What are anticoagulants?
Anticoagulants are medications used to eliminate or reduce the risk of blood clots. They are often called “blood thinners.” These medicines don’t really thin the blood, they just increase the time it takes your blood to clot, thereby reducing your risk of having a blood clot.
What is warfarin (Coumadin)?
Coumadin is the brand name of warfarin, an oral anticoagulant which inhibits your liver’s production of vitamin K-dependent factors crucial to clotting. Taking too little Coumadin can lead to blood clots and strokes. Taking too much can lead to bleeding. Getting the dosage just right requires a delicate balance that can change based on factors such as your diet and other medications you might be taking. The balance is monitored by testing your INR.
What is an INR?
The INR (International Normalized Ratio) tells your doctor the amount of time it takes for your blood to clot and enables the doctor to adjust the Coumadin dose appropriately.
Why is the Apple Valley Medical Clinic changing to an appointment only basis?
We are changing to an appointment only basis to enable nurses to spend quality time with you. Appointments are offered conveniently Monday through Friday. Two registered nurses, working under the direction of our physicians, will monitor your INR and Coumadin dosing. They also will determine when you should return for your next INR appointment and can make that appointment for you.
What information will I have when I leave my appointment?
You should have your current Coumadin dose, your current INR value, when you should return for your next appointment and whom you should contact if you have any questions before then.
Are the charges any different than they have been in the past?
Possibly. Your first visit to the anticoagulation clinic will be billed as a nurse visit in addition to the usual lab charges. This is because the nurse will gather information to establish your case, such as reviewing your medical history, medications, risk factors and any other pertinent information. After the initial visit, you will continue with the lab only charges as in the past. However, if you have abnormal lab results, you may be charged a nurse visit in addition to the lab charges. The nurse visit charge depends on the review of your case, adjustment of your medications, additional risk factors added or the nurse having to consult with the doctor.
What is the additional charge for a nurse visit?
Your insurance company will be billed $40 for the nurse visit in addition to your normal lab charges. The actual amount you may owe will depend on your insurance benefits.
How much will I have to pay out of pocket for a nurse visit?
Coverage varies by insurance company. Please keep in mind that the information below is only an estimate, and you should refer to your insurance guide or call your insurance company with questions about coverage.
Regular Medicare coverage is 80/20. You may owe 20 percent (or about $5) of the Medicare allowed amount for the nurse visit charge, which is about $21.
Regular Medicare plus a supplemental insurance coverage is decided by the supplemental benefits. If there is a co-pay or deductible with the supplemental insurance, you may owe up to 20 percent of the allowed amount designated by Medicare. If your supplemental plan pays for Medicare coinsurance and deductible, you may owe nothing for the nurse visit.
Medicare replacement plan coverage is decided by the replacement plan benefits. If there is a co-pay for office visits, you will be billed a co-pay for the nurse visit. If there is a deductible, and it has not been met yet, you may be responsible for up to $30 of the nurse visit, depending on the insurance company. If the deductible has been met, the nurse visit will be paid in full by your insurance company, unless there is a co-pay for office visits.
Regular commercial (group, self-insured, etc.) health insurance plan coverage is determined by the insurance benefits. If there is a co-pay for office visits, you will be billed a co-pay for the nurse visit. If we do not contract with your insurance company, there is a deductible and it has not been met yet, you may be responsible for up to $40 of the nurse visit. If we do contract with your insurance company, there is a contractual adjustment taken, and your balance will be less than $40.
Please keep in mind this is only an estimate. Check with your insurance company for your specific insurance benefits. What you may owe for the lab draws will remain the same as it has been in the past as long as your insurance is the same.