cash upfront for it, then filed ith Aetna for reimbursement. Was able to save $1,000 by paying cash upfront instead of having the vendor go through insurance. It cost me, after reimbursement, about $600. I've had it several years now.
 
Kristen, like many other things you cannot take no for an answer. I was turned down at first until I obtained a letter from my cardio that explained two specific points.
1) It was medically necessary that I would have to test weekly (insurance does not want to pay weekly lab cost)
2) It should be obvious considering you have a mechanical valve, but the letter should also state you will need Coumadin therapy for the rest of your life.
Most importantly never surrender, always ask for a manager; and wear them down like Crazy Horse at Little Big Horn.

As for learning how to modify your dosage, that is something you will learn over time; there is no rule book. The only comment I could add would be to not make drastic changes in dosage without help from a Coumadin clinic. Often times small adjustments work fine
 
Here is my journey to getting a home INR meter:
I called Philips remote cardiac services. They told me to have my doctor fill out their request forms (including prescription) and fax to them. My cardiologist's office helped me with that. In about 3 weeks, I received "Approved Request for Services" letter from my insurance company (Excellus BCBS) stating that they approved my request for provision of test materials and equipment for home INR monitoring. However, my doctor told me that all I need is a home meter, and report INR to his office directly. Probably I don't need a full service provider like Philips. So I called Philips and my insurance company to cancel the approved request.
Since I only need the home meter, I called Roche (maker of CoaguChek) directly. Their Texas rep (Vincent Williams, 317-521-5358, [email protected]) emailed me 3 forms (Physician Order, Authorization, and Insurance). I filled out the authorization and insurance forms, and faxed to them. My doctor did the physician order for me. Now I am waiting for the approval of my request for CoaguChek.
 
[
As for learning how to modify your dosage, that is something you will learn over time; there is no rule book. The only comment I could add would be to not make drastic changes in dosage without help from a Coumadin clinic. Often times small adjustments work fine[/QUOTE]


Actually, there ARE dosing charts that can be quite useful for self-management, and people on this forum can probably provide links, or advice, on dosing adjustments.

SMALL adjustments are the best way to manage the INR. Because it takes days for the effects of a dose change to show up in an INR, the changes must be gradual. Dosing calculations are based on WEEKLY dosages -- adjustments are usually made based on the total weekly dosage. Small changes are essential to avoid the roller coaster effect of large changes, and to prevent any spikes in INR.

It's also a good idea, once your dosage seems to be correct, if you can set up dosing so that you take the SAME dose every day. This is because, if you take different doses on different days, your INR may vary from day to day, depending on which day you test. (I learned this the hard way when I changed my weekly dose from 49 to 51 (four days at 7.5, three non-consecutive days at 7.0). Depending on which day I tested, my INR also reflected the doses from a few days earlier. Although the changes in INR were relatively small, if I was quick to adjust my dosing based on ONE day's INR, I could have over or under anticoagulated. (I could have gotten to 51 a few different ways -- I could have taken 7 mg for five days and 8 mg for five, but this would have produced even larger shifts in INR from day to day than the previous plan. Again, trying to take the same daily dose, if possible, is a good way to maintain your INR at the same value every day).

The trick is to respect the 'range' and to not try to micromanage your dosing.

I'm sure that you'll get the hang of managing your dosing -- and resources at this site (including some of us here) should help you do it.
 
Ok, so I'm finally going to try my hardest to get my own INR machine for home. My cardiologist wrote me a prescription for one.. now what?? How do I find out if my insurance will cover this? What do I sent them?

Also, once you have one & you get the results of your test, how do you know how to adjust your coumadin.. or do you call the results in to your PT clinic and then have them adjust?

I'm just so frustrated with my clinic and never being regulated.. I want to check more regularly at home and adjust myself if at all possible.

Thanks for any advice in advance!

I got mine thru mdINR and they deliver thru Lincare and they took care of all insurance paper work sent a RN to the house for 3 test to confirm that I knew how to use it. I test every monday call it in to a 1-800- give them my pin # and they log the recording of what my INR is for that day they contact drs office and cardio calls me the next day to either increase or decrease or stay the same...was very easy to get and they took care of all paper work and I use the same machine as the comudian clinic at my cardiologist coagu scheck xs . I call mdinr when I have 2 strips left and they overnight me another round of supplies..
Hope this helps and good luck...
 
From your picture you look like you have a few more years to go before you hit 65 :) so doubtful you're eligible to get it covered through Medicare (if you're over 65 Medicare will pay for it). What you need to do is go to your health/medical insurer (probably Member Services) with Doctor prescription in hand, and make the case that they should pay for at least part of the tester and supplies (strips, lancets). Be prepared for a battle. Most insurance companies do not currently cover INR testers, for reasons related primarily to being cheap. The functionality of the testers is very similar to that for diabetics; i.e., to test the blood for recurring medical reasons. One thing you can do is contact the INR home tester manufacturers and request their assistance in preparing a case to present to your insurance company. They have all kinds of data and information that may help you in your quest. I figured at best that the insurance company would only cover half or less of the cost of the tester and supplies, so I ended up buying my INRatio off eBay at a cost that was less than I would have paid had I fought the insurance company and won. And it works fine. First check your health/medical plan brochure in the Durable Medical Equipment (DME) section to see if they cover INR testers (unlikely) or Diabetes testers. Take it from there based on what you find. Be prepared for a lot of double talk and resistance on the part of the insurance company. But, with the Doctor's prescription in hand you are part way there (and the Doctor's prescription is a good start). My Cardiologist would not give me a prescription because he does not believe in home testers so I went to my Primary Care Physician and got a prescription from him. It was moot because the outfit that sold me my tester off eBay did not ask for a prescription.
 
I've bought my testers on eBay, and with the exception of one that I bought for $1 as is (I bought it primarily for the charger and manuals), all have worked fine. I probably shouldn't have bought a CoaguChek S, which the manufacturer discontinued years ago, and which the manufacturer adamantly claims is NOT for home use, but my InRatio and ProTime meters have worked accurately and easily. I didn't need a prescription when I bought on eBay.

I've bought strips on eBay, and I've had a doctor buy them from a medical supply company. In both cases, the strips were fine.

It may be easier, as Dan suggests, to just handle the purchase yourself, if the insurance company puts up too much resistance -- and buying on eBay may actually cost less than the copay that your insurance company requires.

I'm not advising you to buy from other than authorized dealers -- just telling you what worked for me.
 
Wow, thank you all for your suggestions! I'm going to go over these with my husband and decide which avenue we want to try first! I definitely need one here at home.. as I'm getting frustrated with my PT Clinic. I never had a problem being regulated until I moved to my current location, now my INR is just all over the place. In fact, yesterday morning I was a 1.6. I thought I had been too thin due to about 13 tiny bruises behind my knee area that appeared suddenly Thursday. I took it upon myself to take only half my dose Thursday night because I thought I was too thin (half for me is 5mg). So I took 5mg at 9pm, had my PT/INR drawn at 9am Friday morning.. and at 2pm I talked to my PT nurse in person and she informed me that I was at 1.6. She went on to say I was probably too thin all week and then because the night before I took 5mg instead of 10mg, that I dropped to 1.6 overnight.. I said, so you're saying in 12 hours that I would've gone from being too thin to 1.6?? She said "Yes", it acts quickly.. Now I've always been told it takes a couple days before what you take today to be in effect.. have things changed?? Or is she as bad at regulating as I'm thinking? Either way, I'm getting a home machine!
 
You were probably low all along. And no, halving your dosage would not have dropped your dosage to 1.6 overnight from whatever it was. An INR done 2-3 days after halving your dosage might shop a change, but not overnight.

Is this PT nurse an RN or LVN or what? Is she affiliated with your family doctor, cardiologist or what? If you're taking 10mg, your INR can nosedive if you forget to take a dose or start halving your dosage for a day or two, but it should take a couple of days before the effects are evident. That's why it takes at least several days -- not one or two -- to get back into range after discontinuing warfarin for a medical procedure. For that reason, doctors often prescribe concurrently bridging with a low molecular weight heparin (Lovenox, for example) as protection against clots until your INR is back in range after you resume taking warfarin. When the INR is back in range, you discontinue the LMWH product.
BTW, your blood is neither too thin or too thick (unless you live in the Arctic and are outside a lot, which does coagulate anyone's blood, regardless if they take warfarin). Correct terms are too anticoagulated or not enough -- meaning your INR is higher or lower than desired.
 
Even at 1.6 for a week, your risks are relatively low because you're 10 years post-op and have a bileaflet valve (according to guidelines from Duke University). The need for bridging may be overplayed by many -- you aren't at imminent risk of throwing a clot if your INR drops below 2 for a few days. (I was at 1.1 for who knows how long? and it took a week or more for my INR to finally bring me into range, and I survived without bridging, although I certainly wouldn't want to drop that low ever again, except maybe for surgery).

As Marsha said, it takes days for the effects of warfarin to show up in your INR. Any 'nurse' who thinks otherwise is either poorly trained or badly misinformed.

You need a meter...
 
Thanks Marsha & Protimenow.. I'm not sure what her title is, but after talking to her in person, I'm not impressed with her at all. I plan on informing my cardiologist.. she may be fooling some people, but I have felt for quite sometime now that she doesn't know what she's doing.

Sorry Marsha I get in a habit of saying "too thick or thin" to my husband, lol.. it's easier for him to understand than saying "too anticoagulated or not enough" but he knows what I mean.. :eek: I should've used those terms on here.. I was on Heprin post-surgery in 2000 and in 2007 I was on Lovenox injections after completely stopping Coumadin for my egg retrieval and bridged back. I also had Heprin injections after stopping Coumadin during two incidents of ovarian cyst ruptures many years ago..but, my PT clinic has never suggested them for my INR levels.

I'm still shocked that someone who's been regulating my PT/INR levels for so long now actually thought that overnight my level would drop after taking half of a dose. She suggested that Friday night I take 15mg to make up for the 5mg I didn't take Thursday night and check back in 3 weeks.. To me, I'm thinking 15mg is going to make me extremely thin in 2-3 days.. Nevertheless, I'm getting my own machine one way or another.. :thumbup:
 
Thanks Marsha & Protimenow.. I'm not sure what her title is, but after talking to her in person, I'm not impressed with her at all. I plan on informing my cardiologist.. she may be fooling some people, but I have felt for quite sometime now that she doesn't know what she's doing.

Sorry Marsha I get in a habit of saying "too thick or thin" to my husband, lol.. it's easier for him to understand than saying "too anticoagulated or not enough" but he knows what I mean.. :eek: I should've used those terms on here.. I was on Heprin post-surgery in 2000 and in 2007 I was on Lovenox injections after completely stopping Coumadin for my egg retrieval and bridged back. I also had Heprin injections after stopping Coumadin during two incidents of ovarian cyst ruptures many years ago..but, my PT clinic has never suggested them for my INR levels.

I'm still shocked that someone who's been regulating my PT/INR levels for so long now actually thought that overnight my level would drop after taking half of a dose. She suggested that Friday night I take 15mg to make up for the 5mg I didn't take Thursday night and check back in 3 weeks.. To me, I'm thinking 15mg is going to make me extremely thin in 2-3 days.. Nevertheless, I'm getting my own machine one way or another.. :thumbup:

Kristen:
Sometimes a medical practice just trains someone to run a test and then if the INR is out of range, they consult the doctor.
I do sometimes have to translate INR meanings as "too thick" or "too thin," but I also explain that my blood is supposed to be more than double anticoagulated than someone who doesn't take warfarin. That makes the number system more easily explained.
If you have a smartphone, search your available apps for one on warfarin. I got an iPhone in June and downloaded quite a few free ones (hotels, news, travel, shopping, medical), etc. Then I searched WARFARIN and found one that's oriented for the medical profession but that is easy to use. Very commonsensical. Not unlike the dosing algorithm chart that I use. After nearly 8 years of home testing and almost 7 of adjusting my own dosage, it's almost second nature as how much to adjust, when needed.
If you will PM me with your email, I will send you the algorithm chart I use so that you can become a "non-rocket scientist" like many of us here.
 
Marsha's right -- after managing your own dosage for a while, you get fairly proficient with the minor adjustments that have to occasionally be made. The charts are helpful -- and there are a number of them. So is realizing that it takes a few days before a dosage change is reflected by your INR. (I was recently surprised by a 1.1, and I used a dosing recommendation from a Duke University paper, and although it was a bit scary, my INR bounced back within range (without going TOO high), with some careful, slight increases). Just remember that changes are based on TOTAL weekly dosages, and you should be very able to manage your INR - if you don't want to involve a 'professional' in the decision making.

(I keep a chart of dosing and INRs, which is very helpful for convincing doctors that I know what I'm doing, and making them comfortable in ordering warfarin refills. If you plan to manage your own INR, keeping a chart (I use a spreadsheet) of INR, dosing, and 'events' is very useful).

I'm using an Android phone -- but haven't found much warfarin management software so far...
 
Marsha, yes I'd love to see the algorithm chart that you use.. I'll PM you my email address. Protimenow, thanks for the tips.. yes, I'd like to regulate myself at home and not depend on the PT clinic solely. Bina, I don't know what my INR is. I can only assume it's gone up since Friday. My PT nurse asked that I come back in 3-4 weeks. That's why I really feel it'll benefit me to have my own home machine. I know I could regulate myself better than my clinic. Thanks everyone for all of your advice!
 
I've looked at the Android Marketplace for my AT&T phone -- there IS a warfarin calculator app for the Android phones. It sells for .99 -- I didn't buy it, so I can't say whether or not it's useful.
 

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