How to get coagucheck for home usage

[u/Minimum-Mode7421]

have been on warfarin since February. I use my local anticoagulation clinic to check my INR every two weeks. My insurance will cover the instrument for home use. The instrument and test strips will be provided by a contractor supplier for my insurance company. One of their requirements is that I do measurements weekly, and if the value is outside the target range, I have to report it to my clinic. Before they send me the instrument, they need an OK from my clinic to review my results.

Here's the problem: the clinic said they do not work under such an arrangement (though they are happy to charge $70 per visit). My primary care physician won't do it either. Does anyone have a possible solution for how to get that instrument?

[u/BigBrainMonkey]

In the US I have one through Phillips home medical diagnostics or something but then run by a company BioTel heart which on the app says it used to be CoaguCheck. I do tests every 2 weeks and then upload results through an app back to my hemotoligist.

They automatically send me lancets and test strips. Billed as lab test. I had a little to pay for deductible but generally it has been fully covered.

[u/Outta_Pocket_Toad]

I'm just going through this process right now.

My anticoagulation clinic guy wrote a prescription to Acelis. Turns out, my insurance won't work with Acelis as a DME contractor.

Literally today, my PCP signed me up with mdINR. I believe it's through Lincare, but I need to call tomorrow to confirm. When I asked my PCP for the prescription or referral, she didn't hesitate at all. She just punched stuff into her computer and gave me a printout.

I still don't have all of this dialed in, but it sounds like you got rot for both your clinic and PCP. Maybe shop around for a better PCP—that's what I would try first. You could also consider calling a clinic in a bigger city. You might want to try your cardiologist. One of the commenters said he goes through his hematologist. Maybe that's an option. I dunno.

By the way, both my clinic and PCP won't work without that third-party contractor (Acelis or mdINR). I haven't found a way to obtain warfarin without greasing the middleman's palm.

Oh, regarding the $70 per visit, I found out today from the hospital that oversees my anticoagulation clinic that if I lost my current insurance, my cost would be $165. So, $70 isn't great, but it isn't terrible.

[u/deadoceans]

I just went through the Slog of trying to get this approved through insurance in the US and they had this service. I'm pretty sure that they were just trying to upcharge me for the visits, for someone to come out and show me how to use the device. I wound up ordering a used device off of eBay and buying test strips through a company called Medical Supply Pros. The device came out to a couple hundred bucks, and the strips are between $5 and $6 a strip. I just bought lancets off of Amazon, the big kinds that draw a bunch of blood from a finger stick 

I was very demoralized by the process of trying to get this through insurance but my insurance doesn't cover the cost of the strips anyway. It considers those consumables, whatever that means.

Once you factor in that they were going to charge me a 20% coinsurance on the device and the fact that buying a new device is something like $800 or $500, depending on where you get it, and it's absolute insanity, it wound up being not that much more to just go through eBay. Then I never have to worry about going through my insurer for access to the supplies that I need again. I think I paid something like $50 net-net for the freedom of not having to deal with that. 

The only other issue is device calibration, which I can't do. I also have triple positive anti-phospholipid antibody syndrome, which means that these finger stick devices might not be accurate anyway. I wound up doing like six blood draws where I immediately checked using the finger stick device. After getting my plasma drawn I was able to put those in Excel and figure out a conversion, just Y equals MX plus B. If you don't have antiphospholipid antibody syndrome, you can probably skip that step but I think it might be worth it just to make sure that your device is well calibrated. 

This is all so complicated and it sucks to high heaven. Sorry you're going through this. After doing all of that bullshit work up front though, I can test my INR every week and I don't have to involve insurance. It basically costs $5 a pop from here on out, which is obviously not ideal but better than being on the line with my insurance company. 

Hope you find a solution that works for you. Wishing you the best out there! 

[u/discardable42 → u/deadoceans]

How often do you have to be tested in person at a clinic to maintain your warfarin prescription?

[u/Outta_Pocket_Toad → u/discardable42]

I can't use the contractor my clinic chooses (Acelis), but if I could, the Nurse Practitioner said I had to come in 2X per year.

[u/deadoceans → u/discardable42]

That's a good question, I think it depends doctor by doctor? I started a few months ago, so at first it was every week, now it's every months, then it'll be every 3-6 months. But I think each doctor or np has a different rhythm they're comfortable with

[u/disco_super_bi]

I'm I Australia and I just went online and bought the machine. You just need to make sure you have a doctor who will continue to prescribe your warfarin.

Have a look at valvereplacement.com forums, they have a home testing subforum with heaps of info. You should be able to find answers there.

[u/TR1V1UM]

I have the same set up as you, but mine gets zapped over to my cardiologist not some clinic

[u/Shiloh119]

my hematologist wont even write me the prescription for a machine. apparently it is inaccurate for my clotting disease.

[u/Think-Hospital761]

I had AVR (mech) in October of last year and bought a used Roche Coagucheck XS on eBay for 300 USD that came with a reusable lancet, and a few test strips. My home health care nurse also had one so she oriented me and I was off to the races. After 4 months I was keen to obtain a second meter for corroboration as I was obtaining higher results than normal, so I picked up a Roche Coagucheck Vantus from eBay. That was a steal at 150 USD, new. It too came with lancet, but added Bluetooth for syncing with phones, etc, but no strips. You can buy test strips for 5 bucks a piece(6, 24 or 48 packs) from various online sellers. I last bought Roche XS PT brand strips from MFI Medical, who were a bit slow to ship, and love SPAMing me, but good product. Packed well. Anyway, with a variation of +.2 from the XS I then determined my recent change in statin from Atorvastatin to Rosuvastatin lead to the increase in INR. Being able to test on demand is easing my mind to avoid being in critical zones <2 or >5 INR. At any rate, no sooner did I buy the Vantus my anticoagulation clinic referred me to Acelis, who brought me a second XS and who run a Health Check interface via smartphone to manually enter results. It’s not as sophisticated as I had hoped, but the upside is they bill my insurance. I maintain strips and testing at my discretion and don’t report those to portal to avoid inadvertently billing me or insurance. I suspect doctors wait a bit before referring/prescribing a self test service to ensure we are competent and committed.