Because VenaSealTM is the newest, most cutting-edge procedure available for closing varicose veins, it may not be reimbursed by your insurance provider, unlike other kinds of treatment for chronic venous insufficiency. Speak with your insurance representative to learn more about coverage before your operation.
Does insurance pay for varicose vein treatment?
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 larger (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 determine if there is any pathology beneath the skin that meets medical criteria. 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 necessary to dislike the appearance of a vein; however, having symptoms usually is. Aching, heaviness, pain, throbbing, leg fatigue, frequent nighttime cramps, itching, swelling, and restless legs are all common venous symptoms. Other possible presenting symptoms include bleeding, pigmentation (skin discoloration), and even ulceration. Many patients do not realize 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 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 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 safe is VenaSeal?
VenaSeal is a relatively recent treatment option that has proven to be just as effective as other treatments in treating varicose veins.
While varicose veins are inconvenient and ugly, patients with them now have a number of minimally invasive treatment options. The VenaSeal closure system, which was approved for use by the Food and Drug Administration in 2015, is one of the most recently created solutions.
By shutting off a bulging vein, VenaSeal redirects blood to healthier veins. It works on the same basis as other varicose vein removal techniques in this regard. Instead of using heat or a medical sclerosant to seal off and collapse a damaged vein, VenaSeal employs a patented medical adhesive. The following are some of the most frequently asked questions concerning VenaSeal:
What Happens During VenaSeal?
A physician injects the medical adhesive into a vein using a tiny catheter guided by ultrasonography. Patients are not injected with tumescent or a local anesthetic across a significant area of the leg because only a few injections are required. The surgeon applies slight hand pressure to the vein as the glue is administered, ensuring that it is sealed. VenaSeal is a reasonably painless outpatient surgery for most patients, with only a little tugging or pulling feeling experienced throughout the process.
What are the advantages of VenaSeal versus other procedures?
VenaSeal has been shown to be equally safe and successful as heat and sclerosant-based sclerotherapy ablation. It also lowers the chance of nerve injury, which can happen when small saphenous veins are treated. The adhesive dissolves throughout the body over time because only a little amount is injected.
Am I a candidate for VenaSeal?
VenaSeal is suitable for the majority of varicose vein sufferers. Large varicose veins with a diameter of two centimeters or more, as well as veins buried deep within the leg, respond favorably to the therapy. However, not everyone is a candidate for the surgery, so talk to a vein specialist to see whether it’s right for you. VenaSeal, like any medical surgery, carries potential dangers, which your doctor may explain to you.
What’s the recovery time for VenaSeal?
Patients have reduced discomfort and bruising as a result of the lack of anesthesia and several injections, allowing for a quicker recovery. Following the surgery, patients often resume normal activities with only a Band-Aid to conceal a minor incision. Although compression stockings are not required after the treatment, your doctor may advise you to wear them.
While VenaSeal is a successful treatment for varicose veins, the disease may reappear after the operation. Maintain a healthy weight, remain active, and avoid sitting or standing for lengthy periods of time to avoid the recurrence of more varicose veins.
Before the procedure:
The leg that will be treated will be examined with ultrasonic imaging. This examination is necessary for determining the condition of the sick superficial vein and arranging the operation.
During the procedure:
You and the provider can talk about the procedure. It is done in the office as an outpatient procedure. The process takes around an hour and a half, and only a minor amount of local anesthesia is required (numbing medication). Here’s a quick rundown of what to expect:
- A needle stick to numb the location where the doctor will access your vein may cause minor pain or stinging.
- Your doctor will implant the catheter (a little hollow tube) into your leg once the area is numb. You may feel some pressure as the catheter is inserted.
- To supply modest amounts of the medical adhesive, the catheter will be implanted in precise regions along the sick vein. You might feel a slight tugging sensation. During the procedure, ultrasound will be used to guide and situate the catheter.
- The catheter is removed after therapy, and the puncture site is covered with a tiny adhesive bandage.
After the procedure:
As needed, the clinician will recommend follow-up care. After a Venaseal operation, compression stockings are not required. A follow-up ultrasound will be performed in two weeks to ensure that the vein has remained blocked. Additional ultrasound follow-up sessions will be scheduled at 3 months and 12 months after the treatment to document long-term closure of the treated vein.
Is Chronic 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 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 means the varicose veins are causing symptoms like leg pain, heaviness, persistent 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 keeping a daily log of the conservative treatments you’re using. If your primary care physician has already 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.
Does caresource cover varicose vein surgery?
Treatment for varicose veins is intended to alleviate symptoms and complications in order to prevent further health problems; it is not a covered benefit for cosmetic reasons.
What is the cost of VenaSeal?
A VenaSealTM operation costs roughly $3,000 on average, however this might vary depending on where you reside and other factors. This may appear to be a costly surgery, but it is actually a cutting-edge medical procedure that provides patients with immediate relief from varicose vein pain, irritation, and swelling, as well as the unattractive bulging, black lines that develop as a result.
Is VenaSeal procedure painful?
The tubes with valves that carry blood from your body back to your heart are known as veins. The importance of these valves cannot be overstated. They ensure that blood from the extremities may flow back to the heart despite gravity.
Blood flow can be hampered if these valves become compromised. Like the roots of a tree or the path of a river, the veins can expand and twist.
What are Varicose Veins?
Varicose veins are the term for damaged veins. Varicose veins can form everywhere on the body, but they are most commonly found in the legs. They’re caused by the pressure that standing and walking puts on your lower body’s veins.
Varicose veins are an aesthetic blemish for the majority of people. Others, on the other hand, may have pain and discomfort, and in some cases, major health issues like as blood clots or ulcers may result.
Varicose Vein Treatments
There are numerous varicose vein treatments available when varicose veins produce constant pain and discomfort, potentially life-threatening blood clots, ulceration, or are simply too “ugly.”
Invasive and non-invasive varicose vein therapy options include lifestyle adjustments, compression stockings, laser treatments, catheter-assisted heat treatments, ambulatory phlebectomy, and endoscopic vein surgery.
The VenaSeal procedure is one of the most popular and effective varicose vein treatments.
The VenaSeal Procedure
Sclerotherapy is a method of minimally invasive varicose vein treatment that includes the VenaSeal process. In these operations, a vein doctor injects foam or a solution into a varicose vein to seal and close the vein.
The vein specialist injects VenaSeal adhesive, a sort of medical-grade glue, into the vein with a specific instrument during the VenaSeal treatment to seal it off.
VenaSeal operations don’t require a lot of anaesthetic, and patients don’t have to take any drugs before or after the procedure. There is also no risk of skin burns or nerve damage, unlike with heat-based therapies.
What Happens After the VenaSeal Procedure?
Your doctor will clean the injection site and place a little adhesive bandage if there is any mild bleeding after the VenaSeal glue has been injected into the vein. After the VenaSeal operation, you won’t have to worry about any bleeding, swelling, or pain, however some individuals may suffer slight tenderness in the treated area.
The insertion of VenaSeal glue causes your body to enclose and encapsulate the vein with connective tissue, causing the vein to stiffen. The vein immediately ceases to function and, together with the injected VenaSeal glue, is finally absorbed by the body.
Following your VenaSeal operation, you will be able to resume all of your routine activities. Your doctor will urge that you engage in physical activity that encourages healthy blood flow in the legs, such as walking, biking, basketball, or soccer, to speed up your recovery. To ensure that the vein remains sealed, you should avoid lifting heavy weights and standing for long periods of time for 5 to 7 days after the treatment.
The varicose vein will diminish and eventually disappear after a few weeks.
Four weeks after the treatment, your vein doctor will schedule a follow-up appointment to ensure the vein has healed appropriately.
VenaSeal and Other Varicose Vein Treatments
Are you self-conscious about your varicose veins? Is it starting to hurt and swell? The BASS Vein Center is ready to assist you. We offer the most up-to-date varicose vein treatments, such as the VenaSeal technique. If you live in the East Bay, contact the BASS Vein Center to set up an appointment with a vein specialist.
How long does it take to see results after VenaSeal?
How soon will I notice a difference? Within one to two weeks after the surgery, patients report a significant reduction in their symptoms.
What are the side effects of VenaSeal?
VenaSealTM employs cyanoacrylate, a medical glue that has been explored in the treatment of brain blood channel abnormalities since 2000. Cyanoacrylate adhesives were proven to be non-mutagenic, non-pyrogenic, non-hemolytic, non-sensitizing, non-irritating, and non-cytotoxic in trials that led to FDA approval. In addition to gastrointestinal bleeding and tumors, genitourinary problems, and vascular graft leakage, these adhesives have been employed in additional peripheral applications. VenaSeal is safe and effective, according to three clinical trials.
What are the benefits of VenaSealTM?
VenaSealTM offers various advantages over reflux vein thermal ablation. VenaSealTM is a one-time procedure. There are fewer needles and less stinging because tumescent anesthesia (numbing drugs along the vein’s passage) is not necessary. Because no heat is employed, there is no risk of thermal harm. In addition, compression stockings were not required after the procedure in clinical trials, and the treated veins closed and remained closed at 3 and 6 months, just like veins closed with radiofrequency thermal ablation and compression stockings. With VenaSeal nonthermal ablation, you can resume your normal activities almost immediately.
What results are expected with VenaSealTM?
With a 93 percent effectiveness rate after one year, VenaSealTM plugs veins with defective valves. Like a bango string, the treated vein becomes fibrotic.
What can I expect during treatments with VenaSealTM?
VenaSealTM treatments are often painless, outpatient procedures that last less than 60 minutes. VenaSealTM is injected into a failing vein using a customized IV catheter. The VenaSealTM adhesive is applied to the targeted vein segment along its entire length.
What aftercare is recommended following VenaSealTM treatment?
The main benefit of this nonthermal ablation treatment is the immediate return to normal activity without the need for compression stockings.
What are the possible side effects associated with VenaSealTM?
Phlebitis, or vein inflammation, is the most prevalent side effect of VenaSealTM. Injection site bruising or soreness, as well as dermatitis, are other typical side effects. This dermatitis affects people of all ages.
Am I a candidate for VenaSealTM?
VenaSealTM is generally considered safe for most patients. During pregnancy, VenaSealTM will not be used. You may not be a good candidate for VenaSealTM if you have any of the following conditions.