Sent Request to Kaiser Permanente

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kchristian

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Thanks for the great video link on this topic. I want to join the small percentage of self-monitoring individuals and have just emailed my doctor (with Kaiser Permanente) to find out if I can get this covered through them. If not I will do what I need to do to get it on my own. I have complained to both my cardiologist and my primary care doctor about a need for a self-testing device (similar to that for diabetics) to monitor my levels on my own. All they said was that the anticoagulation group does a good job of managing levels and to take my regular (every 3 week) PT/INR tests. Now thanks to this site I found that this technology already exists!

Here is the email I sent:
I would like to move to self monitoring of my anticoagulants. As you know I recently had a 5 hour nose bleed and had to go to ER where I found out that my PT/INR was 4.0 (it was 3.5 just 4 days prior to that). There are several manufacturers available on the market. I have learned that Medicare covers this for mechanical heart valve patients (I am not on Medicare). There are some very informative videos available at http://discoveryhealthcme.discovery.com/anticoagulation/anticoagulation.html if you'd like to check them out (CME credit is available too). The 4 short videos are available under View the Program Online and do not require registration to access. Does Kaiser Permanente offer this to its patients (who qualify)? Since I will probably be taking this therapy for as long as I have this valve managing this level more diligently is of very high importance to me and my family.

Thank you,
Karen Christian


Of course I will post my experiences as I travel down this path.

VW.COM Rocks!
 

erhebergen

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Let us know the reply from your Doc. I asked KP a few months ago, and they said no. However, I didn't ask my doctor.
Regards,
Eric
 
K

kchristian

Guest
Ask and Push Further if Necessary

Ask and Push Further if Necessary

Eric,

I will go up the chain for a final decision on this if need be. As you could see by my email I've learned alot from this group in a few days and have included several points of reference that may help get the attention needed.

You may want to email your doctor via KPs website to see if you get the same response. It would be good for KP to hear from others who are interested and qualify. The more inquries/interest the better. I file formal complaints to Member Services on a regular basis about the Anticoagulation Clinic. I cringe when I have to call them now. In San Diego I have all kinds of issues with them: messages not relayed when I call them back, put on hold indefinately (happened twice - I called them on another line after 15 or 20 minutes and got someone to answer immediately), no call back for several days, sometimes they call my mobile phone which does not have service at my home and is not my primary contact number, playing phone tag while trying to get my PT/INR number (sometimes over a couple days), they do not appear to review my case and understand my diet and medications at times, their phone system is deplorable (I've had 4 different people pick up my call when I was onhold for a particular pharmacist, inconsistent delivery of results to my online records (hopefully that is resolved now), and my primary care and cardiologist think that they do a good job of managing anticoagulants but I have major/confirmed doubts

The email I sent was to the Primary Care Physician. I'll contact my Cardiologist next if needed.

Pushing Forward......
 

dtread

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Karen, I have Kaiser also and they told me that Kaiser would never pay for tester. My cardiologist refused to sign prescription form. So I went to primary and he signed it no problem. I also got him to sign Letter of Medical Necessity. I was then going to do battle with Kaiser Member Services but found a new tester on EBay that met my requirements, and at a very attractive price; probably less than I would have paid even if I had won case with Kaiser (my health plan would have had Kaiser paying half and me paying half, as Durable Medical Equipment - DME). So I went that route, but I know from posts on VR.com that at least some Kaiser members in Calif have gotten Kaiser to pay for at least part of the tester, but it sounded like a protracted effort. You need to do your homework and build a case for why you need tester, and be prepared to answer any objections that they have, like "they're not as accurate as lab test", "we can't control your INR", "who calibrates the tester", etc. Find all the studies you can comparing home testers with lab testers. You can contact the companies that make the testers, they'll probably be happy to furnish you with data. I think the testers should be treated about the same as insulin testers for diabetics. They are FDA approved, and Medicare will pay for one if you qualify for Medicare. But the HMOs haven't bought into it yet, probably due to what it would cost them to furnish testers to so many folks. Good luck!
 
K

kchristian

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New Information

New Information

Dtread thanks for the info. I just got my regular call from the anticoagulation clinic and the pharmacist told me that they have some KP members on self-monitoring and that the best avenue is to request it through my primary care physician. The process should be much easier for those who qualify. Maybe I can help clear some hurdles for others who may choose to go down this path.

As they say at KP: Be well and Thrive!
 

Marty

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McLean, VA
Mid-Atlantic Kaiser says no!

Mid-Atlantic Kaiser says no!

I work as a radiologist at Kaiser Falls Church Virginia. Anticoagulation is handled by a "Coumadin Clinic" managed by two PhD pharmacists. I talked to one of the managers today and she said Kaiser will not pay for self monitors or strips. She said she did not believe the self monitors like INRatio were as accurate as the central lab. I didn't argue but simply thanked her for the information. For those that don't know my history , my cardilogist told me to get a monitor in 1998 at my first post op visit and I've been self testing and and self dosing ever since and my doctors are very happy with it as I am.I trusted Coaguchek for years and now use the INRatio. I get a lab check once a year and we are always close.
 
K

kchristian

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Reporting

Reporting

Marty,

Thanks for the information. I may not get the approval I seek but I'll not give up until I've gone through all the steps (it helps to educate my doctor at the same time too). I also figure the more inquiries from patients the better in dealing with a company like KP. I am prepared to purchase on my own device and supplies if need be.

I was wondering how you go about reporting your results to Kaiser? Do you phone, fax or email them to the Anticoagulation Clinic? How frequently do you do this (if you do it at all)? I presume you manage your own dosage levels. Having an annual lab draw seems like a great idea too.

Also: Another person sent me a link via private message to a previous thread from 2006 about Kaiser Permanent that was most interesting:
http://www.valvereplacement.com/forums/showthread.php?t=18846
 

dtread

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Karen, that link you posted did not work, but I was familiar with that thread. Recommend you get Prescription Form and Letter of Medical Necessity signed by Doctor before you do anything. If your present Doctor won't sign the forms, keep selecting new Doctors until you find one that will sign. Also, gather as much research as you can to reinforce your case as to why the home testers are just as accurate, etc. When you've done all that, then approach them to ask them to pay for their share as DME, and provide them with a solid case, and the supporting forms and documentation.

Regarding Coumadin Clinic, they had me going in about once a week right after the surgery, then spaced it out to about once every two weeks. That's a lot of vein sticks, plus it takes me about an hour when I go to one of the labs (round trip travel time, waiting at lab, etc). I can do the home test in about three minutes. I discussed with my primary and he wrote me up for getting lab sample once every three months, so that I can compare results from lab sample to home tester; to ensure that home tester is accurate. I am not providing the Coumadin Clinic with my results. I guess that could be done; possibly if you purchase the optional printer (I did not), or possibly by downloading information from your home tester, if it has that capability.
 

Marty

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Sorry, Karen, I can't help you with your question about how you should interact with your Kaiser doctors if you pursue self testing and perhaps self dosing. I was employed by Kaiser after retiring from private practise but I have Medicare and I kept my relationship with my private practise doctors.
My surgeon and cardiologist discharged me to a general internist who incidentally they use for their PCP. He sees me if needed during the year but I have been lucky and had no serious problems. He does not ask me to keep him informed of the details about my anticoagulation monitoring or dosing. Once a year I have a complete physical exam and at that time he draws blood for a zillion tests and includes a protime/INR. I usually test with my monitor the day before to get some kind of comparison. All of my yearly lab tests have measured safely between INR 2.5-3.5. And thats all that matters to my very practical and sensible PCP. I would hope you can find a PCP at Kaiser to do this for you. I will say this ;I am very impressed with Kaiser doctors who I have found as good and in some cases better than those I worked with in private practise.
 
R

ruth

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Can I hyjack this thread for a quick question please

Can I hyjack this thread for a quick question please

Speaking of Kaiser, my HMO.

I am on Coumadin due to AFib after my repair. I'm hopeful I'll get off it at some point so I'm not pursuing home monitoring at this point.

BUT, may I ask... Every time I go to do an INR check they send me to the lab for a blood draw from my arm. No finger pricks for them. Is that standard procedure? Should I be frustrated that they jab me in my arm monthly? (I have small weak veins BTW). The lab is free so no complaints there but ouch!

I wish you the best in your pursuit of home monitoring....

Peace,
Ruth
 
K

kchristian

Guest
Arm Draw

Arm Draw

Ruth,

I have been having INR draws since August 2006 and each is a blood draw from the arm by the Kaiser lab. No finger sticks there :mad: I know it can be a bit of a pain. I get mine done every 2 weeks now. I change arms each time and it is marked in my calendar (L or R). In preparation for the event you may want to be sure to drink lots of fluid/water the day before (increase the volume of blood in your body) and warm your body by exercise or clothing or a heating pad (especially your arm). Sometimes I don't feel a thing and other times (like today) it is a bit of a pain and a burning sensation. This can also be due to the skill of the phlebotomist. I don't like to watch (my husband watches when he has blood work done but then he was an EMT/fireman). I've only had it happen one time where they had to stick me multiple times (double ouch).

One additional thought: my son had to have blood work done when he was 10 years old and we found that we could request a butterly needle (much smaller one) and that helped with the stick pain. You may want to ask the phlebotomist if they can use a smaller needle due to your specific situation. It can't hurt to ask.

I hope you get off coumadin soon.

Wishing you good health...
 
K

kchristian

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Thanks

Thanks

dtread said:
Karen, that link you posted did not work, but I was familiar with that thread. Recommend you get Prescription Form and Letter of Medical Necessity signed by Doctor before you do anything. If your present Doctor won't sign the forms, keep selecting new Doctors until you find one that will sign. Also, gather as much research as you can to reinforce your case as to why the home testers are just as accurate, etc. When you've done all that, then approach them to ask them to pay for their share as DME, and provide them with a solid case, and the supporting forms and documentation.
Dan,
Thanks for letting me know about the broken link. I have updated the one in the original post above. Here it is again: http://www.valvereplacement.com/forums/showthread.php?t=18846

I appreciate your advice and have taken note of the specifics indicated. I have been doing quite a bit of research (the Internet is a marvelous tool) and have the recent ER event to point to as a valid concern regarding the ability of the Anticoagulation Clinic to adequately monitor and control my INR levels. I am waiting for the next response from my primary care physician to determine my next course of action. His most recent email was either testing me on my knowledge of self-monitoring or indicating a lack of experience on his part with this kind of request (it may be the first one he's received).

As to reporting the information I was planning to track my INR and dosage in Excel and not be concerned about printing or downloading it. In fact this is something that I will begin now (along with a comment area for changes or issues).
 
K

kchristian

Guest
Marty said:
I am very impressed with Kaiser doctors who I have found as good and in some cases better than those I worked with in private practise.
Thanks Marty. I too have been impressed with the doctors at Kaiser and I've had the opportunity to deal with many different departments in the last 10 years. I have been very fortunate in finding and working with physicians and medical staff there who are caring, concerned, knowledgeable, communicative and reasonable. I've only had issues with a few of the adjunct departments and calls to Member Services appear to have made a difference in practices in those areas.

My request may end up being just a small test of the KP system. I'll continue to post here as new information becomes available.
 

dtread

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Karen, the link now works, thanks. The labs use different testers than the home testers so they need more blood than what can be gleaned from a finger stick. So they have to do a vein stick. But, they can use different vein locations than just the inside of your elbow. However, you have to specifically ask them to do the stick in some other location. The veins on the inside of my elbows are total scar tissue after the years and years of blood donations that I did before I went on Warfarin. That is just one more reason why I got a home tester; i.e., to avoid any more scar tissue. My arm frequently goes numb if I have my arm at any more than a right angle, e.g., when sleeping. However, at one lab draw I had recently the technician used a smaller gauge needle for the vein stick that had a small plastic tube that connected to the container for the blood. I should have gotten more information on exactly what that was in comparison to the standard needles they use, but forgot to do it. Bottom line: if you have to get a lab draw done you could just ask whether they have any smaller gauge needles that they could use, and whether they can do the stick in different vein.
 

Marty

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Self testing way to go

Self testing way to go

I think the Kaiser Coumadin clinics must work better than the hospital lab I was referred to.I would go in a waiting room with a lot of sick patients. Eventually I would be called for the arm stick. I'm 82 and have had my troubles and one of them is I've about run out of veins.After the blood was drawn ,I'm not sure how it was handled but I'd go home and wait for a call from the doctors office. Sometimes it was a long wait ;next day or two, and I'd get a call from a nurse or a tech ,never the doctor. Sometimes I felt they did not know what they were doing. Thank goodness the cardiologist early on prescribed a Coaguchek. Now I test in 5 minutes and know the result. Recently my wife Alice,age 80, developed A-fib. The cardiologists put her on warfarin and were very happy to have me manage her. We're just getting started. I've tested her three times in 10 days and now have her at INR 3.4. I think she's going to wind up stabilizing at 25 to 28 mgm/week. I'm happy we havn't had to wait in the hospital lab and then wait for a phone call.Karen I'd advise you to buy a monitor your self and pay for the strips out of pocket. It may be economical for you.I do think your Kaiser PCP should be informed and OK it.We know the Kaiser pharmacists don't agree but we can disagree without being disagreeable. Just tell your doctor you'll bring him a spread sheet once a month or more often if requested recording your dose and test results. Alice's doctor said that was all he needed.He said it is well established that self testers stay in range better than patients referred to central labs. Good luck.
 
K

kchristian

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All in the Family

All in the Family

Marty,

How wonderful that you and your wife are now self-monitoring together! Marty I know that you and your 'bride' will 'stick together' for many, many years. :) I agree that unnecessary exposure to sickies in the waiting area is not a good thing for anyone and particularly not for those of us who may have slightly compromised immune systems who could be at greater risk.

Yes Kaiser is much the same sort of setup as private labs. I had to go there last week and was recovering from a bad cold at that time. I would have much rather have tested at home. I would have gone to the lab a week later (when I felt better) except for the 'need' to get my INR tested.

I checked my most recent INR test results (from Wednesday) and found that KP had the results 8 minutes after the blood was drawn but I was not notified until the next day (they call you if the result is out of therapeutic range [2.5-3.5] or, as in my case, have requested closer monitoring - try to stay in 2.5-3.0 range to avoid bleeding issues). Bad advice given by the Anticoagulation Clinic in the past has included 'Don't have a salad or eat a lot of greens within 2 days of a test.' Now that is just preparing for a good test result and does not address the variability of the numbers during the past 2 or 3 weeks. That advice startled me at the time but made me start to dig into what really goes on with this 'rat poison' we are taking. I know that although their system may work for most people most of the time I do not consider myself one of the mainstreamers.

Yes I will purchase my own unit if I do not get approval from KP. So far I like the INRatio the best and I've heard from someone here that that is the unit KP has approved. I heard from another KP member (in Northern CA) who indicated that they were the first approved for self-monitoring equipment in their area (over a year ago). They also qualified for Medicare where I do not (only 55 and still working).

I am of the generation that is willing to question authority (respectfully). My husband and I 'educated' his psychiatrist (KP) about 2 years ago. It was a most interesting experience (and not without some negative reaction initially). I know that I am educating my primary care physician and will continue to do so. He is open to listening and learning which is good. This process is not just about me but anyone else who wants to get self-monitoring equipment. Some of us have to just keep asking for good quality health services.

Stay well.....
 

Marty

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Wonderful, Karen. Patients like you will "educate" Kaiser and make self testing available to more patients.
 
K

kchristian

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Vein Stick

Vein Stick

dtread said:
But, they can use different vein locations than just the inside of your elbow. However, you have to specifically ask them to do the stick in some other location...... if you have to get a lab draw done you could just ask whether they have any smaller gauge needles that they could use, and whether they can do the stick in different vein.
Dan,

Thanks for the info (and clarification). It could be a big help to Ruth.

Yes I recall having sticks done in other areas in the past. My daughter (19 at the time) was severely dehydrated due to tonsillitis and they had to 'find' a vein. The term 'butterfly needle' was what was used when my son (who was 8 to 10 years old) had frequent blood work done. He would then request it as he knew it was less painful. http://en.wikipedia.org/wiki/Butterfly_needle

BTW: Thanks for all your blood donations in the past. I was a regular blood donor (O-) until they found out I had a leaky valve.
 

TinaK

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Jan 29, 2008
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Location
Temecula, CA
I will be interested to know if they allow home testing. I go to the Wildomar Kaiser to get stuck, then the Riverside Coumadin Clinic calls. I complained a few times and now they seem to have their act together. Of course, I am still in recovery mode so the hour it takes to give blood is no big deal. I worry about how I am going to take time out of my schedule after I go back to work, home monitoring would be so much better.
 
R

ruth

Guest
Thanks all!

Unfortunately I've got really crummy veins so I'm down to just my right arm as an option. All my life I've had phlebotimists complain to me that I have the worst veins they've ever seen. I'm a tough cookie for them, I make a point of coming in once per month max even if they tell me 2 weeks. I just can't afford any more scar tissue than that. If I had a mech valve I'd be more vigilant. I've been bored and read their rules on the wall & it says they have to use the butterfly for INR checks, I guess cause we're "regulars". I get mad at them if the pull out the big honkin needles on me! :eek:

I have Kaiser website access and the results come in at about 8pm when I visit the lab just before closing at 5pm. Not bad. That way when they call me I already know the INR number. By & large I think their advice when they call is sometimes suspect but I pretty much just follow my own common sense if they tell me something that seems wrong.

Peace,
Ruth
 
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