Remote INR taking over Coaguchek

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Have you considered doing your own home testing and reporting? After several outrageous charges from HomeINR I bought my own machine on ebay and test strips made arrangements with doctor to call in once week with results all at no cost after initial cost and once year strip purchase.
I do the same. Self testing is the way to go. Just bought my strips for the upcoming year on eBay- 48 strips for $190 plus postage. A very small price to pay for the peace of mind of taking the testing into one's own hands.
 
I don't call my results in. The doctors probably don't know as much about INR management as many of us on this forum. They're using outdated materials or outdated dosing tables, and don't always have the right advice.

I've been self testing and self managing since April 2009. Others have done it even longer.

Pellicle is a great source for information regarding INR management. Many of us can do it - often more appropriately - than many/most 'coumadin' clinics, doctors, pharmacists, or nurses. We have a lot more to lose than these professionals do.
 
Since people are discussing INR home measurements and reporting, I will give a report on 1 company, Webcare Health, that supports this process.

My Coagulation Clinic (CAT) contracts out self INR monitoring to Webcare Health (WebCareHealth). I was offered this as an option to avoid biweekly blood draws at a lab. Webcare Health manages self INR monitoring for many healthcare systems around the USA. Mostly they are in the midwest, but they are also found in some western and eastern states. They trained me to take my own INR measurements and they issued me a Coakuchek meter. After I take the measurement, I report it to Webcare via an 800 number automatic system, or via a smart phone app. Webcare then enters the INR report into the CAT clinic's system. Webcare also has an automated system for me to order replacement strips, and they provide telephone support if I am having trouble taking my INR measurement. Once an INR is reported to Webcare, they are out of the loop. The CAT clinic does all of the dosage calculation, Warfarin prescriptions, etc. Webcare's paperwork clearly states that I am NOT to adjust my own Warfarin dose; only the CAT clinic will do that. I am doing weekly measurements. I am on original Medicare, and I think all of the Webcare expense will be covered, but I'm not sure about that yet.

The Webcare training was poor. They violated the basic rule of teaching a skill, because they did NOT have me practice taking a measurement the same way I was told to take a measurement at home. They told me that before taking an INR measurement I should wash my hands with soap and water, and I should NOT use an alcohol swap. But during their training, I did NOT wash my hands with soap and water, and they used an alcohol swap to wipe off my finger. Minor item, but this is not how you teach people skills. Fortunately Pellicle and others have good training videos for all of us to refer to. The Webcare nurse who gave me the training said to call their 800 number if I have any trouble taking an INR measurement.

The Webcare Health phone app is easy to use for reporting the INR. It looks like it will also be easy to order new strips when I need them.

My CAT clinic is at Unitypoint in Cedar Rapids, Iowa, USA. They call me within a few hours after getting a new INR measurement and tell me what dosages to take.

Self management of Warfarin doses has not been offered as an option. I have not asked about it, but the paperwork I've been signing clearly says self management of Warfarin doses is not allowed.
 
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So I am the OP. Still having massive problems with Biotel. Has anyone switched to another company and if so, which one? I now have BCBS insurance so it’s been a nightmare.
 
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Self management of Warfarin doses has not been offered as an option. I have not asked about it, but the paperwork I've been signing clearly says self management of Warfarin doses is not allowed.

Did you determine your warfarin dosage by yourself without permission?

1706588055049.png
 
Did you determine your warfarin dosage by yourself without permission?
this guy apparently did:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477086/apparently the title wasn't well proof read.


We report the case of a patient with a prosthetic aortic valve without any event to date despite not using warfarin for 31 years.
...​
In their study, Andersen et al. (2) reported that after 10 years, there was a 41% incidence of thromboembolism and 17% mortality in 43 patients who discontinued anticoagulation mechanical aortic valve replacement and were followed for a mean period of 7.2 years without anticoagulation.


I wonder how much of people going AWOL is down to how difficult the system makes it for poorer people.
 
But during their training, I did NOT wash my hands with soap and water, and they used an alcohol swap to wipe off my finger. Minor item, but this is not how you teach people skills.
from the Roche manual

1706591218587.png

and
1706591436102.png


I do also recall advisance to specifically not use an alcohol swab because it may provide a contaminant ...
 
So I am the OP. Still having massive problems with Biotel. Has anyone switched to another company and if so, which one? I now have BCBS insurance so it’s been a nightmare.
I also have had issues with Biotel and BCBS insurance. After noting that others bought testing strips on eBay, I received my first order last week. Then on Saturday I received an email that strips would no longer be available to purchase on eBay, but available on their website: selfcaredepot.com.
 
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Then on Saturday I received an email that strips would no longer be available to purchase on eBay,
I wonder how they'll enforce that or if some legislational change has been enacted?
I just checked eBay USA
1706595264802.png


FWIW I buy mine online here in Australia, but I've also reposted another online seller on the East side of the USA recently

I'll be curious to see how this unfolds
 
So I am the OP. Still having massive problems with Biotel. Has anyone switched to another company and if so, which one? I now have BCBS insurance so it’s been a nightmare.

I had to get away from Biotel as well (detailed all they hassles I had with their billing dept earlier in this or other threads). I did not go to another company though, I went to the do-it-yourself model after having ridiculous hassles with billing for 2 out of 3 monitoring companies I used over 8-9 years.

So yeah, there are other companies out there, and I was using one prior to Roche which sold that business to Biotel/Cardionet/Philips/whatever they call themselves. They were called RCS (can't remember what that stands for for sure but think it might be Remote Cardio Services?). I had a problem with their billing dept. though, which caused me to switch to Roche who were great (then everything fell apart/went nuts billing-wise with Biotel/etc, even worse than with RCS).

The problems with RCS' billing might not concern you but went something like this for me. They would properly (unlike Biotel) submit my claims to BC/BS. I would get my EOBs from BC/BS, expecting the bills from RCS to match those EOBs leaving me to then pay RCS my copay not covered by BC/BS. But RCS bills vs the EOBs went into a twilight zone after which they NEVER matched my EOBs which caused me MAJOR hassles because through work I had a medical rewards debit card/account thing which put money into a debit card I would use for medical expenses, and I would USE that card for the RCS bills since they were medical bills through my medical insurance BC/BS.

However the company that oversaw those health account debit card charges etc would use my BC/BS EOBs to match up what my payments should be and since after they no longer matched would deny the charges. Causing me over and over and over and over again to call/fill out paperwork/try to explain what was going on which made no sense so I could get my charges approved. And after a year or so it got to be so damn time consuming (and they tightened up how they handled that approval process making it even more of a PITA) I could not take it any more so I found Roche and switched to them.

Note that I spent hours and hours on this crap trying to get my charges approved while working 15 hour days including calling RCS to try go get them to fix their billing system which they were incapable of doing - the problem was something like once I hit my deductible my insurance paid 90% & I paid only 10% of RCS' charges. Prior to that I had to pay the whole thing up until I hit my deductible. And during the time I had to pay the whole thing eveyrthing was fine (the EOBs and their bills matched). But once that first year hit that I reached my deductible and my insurance paid 90% and I was only responsible for 10% RCS' billing system basically imploded such that at the start of the next year when I should have been billed in full again, their system was billing me only at 10% by mistake. I called RCS about that and let them know - they said not to worry about it, that it would get made up for later as the year went on - which did happen, in that for months they only billed me at 10% incorrectly then for the other months they billed me at nonsensical charges to make up for their deficit in payments, after which nothing EVER matched my EOBS causing the company that oversaw my payments through my work health account to constantly deny my charges. Now, in addition to that hassle, it was so complicated I could not even figure out if they were billing me correct amounts as the months/years/wore on such that even if I did not have that hassle factor of using my medical rewards balance to pay the charges it was really difficult to even know when/if I was being overcharged.

Then after I switched to Roche, RCS continued to bill me ridiculous amounts, exceeding what I even owed them due to their own improper billing system in the first place. I then had to call RCS mutliple times being bounced around to people that had zero understanding of their own billing system and the mess it was then causing me, until finally through mutliple phone calls I was able to get to speak to a high muckety-muck at RCS and reach some kind of agreement as to what I truly owed and was willing to pay that and not one penny more (actually I think I ended up paying for an additional month of service which I was NOT responsible for but was willing to do that to just make them go away).

If you can follow any of that then you deserve a medal! Point is RCS' billing sucked and I cannot recommend them. Biotel/Cardionet/Philips/whatever's billing was even worse. Roche did it right and I would recommend them but they are not in the monitoring business anymore.

So...RCS might be an option for you but I cannot recommend them.
 
If you can follow any of that then you deserve a medal!
Wow, that puts my simple overbilling issues with Biotel to shame. I, for one, will scour the interwebs for test strips to avoid going back to paid testing. I purchased my meter and strips from Reliaston (in the US) and they show as available. Hope I don't have to start meeting a dealer in a dark alley to get supplies.
 
There are a few other providers of INR test meters sold in other parts of the world.

For one reason or other, they aren't approved by the FDA, so they can't (legitimately) be sold in the U.S. They seem to do well in other countries.

The FDA approval process may be too expensive or complicated - however, my understanding is that new devices primarily have to show results that match the results of approved meters - head to head tests matching the new meter to an XS results may be the most important part of the approval process. Of course, even if approved, the meters and strips may be no less expensive than XS, and the strips will probably STILL not be available on eBay.
 
So I am the OP. Still having massive problems with Biotel. Has anyone switched to another company and if so, which one? I now have BCBS insurance so it’s been a nightmare.
When I was in a kerfuffle with their billing department, I looked into other services and I also bought my own coaguchek meter on ebay. However, my dispute has since been settled. This is subject to change with each new insurance plan year so I cannot rule out the possibility of my net cost becoming untenable or arising into a troublesome issue again. Anyway, it seemed to me that there were 4 such services including biotel:
* Remote INR by Biotel / Cardionet (bought Roche Coaguchek Patient Services) - owned by Philips
* mdINR / Advanced Cardio Services - owned by Lincare
* Acelis Connected Health (formerly Alere Home Monitoring) - owned by Abbott
* Remote Cardiac Services

I had contacted mdINR a couple of years ago. I had to ask my cardiologist fill out their enrollment form to prescribe to their service in order to find out what my out of pocket cost would be after insurance. I did not go through this process to find out my costs for the other services. However, I have no insight on these other services since I did not switch services anyway.
Dropping the monitoring service altogether for me would mean getting buy-in from my cardiologist. but I have not yet broached that subject. Otherwise, I am postured for self-testing without a middle-man reporting and supply agent.
I have purchased test strips on a couple of occasions from selfcaredepot via ebay. I was already aware that I could purchase direct from selfcaredepot or reliaston outside of ebay so it looks like that will be the approach now for my next purchase.

When I was trained for home testing, the trainer specifically said that he recommended soap and water only, due to alcohol could contaminate the blood specimen.
I wash with soap and water before my home testing, but when I have tested with a coaguchek at a clinic they use an alcohol swab. I understood that the use of an alcohol swab could conceivably impact the result if you did not allow time for it to completely dry before the finger prick.
 
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