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.
Are varicose veins covered under insurance?
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 reimbursed by most insurance types (including Medicare and Molina), but not for “cosmetic care.” Varicose veins (bulging leg veins) must produce symptoms such as leg pain to be covered by insurance. 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 medication like ibuprofen or vasoactive agents like horse chestnut or Vascular, and hot/cold packs are all examples of conservative management.Many insurance types REQUIRE 6 to 12 weeks of wearing medical-grade compression stockings before being approved for treatment.You should schedule your consultation as soon as possible and begin incorporating conservative management into your lifestyle. 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.
Ultrasound testing is required to confirm underlying venous insufficiency. 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 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 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.
Do I need a referral for varicose veins?
Anyone with suspected varicose veins and any symptoms, such as skin damage or leg ulcers, should be referred to a vascular service as defined by NICE, which is a clinic with a team of people who can give duplex ultrasound diagnostic and the full range of venous treatments.
Do vein Clinics work?
Sclerotherapy, laser treatment, and radiofrequency closure appear to be as effective as surgery. 1
In terms of how well they block off varicose veins, all of the procedures are essentially the same. In roughly 80 to 93 persons out of 100, the treatments work. About 7 to 20 persons out of 100 may not respond to the therapies. 2
Does caresource cover varicose vein surgery?
Treatment for varicose veins is designed to alleviate symptoms and complications in order to prevent further health problems; it is not a covered benefit for cosmetic reasons.
Does insurance cover spider vein treatment?
Veins that are swollen and painful are signs that medical attention is needed. Wearing thigh-high compression stockings can help blood flow around the problematic area, but varicose veins will remain until they are surgically removed or closed.
Before covering varicose vein treatments, most insurance companies will want to see the results of a venous ultrasound. A quick consultation appointment in a vein specialist’s clinic is covered by most insurance plans, and the provider will be able to present the quality of your veins. Your therapy will be categorized as medically required if the ultrasound reveals that your varicose veins are causing swelling, ulceration, heaviness, or backward blood flow. This proof will provide your insurer with the information they require to fund the removal operation.
If Your Veins Are Cosmetic Concerns
The look of lesser vein problems can be dramatically improved with cosmetic vein therapy. Cosmetic veins, such as spider veins, are not considered symptomatic of medically essential therapy, unlike varicose veins. As a result, this sort of treatment is classified as cosmetic and is rarely covered by health insurance. As a result, patients will almost always have to pay for cosmetic procedures themselves.
Endovenous laser ablation
The energy used in this treatment cauterizes (burns) and closes varicose veins. This vein treatment is effective in reducing discomfort, edema, and irritation associated with veins. Ablation is a less invasive and safer alternative to standard vein removal surgery. Ultrasound will be used by your doctor to visualize the vein. Through a small incision, a fiber or electrode is transferred to the desired spot within the vein. To collapse the vein around the fiber or electrode, local anesthetic is given into the tissues around the vein. The energy warms the vessel, forcing it to close and shrinking the defective vein.
Chemical ablation using state of the art foam sclerotherapy (Varithena)
Varithena (polidocanol injectable foam) is an injectable foam used to treat varicose veins caused by problems with the great saphenous vein (GSV) and other veins in the GSV system of the leg. Varithena reduces the appearance of varicose veins and alleviates symptoms associated with or caused by varicose veins. Within seconds, a column of concentrated foam will ruin the vein wall’s lining, triggering an inflammatory response that will allow the vessel to close. In general, as compared to other types of sclerosis, it is a far safer and more effective tool to utilize at this time.
Medical adhesive that results in closure of the unwanted veins (Venaseal)
The vein is closed with an adhesive in this process. A qualified clinician fills a syringe with medical adhesive, which is then injected into the VenaSeal closure system’s dispensing gun, which is linked to a catheter, during the process. Under ultrasound guidance, the catheter is inserted into the affected vein. The catheter is implanted in precise regions along the sick vein, and the medical adhesive is delivered through a series of trigger pulls by the clinician.
Mechanochemical ablation of the vein (MOCA)
Sclerosant chemicals are administered directly into the defective saphenous vein trunk with a catheter that also rotates and somewhat damages the vein lining during mechanochemical vein ablation. This combination is intended to boost the vein’s obliteration success rate.
Ambulatory microphlebectomy
Through small, slit-like incisions in the skin, ambulatory phlebectomy eliminates superficial veins. This procedure can be used to treat both asymptomatic and symptomatic superficial veins in the skin. Larger veins that bulge over the surface of the skin, as well as varicose veins, are commonly treated with this procedure. Small incisions are used to define the veins, and bulging veins are surgically removed segment by segment.
Finding The Best Treatment Option For You
It can be difficult to tell whether your leg pain is caused by a normal ache or soreness from a long day at work, or if it is a symptom of a more serious problem that necessitates medical attention. Contact Hinsdale Vein & Laser today to schedule a consultation appointment to see if your insurance will cover the removal of your varicose veins.
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.
Do Dermatologists treat varicose veins?
Patients with varicose and spider veins are treated by dermatologists in other circumstances. Dermatologists can detect superficial varicose veins and spider veins through the skin and diagnose them. They may use a laser to seal the veins, which are then reabsorbed by the body. This superficial dermatological vein therapy frequently fails to eliminate symptoms and fails to determine the main cause of the disease, preventing a full and successful treatment.
Dermatologists don’t usually go so far as to use ultrasonography to check your vascular system in detail. They may send you to our vein treatment specialist for a more thorough examination, as we have the equipment and experience to pinpoint the source of your vein problems and make an accurate diagnosis.
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.