Remote INR taking over Coaguchek

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Protimenow

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If it's Philips, it's probably the conglomerate that makes a LOT of stuff - Sonicare Toothbrushes, Electric Shavers, and other consumer goods. They probably make a lot of more industrial stuff.

I wouldn't be too surprised if they took over from the shadow company (?) that originally licensed the testing service from Roche. THIS company should know how to bill you and/or your Insurance carrier.
 

RAS

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They now call themselves "Philips"

Royal Philips merged with BioTelemtery late last year. I think that was less than 6 months after BioTel acquired the Coaguchek service from Roche. So the billing delays many of us have experienced are no surprise. I was actually pleased (in my case at least) that there were no operational snags in ordering supplies.

I worked in Finance / Financial Systems IT for several decades and did many system conversions. Billing/AR is the most difficult and time consuming. In this case there are 3 entities involved and I doubt the Roche A/R was converted to BioTel systems before the Philips merger. I have no idea what their conversion strategy is in this situation, but 12-18 month timelines to complete conversions is common. Typically back office functions are shared services and therefore not easily portable to the acquiring entity.

My own Coaguchek ordering/billing experience has gone like this:
  1. Supplies ordered while Roche owned Coaguchek have not been billed yet, however insurance claim submitted and EOB received.
  2. Supplies ordered post BioTel acquisition and pre Philips merger have been billed with the paperwork and address listing Biotel. There were no issues with ordering supplies.
  3. Supplies ordered post Royal merger have not been billed yet. Also no issues with ordering supplies.
My expectation is that #1 above will eventually be billed, once they convert A/R.
In this situation where a relatively small company buys a division of a much larger company, there is often a service agreement in place where the original company will perform billing (and other back office functions) as a service (for a price) for a period of time until the acquiring company can take over. This may be until the pre-acquisition A/R is all billed and collected or until it is converted. I'm guessing there was no such agreement in place. If that is the case, then I would not expect to see a bill until the A/R is converted - possibly sometime between mid and end of this year. There is also the possibility (unlikely) that Roche did not include the outstanding receivables in the assets to be turned over to BioTel. In that case, it is still up to Roche to invoice clients. However, I would have expected that to already have happened.

#2 played out as I would expect. They rather quickly rebranded the web-site, and - just speculation - BioTel probably took over the operation of Coaguchek relatively quickly since it was likely a separate operating unit of Roche and therefore more easily portable to the acquiring company. They probably redirected all order transaction feeds (along with the client masterfile) to the BioTel financial system and therefore were able to process billing and A/R going forward in their own system. Getting that setup would still have taken time but it would normally be the priority ahead of converting the pre-acquisition A/R.

#3 My guess is BioTel CoaguChek service is still operating independently for the most part since the web site branding has not changed. The Royal acquisition just closed in February. The CoaguChek website remains BioTel branded, but since you have already heard Philips on their IVR it is likely that branding will change as well.
 

Sheenas7

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Here's a couple weird things lately regarding "Biotel Heart" who took over my monitoring from Roche.

(1) I finally got an EOB from my insurance for my year 2020 Biotel charges about a month ago. However I still have not received a bill from Biotel for my portion.

(2) Calling in a test result last night Biotel's answering message system has changed. They no longer mention Biotel etc. They now call themselves "Philips" (or Phillips?). I assume they have been bought out/merged (??). Have no idea. My impressions of them as mentioned earlier in the thread were not great at all (unable to call in my INR for weeks after they took over because of problems with their system, not getting billed for 10 months, them not being able to answer anything when I asked when I would be billed or how much multiple times etc). Maybe Philips will or is getting their act together (?). Who is Philips anyway??
I have been dealing with Biotel and my insurance. They corrected an error on billing me for something my insurance pays (Cigna). I guess we will see if things are better now. Phillips? I haven't heard that name but I didn't call this week because I went to Quest labs since I had to get a blood draw for something else. Hope they have it together.......
 

Protimenow

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If you use consumer electronics, you've seen the Philips name -- Sonicare Toothbrushes, Philips electric shavers, lots of other goods with the Philips name on them. Now that you're sensitive to the name, they'll shout out at you.

I'm glad that I self-test -- I own my meter, I self-manage, I pay for this stuff myself.

When Bio--Tel and Philips finally get their billing stuff together, I wonder if they'll send out a MASSIVE bill for the services that haven't been billed for a year or more. I'm happy that I won't have to worry about such a bombshell.

OTOH - they may not bill for the time when their billing systems were messed up -- it's not the customer or insurance company's fault that they weren't billed - and start billing when stuff is actually working again.
 

MdaPA

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OTOH - they may not bill for the time when their billing systems were messed up -- it's not the customer or insurance company's fault that they weren't billed - and start billing when stuff is actually working again.
I checked my wife's insurance claims and see that they just recently billed her insurance for all the outstanding bills (6 months worth) from last year and for Jan 2021 so it looks like they are getting caught-up now. She wont owe anything for last year's claims, as she met her out-of-pocket limit, but will have to pay her co-insurance (10% of $101.43) for this year when she finally receives the bill(s).
 

slipkid

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Wow. This billing stuff is totally crazy.

I mentioned earlier that I FINALLY got a statement from my insurer (BC/BS) that shows that "Biotel" has billed them; which took about 8-9 months to get submitted....

I actually got two statements, the first dated March 7, 2021 that said that Biotel billed BC/BS $880.00 for a "medical service" dated 12/01/2020 for that month (note that I used to be billed about $120-150 for this same service for Roche and the previous supplier).

Of that $880 BC/BS allowed only $11.76 to be charged to me. And I was only responsible for 10% of that since I had already reached my deductible for 2020, which means BC/BS pays 90% ($10.58) & I only am responsible for 10% of charges ($1.18).

The second statement was dated April 13, 2021. That statement was for charges incurred dated 1/7/2021 and 2/19/2021. Again billed $880.00 for each month. Again knocked down by BC/BS to an "allowable" $11.76. This time I am responsible for all $11.76 for each month.

So as of April 13th I owed "Biotel" $11.76 + $11.76 + $1.18 (total of $24.70).

As of today, July 12th, I have still not actually received any bills for any amounts from Biotel (or whatever they are called now) for me to pay them. Or any statements from BC/BS showing I was billed for March through June 2021 yet.

HOWEVER, in today's mail I got another statement from BC/BS.

This statement concerns MULTIPLE bills presented from Biotel, some actually duplicates of each other listing the exact same service dates - 7/6/2020, 8/18/2020, 7/6/2020 (yet again), 11/3/2020, and 9/23/2020. All for $880 each for a total of $4,400 (!!!).

And BC/BS DENIED every single one of them saying that the claims were submitted after the filing limit!!!!

What a mess. In my experience Biotel is going to resubmit the bills/follow some kind of repeal process and get their bills "approved". I am just praying that BC/BS in the end doesn't screw me and allow them the full $880/month for those bills. I've seen that sort of screwup happen as well. Welcome to "healthcare" in the United States circa the 21st century.
 

Chuck C

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7/6/2020, 8/18/2020, 7/6/2020 (yet again), 11/3/2020, and 9/23/2020. All for $880 each for a total of $4,400 (!!!).
Am I understanding this correctly, that they are billing $ 880 rental per month, for a device that one can own new for less than $600? I gather that so far the insurance has been forcing them to adjust the bill down drastically, but wow!

I'm very happy with my used one that I bought for $ 220 and glad that I don't have to deal with all of that hassle. It might be worth the investment to get your own to save the time in dealing with them, and to remove the concern that they might try to stick you with any of those big charges if the insurance denies them. If you remain under your deductible and have to pick up the charge yourself, even at the significantly adjusted rate, it sounds like the device will pay for itself in 2-3 years, at least if you get a decent deal on a used one. There is something to be said for having the independent freedom of owning your own device and to not have to jump through their hoops.
 

MdaPA

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Again billed $880.00 for each month. Again knocked down by BC/BS to an "allowable" $11.76. This time I am responsible for all $11.76 for each month.
May I ask what BC/BS plan you have? I'm also in PA and looking at a BC/BS ACA plan (Personal Choice Gold plan) and trying to understand what the "allowable" amount will be. Also, does your Dr. charge a fee each time he/she gets your test results from Biotel? If so, what is the "allowable" amount for that?

This statement concerns MULTIPLE bills presented from Biotel, some actually duplicates of each other listing the exact same service dates - 7/6/2020, 8/18/2020, 7/6/2020 (yet again), 11/3/2020, and 9/23/2020. All for $880 each for a total of $4,400 (!!!).

And BC/BS DENIED every single one of them saying that the claims were submitted after the filing limit!!!!
You should not be responsible for these bills.

Biotel is going to resubmit the bills/follow some kind of repeal process and get their bills "approved". I am just praying that BC/BS in the end doesn't screw me and allow them the full $880/month for those bills.
You should only be responsible for paying your deductible/co-insurance only if/after approved by your insurance co.

As of today, July 12th, I have still not actually received any bills for any amounts from Biotel (or whatever they are called now) for me to pay them. Or any statements from BC/BS showing I was billed for March through June 2021 yet.
My wife has not seen any 2021 bills from Biotel since Jan as well as a bunch of bills from 2020. I'm sure we will get them when they get their billing systems caught up after the transition.
 
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MdaPA

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Am I understanding this correctly, that they are billing $ 880 rental per month, for a device that one can own new for less than $600? I gather that so far the insurance has been forcing them to adjust the bill down drastically, but wow!
Yes, as you stated, Biotel, as well as other providers and facilities, bill the highest amount they can but the negotiated in-network rate (aka "allowable" amount) with the insurance co is usually lower, and in this case, much lower. If you didn't have insurance or used out-of-network benefits, then you could pay the higher amount unless you negotiated a discount/different amount up-front.

Like anything else, some like the convenience of using a service (e.g. Biotel) but will usually pay more than if they bought their own equipment and supplies.
 

RAS

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got a statement from my insurer (BC/BS) that shows that "Biotel" has billed them;
I've posted on the billing situation before, but it's worth repeating - the $880 is irrelevant to your cost and your insurers cost.
I worked for about 5 years providing telecommunication services to healthcare providers and insurers and as a result had some exposure to claims and revenue cycle.

I assume what you are describing here as a "statement" is your explanation of benefits (EOB) sent to you by your insurer.
Just to be clear for all reading this, the EOB is not a "billing" document from either the provider or the insurer. It does however communicate information (sometimes cryptic) that gives you an idea of what you will probably owe when/if your provider invoices you.

Different insurers vary in how they present info on the EOB. I'll just give you a couple examples from mine (Medica). One example from the Roche era, and one from Biotel

Date of Service: 6/22/2020
Provider: Roche Health Solutions Inc
Description: Professional Service
Status: Approved
Total Charges: $250.00
Discounted Balance: $137.00
Plan Paid $0.00
You Owe: $113.00

Date of Service: 3/21/2021
Provider: Bio Tel Inr LLc
Description: Professional Service
Status: Approved
Total Charges: $880.00
Discounted Balance: $767.00
Plan Paid $0.00
You Owe: $113.00

Status: This gives you an idea whether the claim is final or has some other action. Medica uses the term "Approved" Other statuses I've seen are reversal, re-submission, denied, etc. You might see the same claim submitted multiple times each with different status. There might also be some codes and footnotes explaining further.

Total Charges: This is the "Chargemaster" price. Think of it as a list price, MSRP, etc. Again - different insurers use different terms.
- The insurance company never pays this price.
- Patients with insurance for covered services don't pay this price. There may be exceptions where a patient will get a service that the insurance does not deem required/covered in their situation. Generally you can negotiate (preferably in advance) to the insured contract price or even less. It's surprising the discounts you can get by simply calling the provider billing department.
- Patients without insurance (or an uncovered service) only pay this price if they have sufficient wealth (i.e. not qualified for a poverty situation or unable to pay for some other reason), and have terrible/non-existent negotiation skills.
Providers and Insurers have contracts that specify the price for each service. I don't know for sure why the insurance company shows the Chargemaster price, but just speculating that they want to show you how much money they are "saving" you. Unfortunately, I think it leads to more confusion than clarity.

Discounted Balance: This is the difference between the Total Charges(Chargemaster) and the contract price.
6/22/20 claim from Roche: $137. I can back into the contract price as follows: 250-137=113.
3/21/21 claim from Biotel: $767. Contract price: 880-767=113.
Insurers I used in the past would use the term "Plan Cost" (contract price) and show the $113 rather than the difference between Chargemaster and Contract price. My insurer does the opposite, but it's easy to calculate contract price as shown above. The $113 is what will be paid to the provider in total between the insurer and the patient.

Plan Paid: This is the portion of the contract price that the insurer paid. This is dependent on the particular coverage the patient has. The deductible balance as of the service date, the copay or co-insurance amount, etc. In my case, the cost of strips is my obligation until I fulfill the deductible. If I had fulfilled the deductible, then I would pay 50% co-insurance of the $113 and the plan would pay 50%. ($56.5 each). Of course this amount will vary considerable depending on your plan and your deductible situation.

You Owe: This is what the patient owes. In my case - the full $113 contract price since I still have a deductible balance.

In summary, the $880 chargemaster price under Biotel did not change what the insurance contract price is for the test strips/meter. This is over two calendar years so far. No way to predict the future contract price, but generally it depends on the size of the insurer's patient population that are likely to use each service. The more usage an insurer brings to the provider for a given service, the lower price they can get for that service.


And BC/BS DENIED every single one of them saying that the claims were submitted after the filing limit!!!!
There are claim submission time limits in some contracts. There are also some jurisdictions that have billing timeline statutes. In other words, if the provider did not bill within the defined legal timeframe, then they can't bill and collect from the patient. I don't know how your situation will play out in the end, but @slipkid it looks like you got free strips!

In my case, I have been billed slowly, but consistently by Biotel for each shipment since they acquired the service (and since they were in turn acquired by Philips), but I never received a bill from Roche for the 6/22/20 shipment. Maybe I never will!

Anyway all of that was a rather long explanation for why you should ignore the $880 "Chargemaster" price. Neither you or Blue Cross will pay that.
 

Chuck C

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Generally you can negotiate (preferably in advance) to the insured contract price or even less. It's surprising the discounts you can get by simply calling the provider billing department.
I would agree. It is always worth calling to ask for a discount. I'll share my 2018 eye injury story which overlaps with a couple of your points.

In 2018 I had an eye injury which sent me to emergency. I ultimately had to be sent by ambulance to another hospital for an emergency surgery- blowout orbital fracture, with entrapment. I was supposed to be sent to Loma Linda Hospital in Orange County for the surgery, but they were at full capacity so they sent me to University of Riverside Hospital, which happens to be out of network. The surgical team travelled from Loma Linda over to Riverside to perform the operation.

Because they were out of network, Riverside charged retail price for all hospital services - MSRP as you say. It was a big bill. I had gone over my deductible at the first hospital emergency room, so it was my carrier that had responsibility for all of it. It was a big one. My carrier tried to negotiate for 6 months but the university would not budge and they ultimately paid the full billing amount, which I am certain was well over any contracted rate. So, there is a reason why they start out with these egregious price tags for services- sometimes they hit the lottery and they get a situation where someone has to pay full price.

Negotiating bills:

My deductible was $ 10,500, which was reached at the Loma Linda emergency branch in my area. The hospital portion was about $7,000, which already had the contracted reduction. I called billing and explained that I was paying out of pocket for it and was swamped with bills, asking if they could do anything. She told me that if I was able to pay right then by credit card that she would give me a special cash discount price and knock $5,500 off it. I whipped out my credit card as quick as I could- so effectively, with one 5 minute call I saved $5,500. They usually say no, but sometimes they say yes, so always ask, especially when it is a big one and you are still under your deductible.

Another interesting thing happened while at the emergency room. Loma Linda is in my network, but apparently, that does not mean that the physician who sees you in emergency is in network. She was not. She spent about a total of 30 minutes with me and billed me $ 5,000, which is insanity. My insurance said that only $ 500 would count towards my deductible, as that would have been their contracted rate if she was in network. I spoke to her billing company, explaining the amount approved on my EOB and they told me it was tough luck. Even though she was doing rounds at a hospital in my network, she was not in network and they were not obligated to honor the contracted rate of $ 500. This seemed criminal and, actually it was.

So, I did a little research and found out that this type of billing surprise happens a lot. It also turns out that the prior year the CA legislature passed AB-72 protecting patients from these charges. I printed a copy of AB-72 and a copy of my EOB and mailed them a check for $ 500. The law was on my side and they dropped it.

AB-72

"The California law, which took effect in July 2017, protects consumers who use an in-network hospital or other facility from being hit with surprise bills when cared for by a doctor who has not contracted with their insurer. If that happens, consumers are responsible only for the copayment or other cost sharing that they would have owed if they had been seen by an in-network doctor."

Source: California Surprise-Billing Law Protects Patients But Aggravates Many Doctors
 

slipkid

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May I ask what BC/BS plan you have? I'm also in PA and looking at a BC/BS ACA plan (Personal Choice Gold plan) and trying to understand what the "allowable" amount will be.
Mine is through Anthem BC/BS of Georgia since that is where the corporate headquarters are of were I work. It is called "Healthplus Premium PPO".

Being through Anthem BC/BS caused me quite a bit of pain as I discovered way back when I tried to use Alere as per my cardiologist at the time in 2014, because Anthem BC/BS had a "contract" with Alere & they were "in network" but whatever crazy Pennsylvania BC/BS billing system handled this did NOT, so despite my having BC/BS that DID cover it, there was something called a "blue gap" which prevented me from being able to use my insurance to cover bills from Alere. This took me something like 3-6 weeks to figure out what was going on. Most of the people at Alere did not understand it (I came up as "in network" from what they saw), neither did BC/BS, very very long and twisty story.

Also, does your Dr. charge a fee each time he/she gets your test results from Biotel? If so, what is the "allowable" amount for that?
No my Dr does not charge me anything. He hardly even ever bothers to look at the results and I manage myself. He is on there as name only I guess. If I were to have a dangerously high or low INR I assume he would be notified and do something, but from my contact with Drs over the years I've learned that most of the time they have no idea what they are doing, and don't do a thing like they are supposed to....
 

Unicusp

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AB-72

"The California law, which took effect in July 2017, protects consumers who use an in-network hospital or other facility from being hit with surprise bills when cared for by a doctor who has not contracted with their insurer. If that happens, consumers are responsible only for the copayment or other cost sharing that they would have owed if they had been seen by an in-network doctor."

Source: California Surprise-Billing Law Protects Patients But Aggravates Many Doctors
Nice. I wish we had that law in PA because I got hit with the same BS with my passing out event this past December, the start of my road to second surgery. Went to the ER (on a Sunday night) for pretty bad open bleeding facial wounds and they said that they were an In-Network facility. Turned out that the only Doctor on-duty who did the suturing, was not In-Network. Got hit with some insane bills.
 

slipkid

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Nice. I wish we had that law in PA because I got hit with the same BS with my passing out event this past December, the start of my road to second surgery. Went to the ER (on a Sunday night) for pretty bad open bleeding facial wounds and they said that they were an In-Network facility. Turned out that the only Doctor on-duty who did the suturing, was not In-Network. Got hit with some insane bills.
Similar story for me when I was brought to ER following heart attack.

Was taken to local hospital 5 minutes from where I was at work when I collapsed (if not might be dead) and about 30 mins from where I live.

At some point a lady Dr came into my curtained area in the ER and talked to me for about 1-2 minutes tops, told me I had/was having a heart attack, that I was stabilized, and would be taken up to the cath lab very shortly.

Weeks/months later during my recovery from the heart attack & open heart surgery I got a bill for several hundred $$ for that "service" which was considered "out of network" by BC/BS.

I could not understand why/how I could be billed for something "out of network" when I was taken to the ER of an in network hospital. Most people know about this phenomenon now as it has gotten some press in recent years but at that time it was a huge shock.

I questioned the charge by calling BC/BS but was told the Dr was NOT in network so I had to pay that bill as such.

I called her practice to inquire further since BC/BS was NO HELP AT ALL and THANKFULLY they told me that it was utter nonsense, that it happens to their practice ALL THE TIME (this Dr was on loan covering that ER although her actual practice was not even in this state), and they gave me the best health care/insurance/coverage advice I have ever received in my life - which was to KEEP CALLING BC/BS and complain/question this until I could get someone on the phone who understood what the actual policy was and if it takes 100 phone calls or more, keep calling and calling and calling.

That strategy worked - eventually I was able to get a customer rep on the phone who actually knew how to do her job and was willing to help me.

According to her when the reps check your coverage/bill in regards to emergency room etc coverage - at least with MY PLAN - the rep had to click on some other button/option in their system with that charge at which point a window pops up and shows an EXCEPTION for the out of network charge, being if in an ER/emergency (or maybe it was this specific case of being in an ER/hospital that was in network but seen by an out of network Dr there) it is to be covered IN NETWORK.

If not for her (THANK YOU ANNETTE) I would have been stuck with that bill. She was so great that she gave me her own phone # and helped me straighten out a lot of crap insurance wise as time went on. It simply boiled down to getting someone at BC/BS who not only CARED & WANTED to HELP patients but also was experienced enough to know how to go about doing it....
 

LondonAndy

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I know it has been said before, but I am so glad I don't live under the American system of health care! Here in the UK my ambulance to hospital, tests, OHS for the valve replacement and then an operation for a pacemaker to be inserted were free. I bought my own INR meter directly from Roche (£299 / US$415 in 2014, still the same price if I needed one today), test weekly using strips provided on prescription (which would be £10 / US$13.90 per 24 strips if I had to pay, but like approx 90% of people my prescriptions are free). I provide a test result once every 2 months or so to my local anticoagulation clinic, but if I needed their help for something this can be done any time. No charge.

My elderly mother had a tissue valve inserted in 2009. Her hospital bed overlooked the Houses of Parliament, though apparently the food was not great. She had a small stroke a few years ago, and fell and broke her hip in the street about 2 years ago. She has lost her mobility, and has been provided with a hospital bed with full electrical adjustment, for free, including delivery and set up to use at home.

Yes, we pay higher tax, and our system is far from perfect, but on balance I think it is the better approach to health care. And no, I am not a socialist :)
 

Michael O

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Similar story for me when I was brought to ER following heart attack.
Similar story for a co-worker in FL. Her delivery - all docs, anesthesiologists, etc - pre-approved as in-network by Humana. Baby shows up 7 days early and won't wait, so her scheduled doc/etc weren't available. Bill shows up for $234827948237948 because the delivery on staff weren't all in-network.

Took months of fighting w/ Humana to get it covered, but she had to borrow from friends, family to pay the hospital before they sent it to collections.

Oddly, this crossed my desk today: Administration Issues Initial Rule Limiting 'Surprise' Medical Bills - current admin's HHS is building rules so hospitals can't ding you for emergency care delivered by non-network providers, or by care delivered by non-network providers at in-network facilities. Won't start until 1/1/22, though.

Happy to bounce this to a separate thread if it's more appropriate.
 
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Lynn

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Not to side track the thread, but like LondonAndy reading this makes me so
grateful that the only card I take out of my wallet when I go to the hospital is my Health Services Card. No system is perfect but the administrative cost to the U.S. system must be astronomical. Never mind the stress of navigating it. I go crazy just navigating my supplementary insurance plan that covers peri medical services and the portion of prescriptions not covered by Provincial Health Services plan here in Canada. Coaguchek is not covered, so as I say no system is perfect. But I bought the meter new for $450 Cad and the test strips seem to be sometimes covered by my supplementary plan, sometimes not.
 

slipkid

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Oddly, this crossed my desk today: Administration Issues Initial Rule Limiting 'Surprise' Medical Bills - current admin's HHS is building rules so hospitals can't ding you for emergency care delivered by non-network providers, or by care delivered by non-network providers at in-network facilities. Won't start until 1/1/22, though.
I vaguely remember talk of such legislation to ban "surprise" healthcare bills being discussed in congress for years (?) but that it was defeated or delayed (thx to lobbyists of the industry of course). As usual in this country everything designed for actual citizens gets pushed to the side in favor of industry benefits or becomes so watered down & underwritten to be almost worthless (or at least delayed for long periods of time until the tide of public sentiment finally pushes it into motion). Don't get me started.
 
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