Insurance coverage for home testing supplies

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CATDOG

Well-known member
Joined
Sep 27, 2010
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110
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Hello. I don't expect anybody to be able tell me if MY insurance plan will cover this or that, I'm just trying to figure out what category to look in.
I'm assuming that a self-testing INR machine would fall into the DME category, but where do TEST STRIPS fit into most insurances? They can't be DME, can they, if they get used up? My plan guide lists out diabetic supplies, but I see no mention (yet) of anything related to INR testing.
For those of you that home test, do you get an RX with refills for the test strips, and a separate "order" for the machine?
(Sorry thought I had clicked on Home Anticoag Forum.)
 
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My Insurance Company classified the Test Strips as Durable Medical Equipment which was handled by the Home Office in another state. I was NEVER able to find anyone in the home office who even knew what anticoagulation or INR was. Since they covered the Finger Stick and/or Vein Draws at my Coumadin Clinic 100%, I just kept going there.

Bottom Line: Check with your Insurance Company and see if they will cover Home Testing. QAS / Alere can often help with the necessary forms and 'persuasion' if the Insurance Company is receptive to the idea. Good Luck! Maybe in another 10 years Home Testing will be more accepted in this country. Medicare DOES endorse Home Testing but it's going to take more time and effort before it 'trickles down' to the rest of the industry and medical community.
 
CATDOG said:
Hello. I don't expect anybody to be able tell me if MY insurance plan will cover this or that, I'm just trying to figure out what category to look in.
I'm assuming that a self-testing INR machine would fall into the DME category, but where do TEST STRIPS fit into most insurances? They can't be DME, can they, if they get used up? My plan guide lists out diabetic supplies, but I see no mention (yet) of anything related to INR testing.
For those of you that home test, do you get an RX with refills for the test strips, and a separate "order" for the machine?
(Sorry thought I had clicked on Home Anticoag Forum.)
Click to expand...

QAS, which has been absorbed by Alere, did code the testing supplies as DME. However, another vendor I used told me the same, but did not and I had to pay out the kazoo for its supplies.

My PCP wrote an Rx for both machines and indicated how frequent I was to test. United Healthcare covered my first monitor 100%; Aetna covered it at 80% of the "usual charge," which translated to 60% of the cost. I had paid cash for my INRatio and was reimbursed after I provided receipts, etc. No problem getting reimbursed.

I buy my strips out of my own pocket and file for reimbursement through my Flex plan.
 
My Insurance company covers DME at 100%. Phillips provided the machine (purchase) and the test strips. They classified the strips as DME so the insurance pays the whole shot! Of course, I work for a large multinational corp which has a self funded health insurance (Basically single payer with a mean payer), so that could make a difference when the insurance company actually has to pay rather than just manage benefits.
 
My insurance: DME is covered at 80%, Labwork at 100%. I just don't like the idea of being tied to a lab, although I work right next to one, and have probably 10 within 4 miles of my house. I've been going to the lab for other stuff monthly for several years already, but that is clearing up and hopefully going to become less frequent. I just like to be independent. I'm just researching right now as I don't go back to the cardio for a year, and I want to be more prepared this year to talk details. Also, we have a few insurance plan choices, and I need a better idea which will be my best choice. I'm sure there will still be surprises regardless.
 
With insurance, any insurance, phillips charge around $77 for 12 test strips (approx 6.41 per strip), so your co-pay would be around $17. Without insurance, the cost is double (almost $160). If you purchase the machine, and you test every week. This would last 12 weeks. every 2 weeks, 24 weeks. you get the picture. This would be whatever you and your cardio, or whomever will monitor your INR, would be comfortable with. If you lease the machine, you HAVE to test every week! And phone in the results to phillips or whoever you are leasing the machine from. Lastly, the machine itself is around $1500, so at 80% you are looking at $300 for the purchase.

I am VERY happy I purchased the machine. Makes me independant!
 
My INR tech submitted the paperwork for a machine for me and found out I have to be on Coumadin 3 months before I can request a machine from my insurance company.

I have no co-pays for the current INR testing at the drs office.
 
For yrs my supplies have been covered by my husband's insurance as DME. I always had to pay a $50 copay for my 25 cuvettes for my protime 5 machine. Then, I decided to see if our insurance would cover a new coaguchek and it did as DME for a $50 copay. I assumed the strips would be the same as before. However, I am getting them from a new source that my HMO had wanted me to use for a long time, now, but they never had protime 5's so I continued to use QAS now Alere. So, now, strangely, I am getting my test strips for the coaguchek at no cost to me. I am a bit ticked that I paid $50 for so many yrs and don't quite get why I now have no copay. But, I don't want to rock the boat, and if they say no copay, I am just going to go by what they say my insurance pays, and this new supplier tells me.
 
seems like it is up to the supplier to decide if test strips are DME, then the insurance approves it. If the supplier doesn't classify them as DME, your screwed. Weird system!
 
It's good to hear that your insurance paid for the CoaguChek (it IS an XS, isn't it) and the strips for testing. I wouldn't be too upset about paying for the ProTime strips in the past. Even if you were testing once every two weeks - that comes out to about $50 a year. It sure beats going without testing, or having to go to a lab for tests.

I've moved over from a ProTime meter (from a classic to a Protime 3) to an InRatio and have no regrets about the move. I've seen some on this forum say that they like the CoaguChek XS the best, of all the meters tested. I'm sure that you'll really appreciate the XS a lot more than the ProTime. Getting it, and supplies, for free is just icing on the cake.

Enjoy.
 
Convenience items? Maybe you should start charging the insurance company for the time it takes you to get to the lab and back, the roundtrip mileage to the lab and, of course, the parking. There seems to be some bonehead at the insurance company that made this determination - it may not be worth the fight, but I wouldn't be surprised if someone higher up would change his or her mind when confronted with the recent articles that conclude that home tester INRs are more often in range than those who have to go to labs for testing. And here's the kicker -- people who are out of range are at higher risk of stroke or bleeds (from INRs that are too low or way too high) - and the resulting hospitalizations certainly cost a hell of a lot more than a meter and strips.
 
Thanks Protimenow, I quite agree. I have been fighting it, but I am just about to give up. I alternate between being depressed about it to being angry about it. I have GEHA insurance (This is government employees hospital association.). Does anyone else "out there" have this ins? Have you gotten them to cover home testing? If so, how? Since they will pay for the lab work, I am tempted to go at least weekly. If I buy my own monitor, they won't even have to pay for the lab anymore. I've been wondering and maybe you can tell me--do the veins in your arms eventually get worn out from all the blood draws? My left arm got infiltrated when I was in the hosp for surgery and they still can't use it to draw blood--so it is always from my right arm.
 
mecretired said:
Unfortunately, my ins company considers home INR monitors as convenience items and will not cover them at all. They will pay 100% for all the lab testing but I never get results until the next day.
Click to expand...

You need to do some homework and resubmit. Find studies that show that warfarin patients who home-test stay in range more frequently than those who go to a lab or Dr's office. The studies are out there online.
Many insurance companies, including Aetna which I have, consider home-testing a convenience for most cases of a-fib, but not for mechanical valvers.
When I bought my INRatio 3 years ago, I paid cash, then presented my claim, evidence of my history, an online statement from Aetna supporting home-testing for mechanical valvers, etc. You just never know who handles the paperwork, if the right hand knows what the left hand has previously OK'd.

When an insurance company sees the evidence, realizes their savings if a patient tests at home -- rather than having to make AND KEEP appointments for INR tests, it's a no-brainer. And, yes, I realize that insurance companies don't always have brains.

If you are eligible for Medicare, you can get a tester that way.
 
Yes, you build up scar tissue in the veins from repeated blood draws. I have had 3 OHS's, plus endocarditis, lots of hospital stays in 20 yrs, and I have substantial scar tissue in my former great veins. Only the good lab tech can get a good draw on the 1st try!
As far as the machine, I would use the 'you pay for diabetic testing supplies so you better pay for this', and of course, the doctor has to say it's a medical necessity, and it should be covered!
 
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