Patients with both medical and aesthetic vein problems are not rare. What is the distinction? Most insurance companies only cover varicose vein therapy if it is judged necessary “Medically required.” Cosmetic treatments are those that do not meet the policy’s criteria. What is considered medically necessary by insurance companies? Is it even worth it to try to get your insurance to pay for your vein treatments? All of these are regular inquiries that we receive on a daily basis. Sometimes the answers are self-evident, and other times the distinction between medical and cosmetic vein disease is hazy. The answer to whether or not your varicose veins are medically necessary may be determined not only by your symptoms, but also by the terms of your insurance policy. This means that what is medically necessary under one insurance plan may be considered cosmetic under another. In this article, I’ll explain what you’ll need to get insurance to fund your vein treatments, as well as whether or not attempting to do so is in your best interests.
To begin with, most insurance plans will state that spider vein treatment is not medically necessary. As a result, the majority of spider vein treatments are deemed cosmetic. The only exception is when a patient’s spider veins are causing bleeding. Spider veins are small red and blue veins on the skin’s surface that are smaller than 1mm in diameter. Varicose veins, on the other hand, are bigger (3mm or greater), ropy veins beneath the skin’s surface. Varicose veins frequently bulge or protrude, forming lumps. However, not all varicose veins are visible on the surface of the skin; in fact, many people have varicose veins beneath the skin and only visible spider veins on the surface. An examination by a vein care specialist can help you establish if there is any pathology beneath the skin that meets medical requirements. Swelling and even ulceration, for example, are symptoms of severe vein disease, although they can also occur in the absence of ropy varicose veins.
This brings us to the first medical necessity criterion: symptoms. It is not medically required to dislike the sight of a vein; however, having symptoms usually is. Aching, heaviness, discomfort, throbbing, leg tiredness, frequent nighttime cramps, itching, swelling, and restless legs are all common venous symptoms. Other possible presenting signs include bleeding, pigmentation (skin discoloration), and even ulceration. Many patients do not know how symptomatic they are until their veins have been treated, in my experience. Patients mistakenly feel that their symptoms are just normal indicators of aging since venous disease symptoms develop slowly, frequently over several years. It’s important to keep in mind, though, that your legs should not hurt or be tender. On a daily basis, fatigued or heavy legs are not normal. Similarly, leaving imprints on your ankles with your socks is a sign of swelling. If you experience any of the symptoms listed above, you may have venous insufficiency, and a medical vein disease workup is recommended.
Venous reflux is the next criterion that most insurance companies use to determine medical necessity. This criterion is reasonable. In essence, the insurance companies are claiming that they would not cover the costs “If a vein isn’t broken, it can be repaired. Although blood should go up the veins from the legs to the heart, gravity always pulls it back down to the feet. Backwards flow is prevented by valves in the veins of our legs. If the valves fail, gravity pulls the blood back down rather than up the vein. Reflux is the term for this retrograde flow. An ultrasound is the most accurate technique to identify whether you have reflux or not, and it should be performed in a standing position to be accurate. This criterion also rules out spider vein treatment because ultrasounds aren’t sensitive enough to detect reflux in such small veins.
A trial of conservative therapy is the final requirement frequently seen in most insurance policies when it comes to the medical necessity of venous care. Essentially, your insurance provider encourages you to attempt non-invasive methods to alleviate your symptoms. Maintaining a healthy weight, walking, periodically lifting your legs above the level of your heart, calf raises, and using compression stockings are all conservative steps you may take at home. In fact, most insurance companies require you to wear class 2 compression stockings (medical grade or at least 20-30mm Hg) for 6-12 weeks before they will pay treatments. To aid with venous symptoms, I usually recommend all of the aforementioned conservative approaches. Unfortunately, while compression stockings, leg elevation, and walking all assist, none of them provide long-term relief in my experience. That is, symptoms usually return shortly after you remove the compression stockings or put your legs back down.
In summary, the three most common medical necessity criteria are symptoms, venous reflux, and a conservative therapy trial.
Is this to say that everyone with symptoms should bill their insurance for all of their treatments? Again, the answer to this question will be determined by your policy and deductible. If you have symptomatic varicose veins that are likely to show reflux on an ultrasound but could be easily treated with sclerotherapy and a high deductible plan, you might be better off treating and paying for it as a cosmetic procedure. This is because the cost of an ultrasound and therapy will almost certainly be less than your deductible. In certain circumstances, bypassing the ultrasound and going straight to therapies could save you money.
If, on the other hand, your deductible has been met, the identical scenario could be ethically and legally billed to your insurer because the veins are symptomatic and meet the policy’s medical necessity rules. Of course, you should consult with a physician to see if you can avoid the ultrasound. If the veins are small but overlie or drain areas of commonly diseased veins, you may have a problem with one of the named superficial veins, such as the Greater Saphenous Vein. In this case, sclerotherapy alone is unlikely to provide long-term relief, and an ultrasound would be recommended to determine the exact source of the problem. If your doctor determines that an endovenous ablation is necessary after the ultrasound, those operations are more expensive, therefore it’s probably preferable to bill them to insurance and have them applied to your deductible.
It’s also worth noting that these are just guidelines; each insurance policy is unique. It’s critical to verify with your insurance company to see what your policy’s exact requirements are.
Please contact our office if you have any further questions about whether you have medical or cosmetic vein disease, or both. We provide free cosmetic tests, and if it is discovered that you have a medical condition, you may be scheduled for a formal and full clinical assessment, as well as an ultrasound if necessary.
What insurance covers varicose veins?
Is Varicose Vein Treatment Covered by Insurance? The following are the factors used to assess if insurance will cover varicose vein therapy.
Varicose vein treatments that are considered “medically required care” will be covered by most insurance types (including Medicare and Molina), but not for “cosmetic care.”
To be covered by insurance, varicose veins (bulging leg veins) must produce symptoms such as leg pain. Spider veins (tiny clusters of blood vessels on the surface of the skin) are a cosmetic procedure that is not covered by insurance.
Vein treatment that is medically necessary indicates the varicose veins are causing symptoms like leg pain, heaviness, chronic swelling, nighttime cramping, or burning. Leg ulcers (open wounds) from varicose veins, repeated blood clots or phlebitis, ruptured bleeding veins, or skin darkening around the ankle are all symptoms that may indicate therapy.
The symptoms must be severe enough to interfere with a person’s everyday activities or capacity to work. A teacher, for example, may have varicose veins that hinder them from standing and doing their job because they need to elevate their legs frequently. Due to leg soreness after a few hours, a restaurant server may no longer be able to work long shifts. Symptoms might make it difficult to live a healthy lifestyle, such as limiting the amount of exercise one can do or being unable to cook or perform housework owing to leg pain.
In most circumstances, insurance companies demand that conservative methods be taken over a period of time. Compression stockings, leg elevation, exercise, weight loss, anti-inflammatory medicine such as ibuprofen or vasoactive drugs such as horse chestnut or Vascular, and hot/cold packs are all examples of conservative therapy. Before being authorized for treatment, many insurance companies require that you wear medical-grade compression stockings for 6 to 12 weeks. You should schedule an appointment as soon as possible and start incorporating cautious management into your daily routine. You should start maintaining a daily journal of the conservative therapy you’re using. If your primary care physician has previously prescribed compression stockings, having a note from your doctor or the prescription will help you stay within your conservative management time frame.
Underlying venous insufficiency must be verified by ultrasonography testing. Most insurance kinds cover the ultrasound study to determine the treatment as well as the physician appointments.
The following treatments are not covered by insurance because they are considered “cosmetic services”:
If you responded yes to each of the four questions, you are likely to meet the medical necessity requirements for vein treatment. Please note that this is a condensed questionnaire for the benefit of the patient’s understanding.
And/or have you had any of the following varicose vein complications?
- Have you tried conservative management but it hasn’t totally healed your vein problem?
- Yes, I’ve tried compression socks/stockings as well as at least two of the following:
- OTC supplements like horse chestnut or grapeseed extract or venoactive medications like Vascular
- Have you had an ultrasound to see whether you have underlying venous reflux disease?
- Yes, my ultrasound showed reverse flow in my veins, which was documented (venous reflux)
Some individual insurance policies, however, do not cover varicose vein therapy; this is mainly due to an employer’s exclusion. In this instance, it’s possible to urge the company to include varicose vein treatments in the insurance policy. You can call the number on the back of your insurance card to see if vein treatments are covered. We will assist you in determining what your insurance will cover when you begin the vein treatment process with us. Our prior authorization specialist will acquire preauthorization (permission) for your treatment and will be available to answer any questions you may have.
How much does it cost to have varicose veins treated?
The cost of vein stripping operation varies between $1,500 and $3,000, plus any hospital or surgical center expenses. Depending on how much of the vein needs to be treated, EVLT might cost anywhere from $600 to $3,000. However, if the varicose veins are unpleasant or incapacitating, insurance may cover a portion of the cost.
Researchers discovered that individuals who had EVLT experienced slightly more pain in the first week after their treatments than those who had vein stripping surgery, but that the pain went gone faster as well.
Patients in the EVLT group experienced pain for an average of eight days following their treatments, but those in the HLS group reported discomfort for an average of 17 days.
Does insurance pay for vein stripping?
Varicose and spider veins are frequently dismissed as just cosmetic concerns. Varicose veins, on the other hand, are a serious problem that can jeopardize your circulatory health, as anyone who has experienced the side effects and symptoms of painful veins can attest.
Most health insurance policies, fortunately, will cover treatments for varicose and spider vein removal as long as they are deemed “medically required” rather than aesthetic. Here are the criteria your insurance company will use to determine if vein removal is medically required.
How much does it cost to remove spider veins?
The cost of spider vein removal varies depending on the type of therapy, the number of veins treated, and the number of treatments required. Based on your unique problem and desired results, your dermatologist or provider can offer the best spider vein therapy for you.
How much does sclerotherapy cost?
Sclerotherapy costs about $350 on average. 1 This usually includes the cost of the doctor’s visit as well as the cost of compression stockings. Laser vein treatment for leg veins costs on average $443. 2 Vein stripping surgery ($1,500$3,000) or an ambulatory phlebectomy ($1,000$3,000 each leg) may be required in more severe cases of varicose veins. 3 Costs may also differ depending on where you are.
Is spider vein treatment covered by insurance?
When spider vein treatments are performed only for cosmetic reasons, most health insurance companies do not cover them. Some insurance plans, however, will cover a specialist visit to assess symptomatic spider veins and varicose veins. Some insurance companies will pay the cost of spider vein treatments and sclerotherapy if the procedure is deemed medically essential.
Out-of-pocket costs for spider vein treatments can include deductibles, coinsurance, and copays if you have insurance coverage. It’s a good idea to call your insurance carrier ahead of time to get precise information about your plan’s coverage and benefits.
How can I finance and pay for spider vein treatments?
Payment plans are available from some providers and dermatologists, so it’s worth asking if you can pay for your spider vein treatments in installments. Another option for financing spider vein treatments and sclerotherapy is to use a credit card.
Is venous insufficiency covered by insurance?
Is varicose vein therapy covered by insurance? Most insurance plans cover chronic venous insufficiency, which is a progressive condition. This differs from sclerotherapy, which is considered a cosmetic procedure. Most insurers require the healthcare professional to demonstrate a level of medical necessity before they will approve the treatment of varicose veins. The performance of a diagnostic ultrasonography, which will assess the performance of the valves in your leg veins known as “reflux,” as well as the diameter of the patient’s leg veins, will be used to determine medical necessity. In addition, the doctor will ask you a series of questions to determine how the symptoms are affecting your quality of life.
A primary care physician’s suggestion that varicose vein treatment is purely cosmetic does not imply that the physician is attempting to deceive the patient. In fact, detecting and treating varicose and spider veins is still a relatively young medical speciality. As a result, many doctors are simply unaware of the dangers of failing to treat varicose and spider veins properly.
Should varicose veins be removed?
If you still have pain or other symptoms after 6 to 12 months of home treatment, you may need surgery or a procedure. If your major worry is the appearance of your legs, you could receive treatment at any time. Your legs will not improve with home care.
What happens if varicose veins are left untreated?
When varicose veins are left untreated, blood pools in the veins, aggravating the situation and leading to one or more of the following conditions:
- Increased pain and swelling – If varicose veins are left untreated, the veins get more damaged, causing the pain to worsen and the legs to swell.
- Symptoms that persist. Just because a person with varicose veins isn’t having any symptoms right now doesn’t imply they won’t in the future. The longer varicose veins are left untreated, the more probable they are to cause pain sooner rather than later.
- Tiredness and weakness Untreated varicose veins can lead to leg weakness over time. This means the person will become weary more quickly and with greater severity. This can be a major issue for people who live active lifestyles or work in jobs that require them to be on their feet all day.
- Ulcers – Untreated varicose veins increase the risk of lesions such as ulcers developing. They can also cause spontaneous bleeding and make wound healing more difficult.
- Other conditions If varicose veins are left untreated, they can lead to serious complications like deep vein thrombosis, blood clots, and lipodermosclerosis.
To summarize, failing to treat varicose veins leads to worsening veins, more unpleasant symptoms, and increased vein damage. This is why obtaining treatment is so important. A vein expert can assess your veins, medical history, and lifestyle habits in order to offer treatment suggestions that include not only medications or medical treatments, but also lifestyle changes that can help slow the progression of the problem and alleviate symptoms.
What is better sclerotherapy or laser?
Sclerotherapy is the most effective treatment for superficial spider veins on the legs and hands. Laser treatment is more expensive, slower, and ineffective. Sclerotherapy is also more effective for those who have darker skin. Lasers emit light that might cause skin discoloration in tanned people.
Are spider veins same as varicose veins?
Varicose veins are larger than spider veins, which are sometimes known as thread veins. They are typically red in color. They may resemble spider webs or tree branches. Spider veins are visible beneath the skin, but unlike varicose veins, they do not cause the skin to flare out.