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 have your 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.
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.
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.
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.
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 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.
Can laser remove varicose veins?
Larger varicose veins in the legs can be treated using endovenous laser therapy. A laser fiber is inserted into the vein through a tiny tube (catheter). While doing so, the doctor uses a duplex ultrasound screen to monitor the vein. Vein ligation and stripping are more painful, and laser has a faster recovery time.
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.
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 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 uninformed of the dangers of failing to treat varicose and spider veins properly.
What is the best procedure for varicose veins?
Sclerotherapy. In this operation, your doctor injects a solution or foam into tiny and medium-sized varicose veins, scarring and closing them. Varicose veins that have been treated should diminish in a few weeks. Sclerotherapy is effective if done correctly, even if the same vein may need to be injected multiple times.
Is vein stripping painful?
Varicose veins are visible veins that are swollen, twisted, and bulging beneath the skin. They are usually reddish-blue in color. They are most commonly found in the legs, although they can also be found in other regions of the body.
Normally, valves in your veins keep your blood flowing up toward your heart, preventing it from accumulating in one spot. Varicose veins have either damaged or absent valves. The veins become clogged with blood as a result of this, especially when you are standing.
The superficial saphenous vein is a big vein in the leg that is removed or tied off during vein stripping. This aids in the treatment of varicose veins.
- The bottom part of your body will be numb as a result of spinal anesthesia. You can also be prescribed medication to help you relax.
- Your injured vein has cuts near the top, middle, and bottom. One of them is lodged in your groin. The other will be in your calf or ankle, further down your leg.
- Your surgeon will then thread a small, flexible plastic wire into the vein in your groin and guide it down your leg to the other cut.
- After that, the wire is attached to the vein and pushed out via the lower cut, pulling the vein with it.
- If you have any more damaged veins near the surface of your skin, your surgeon may make small incisions to remove or tie them off. Ambulatory phlebectomy is the term for this procedure.
- After the treatment, your leg will be wrapped in bandages and compression stockings.