How did anyone manage to get one???

[Icarus]

Hello to All, hope everything is OK,

I have recently applied to my insurance company (name withheld because I'm totally upset with them) for a Protime testing unit and the request was denied.
It seems that their criteria to get one is that 1.) You cannot be ambulatory and 2.) You must live more that 30 miles or 30 minutes away from the nearest clinic/doctor/lab to have your blood drawn.
This eliminates everyone in New York City that can walk.
I tried to appeal but with the above criteria, the appeal was totally useless.
I noted to them, the vast irregualrities in my INR, various MRIs and Emergency Room visits but that was ignored. They again pointed out the 2 major criteria.
I will have to admit that what I was getting it for was for an improvement in my quality of life in that I was tired of leaving work early / coming in late just to wait up to 2 hours to get a 5 minute blood check on a weekly or bi-weekly basis.
Quality of Life problems are not an issue with the insurance company.
I want to thank Lance for his help in trying to get one of the units and just ask everyone - did you get your Protimes through insurance or by private purchase? Maybe I'm with the wrong provider.
Sorry about the rant and regards,
Icarus (Rich)

 

[KIRSONRON]

I live in the NYC area and basically like you, wanted the Protime for the same reasons. I had no problem with my insurance company - United Healtcare PPO - fully paying for both the unit and the supplies. I guess its a matter of how each insurance company views "Medical Necessity". That said, the freedom that home testing provides along with the ability to both more closely monitor and adjust your coumadin levels would make me consider paying for it myself. That's a personal decision.

 

[Icarus]

Hi Kirsonron (Ron?)
You're right about making a choice to buy it on my own or not. It would be totally worth it if it wasn't for the one thing that was on my mind throughout this whole ordeal. - Is the drug "Exanta" to be released in the U.S. next year going to happen or not? It's basically for Deep Vein Thrombosis, but I think also for artificial valves.
If that happens, I believe there is no constant monitoring of your INR.
Maybe I'm glad I got rejected, I was really feeling guilty about having the insurance company pay for something I might only use for a year.
Decisions, decisions, descisions.
Icarus

 

[RobThatsMe]

Hi Rich,

MY insurance company covered mine. Lance helped me. The request had to go before the insurance company medical review board for approvals.

I also wrote a letter to submit explaining some reasons as to why I needed the unit.

1. Blood testing every 2 weeks for the rest of my life.
2. Job requires frequent travel.
3. Cost savings. my lab testing cost approx. $58. (cost of the blood draw + lab test).

MY doctor also wrote a letter approving my intent to self test.

Lance was a big help, and I am sure he will exhaust all possible approaches before giving up on your case.

Good luck,

Rob

 

[Icarus]

Hi Rob,
Did all that and the insurance company was still adamant about their criteria of being ambulant and living within the 30 mile limit. My primary care Doctor, who is totally in favor of me getting the unit spoke with the Director of Nursing of the insurance provider during the appeal. - No dice, I can walk and I'm within 30 miles of a doctor.
Oh well, C'mon Exanta (please, please, please)

Regards,
Icarus (Rich)

 

[Rain]

"guilty" about only using it for a year?!

"guilty" about only using it for a year?!

Hey Rich,

I wouldn't feel guilty!! A year is a long time!

At first my insurance co said no way to the protime machine. I sent them tons of paperwork, Lance & his insurance lady sent them tons of paperwork, I got my cardio to write them a letter and then.... I wrote them a letter! I told them the roads were icy, I told them how my INR had been 6.9 and I didn?t get the results for two days.. I cried about everything I could think of. Then I showed them how they would actually save a lot of money on lab work in the end. Because I plan to live for a very long time.

It probably helped that I was dealing with one woman all the way through it. She was the same lady who handled the claims for my surgery. I proved to her how she had paid the same $8,500.00 to the hospital twice ....and she got it back out of them!

Finally she got her boss to okay the machine for the ?out of network? price. 70% More paperwork..... and Lance?s help.. he?s a sweetheart. We convinced her that because it was the ONLY machine available they should pay it at 90% (in network price) They finally did.... and continued to pay for the cuvettes at 90%. THEN I changed insurance .... what a pain. I already had the machine, but they weren?t going to pay for my strips at all. After more of the above..... we convinced them that it is ?LAB work? NOT ?durable medical equipment?. For some reason that?s how QAS bills it..... really messes with my insurance people?s heads.

I don?t know for sure if we convinced them or if they just bought it to get me out of their hair. In the end they paid for the machine and the first 250 cuvettes in full, because I had already met the deductibles with the surgery!

Keep bugging them, Rich!

 

[Igor]

Hi, everybody.
I had an AVR on 5/16/02 and am thinking about purchasing the Protime system.
Just wondering, besides the device itself what other expenses are involved in testing.
I started going to the coumadin testing on a weekly basis a couple of weeks ago and asked the cardiologist and the nurse about buying the Protime test unit . The answers were against buying because my test unit might go wrong and I would not even know it. However, my surgeon from Houston, strongly recommended to get a unit. I am not a big traveler but once a month do get out of town for a few days. The question is, how important do you think to have your own Protime test unit?

Igor

 

[Zipper]

Very Important...IMHO

Very Important...IMHO

Hi Igor,

If you look back in this thread you will see my post on a Lab experiment I did with my ProTime unit and my Lab. As i suspected..the range was so close as to not even consider a difference. I work at the hospital and my Lab Tech was impressed as was my Doc.

I find the importance...for me...is to be able to test...at home..more frequently. Once we are 'stable', we most often are told to test once a month...I'm not comfortable with that period of time lapse. Of course it's a individual choice...my insurance did not cover...I felt it worth any price to be able to monitor on a more frequent level, and if things were not right..I could call my Doc and discuss it.

I'm a Pro 'ProTime' user...and still a novice at it. Do your own research and talk to you Doc. I think EVERYONE on Coumadin should have one!

Zipper

 

[Hank]

Home unit going wrong?

Home unit going wrong?

Hey Igor,

As far as your cardiologist and nurse worrying about the unit "going wrong" and you not getting right readings, I say FAT CHANCE! .

There are safeguards built into the machine, and not only that, you will become so intimately close to your knowledge of your values, that you will know if something "goes wrong".

I have worked in labs where they test INR's and blood gasses and other samples and I would trust my little ProTime machine WAY before I would trust a lab.

The only people who have a fear of home testing, are those who have not been properly educated in our reality.

Wow, that was either profound or goofy, one or the other!

 

[Christina]

Message for IGOR.....

Message for IGOR.....

Hi Igor,

Like that name!!
As for further expenses with the protime unit. You'll have to purchase the supplies in order to do the testing, and you either buy a box of 6 or a box at 25 at $10.00 a test plus S/H. You'll have to watch out for the experation date because the "Cuvettes" won't woork after the exp. date.
My Insurance company refused to cover my unit after 4 appeals but I bought it anyways. Lance was extremely helpful and who can refuse Lance from QAS!
I just LOVE my unit and cannot say enough about it. It is FREEDOM" people. I haven't gone to the lab in almost a year and can test whenever I feel the need.
For example, I forgot to take my Coumadin last night. We went out to dinner and weren't home at the time when I normally take my Coumadin, and when we came home I didn't think about taking it. Don't you think I need to test today or tomorrow just to put my mind at ease and know where I am at? Today is Sunday and no lab is open, so thank GOD for my Protime. I feel so safe with this and I don't spend any time waiting at a lab.
Before I bought my unit I was going up to 3 times a week to the lab, and was showing signs of scar tissue build-up in my arm. Not a good thing!
I did send the unit back for an upgrade to 3 channels in January 2002 however, I have decided to keep using the 5-channel cuvettes. They rechecked everything and I even received a loaner unit while my unit was in the shop. I received a new warrenty again for one year and all this for $100.00.

I hope you'll make the right decision and get the unit.

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St. Jude's Mechanical

 

[Igor]

Christina, Hank & Zipper:
Thanks for your prompt replies. Nothing could be better than feedback people using the Protime unit. My mind is definitely set already to buy a unit. This is just a matter of time.
When do you think is the best time to do that? I am about 3 and ½ weeks since my surgery. Is it better to get it now or wait for a while? I also forgot to mention that I?ve gone to a coumadin clinic already twice and the nurse there is using Protime.

Igor

 

[Christina]

Igor,

Why wait? There is no reason to wait for you and if the nurses at the clinic already use Protime, you know that it's a good thing. Just buy one now. You'll be happy you did! Let me know how it goes. All the best!
Say hello to Lance for me, will ya?

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical

 

[Zipper]

Contact QAS

Contact QAS

Hi Igor,

I agree....there is no reason to wait! If you contact Brian Woodard at QAS...800-298-4515 X 2864 he will give you all the help and info you need to obtain a ProTime unit. The service this company provides is Excellant!!!!

Zipper *~*

 

[Woody]

Igor, Your machine (when you get it ) will not give you a bad reading. If the test has a problem then you will get an error code and not an incorrect INR Value.
Where are my friends out there?

 

[Blanche]

Igor, why don't you call Woody?

Igor, why don't you call Woody?

I can tell you from my own experience that Brian Woodard is one of the most helpful and knowledgeable persons you will ever find. He is to one who helped us overcome all obstacles in getting the ProTime monitor 15 months ago. When we had given up hope because our doctor wasn't sure he wanted us to go this route, Brian gave us materials; sent information to the doctor; spoke with the office people at the doctor's office, and coached us in ways of presenting information that would get the doctor to, at least, deal with the information and our request.

While we are especially partial to Brian (Woody) because he was our initial contact and the person who held our hands through the process, I must say that ALL of the people at QAS are expert, caring professionals in what they do...and they do it well.

The machine itself, while on the cutting edge of technology, is very simple to operate. You can not make a mistake or get a bad reading. There are built in tests and fail-safe mechanisms. If there is a problem, the machine will not complete the test--it will give you an error message. We've had several error messages, but then we do use the machine at least once a week. Twice the machine would not do the test because the battery was low. We saw that the battery was low, but thought it was still ok to do the test. Not.

If you must pay for the machine yourself, Woody will help you with that too. We had to pay for the machine and we also have to pay for the supplies, and it's worth it. My husband went for ten years on coumadin without a problem. Then, he ran out of luck and had a TIA followed in one week by a CVA. Since all other causes of his strokes were ruled out, it has been stated that his strokes were caused by anti-coagulation problems. In other words, he threw a bloot clot. At that time he was going to the lab for testing once a month. Looks like once a month was not enough.

Best of luck with what ever decision you make.

 

[Marty]

Get the word out!

Get the word out!

Last month I went out to Indiana for my 50th medical class reunion(I'm a radiologist, Had MVR with St. Jude mechanical 1998)
I was at lunch with an old friend ,a "GP of the year" a while back and still practicing. When I told him about the experience both Alice and I have had with warfarin and that we self regulated with a little computerized INR monitor it was the first he had heard of these gadgets. He said he would love to prescribe them for certain patients. He knows that he has had patients who hemorrhaged or thrombosed due to poor regulation. I am not sure why self monitoring and self dosing are so little utilized by the medical profession. Roche,ITC, J&J, etc. apparently don't have enough reps to get medicine out of this inertia. While monitoring has been described as accurate over and over in the literature including JAMA we all suffer from information overload ,most of all the busy GP's. I question the motives of some cardiologists who should know better. Some are control freaks and as has been stated here some may have a financial conflict.Well maybe Exanta if it ever gets approved will make all this moot!