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 match 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 coverage. This means that what is medically required 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 would say that spider vein therapy 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 hemorrhage. 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 vital 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 an indication 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 inquiry will be determined by your coverage and deductible. If you have symptomatic varicose veins that are likely to show reflux on an ultrasound but might be readily treated with sclerotherapy and a high deductible plan, you might be better off treating and paying for it as a cosmetic operation. 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 only guidelines; each insurance coverage 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.
How much does it cost to get varicose veins removed?
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.
Does insurance cover laser treatment for varicose veins?
When considered medically essential, most insurers now cover endovenous laser ablation treatment as a main treatment and sclerotherapy as a subsequent treatment.
Is vein disease 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 therapy is solely cosmetic does not imply that the physician is seeking 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.
Is it worth getting varicose veins removed?
When you can, prop up your leg (or legs) on a pillow or a chair, exercise, and lose weight if necessary. If these measures do not alleviate your symptoms, you may need surgery or a procedure.
- If you are concerned about the appearance of your legs, surgery or a procedure is a preferable option. Varicose veins will not improve with home treatment. Pain and other symptoms can also be reduced with surgery and other procedures.
- The sort of therapy you receive is determined by the size of your varicose veins. You may need surgery (ligation and stripping) or less invasive techniques such as radiofrequency closure or endovenous laser treatment if you have bigger veins. Sclerotherapy, external laser treatment, or a little surgery called microphlebectomy are commonly used to treat small to medium-sized varicose veins.
- Procedures for closing varicose veins and preventing their recurrence appear to operate similarly. Laser treatment, radiofrequency closure, sclerotherapy, and surgery are some of the methods available.
- Check your insurance to determine if it covers the cost of any surgery before going ahead with it. Some policies exclude operations performed solely for personal, rather than medical, reasons.
Can varicose veins go away?
Varicose and spider veins do not disappear on their own, however they can fade in appearance. Symptoms may also disappear for a short period of time, especially if you lose weight or increase your physical activity. Your vein symptoms, on the other hand, are likely to recur with time.
Compression socks are thought by some to be a remedy for varicose veins. Although this is not the case, compression socks can aid in improving circulation and reducing leg symptoms such as discomfort and swelling. When you remove them, though, your symptoms will almost certainly return.
Compression socks can assist with some symptoms, but they don’t treat the underlying cause of your vascular illness.
Are spider veins same as varicose veins?
Varicose veins are larger than spider veins, which are sometimes known as thread veins. They are often crimson 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.
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 therapy 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.
What does it mean when you have varicose veins?
Increased blood pressure in the veins causes varicose veins. Varicose veins develop in the veins near the skin’s surface (superficial).
One-way valves in the veins direct blood flow towards the heart. Blood can gather in the veins if the valves become weaker or broken. The veins widen as a result of this. Long hours of sitting or standing can cause blood to pool in the veins of the legs, raising the pressure within them. The increasing pressure might cause the veins to stretch. The walls of the veins may be weakened, and the valves may be damaged as a result.
What kind of doctor removes varicose veins?
Varicose veins are frequently diagnosed solely based on a physical examination. To determine the scope of the condition and rule out other illnesses, tests or procedures are sometimes performed.
Specialists Involved
You should see a vascular medicine specialist or a vascular surgeon if you have varicose veins. These are doctors who specialize on diseases of the blood vessels. You could also visit a dermatologist. This is a dermatologist who specializes on skin problems.
Physical Exam
Your doctor will examine your legs while you are standing or sitting with your legs dangling to check for varicose veins. He or she might inquire about your signs and symptoms, as well as any discomfort you’re experiencing.
Doppler Ultrasound
A Doppler ultrasound may be recommended by your doctor to examine blood flow in your veins and look for blood clots. Sound waves are used in a Doppler ultrasonography to create images of structures in your body.
A handheld gadget will be placed on your body and passed back and forth over the affected area during this test. The sound waves will be converted into a picture of the blood flow in your arteries and veins by a computer.
Angiogram
Your doctor may arrange an angiogram to gain a more detailed look at the blood flow via your blood arteries, though this is uncommon. Dye is injected into your veins for this treatment. On x-ray scans, the dye highlights your veins.
Your doctor can use an angiography to determine whether you have varicose veins or another condition.