Does insurance cover varicose vein treatment? Chronic venous insufficiency is a progressive disease that is covered by most insurance programs. This is distinguished from sclerotherapy which is deemed to be a cosmetic treatment. In order for most insurers to authorize the treatment of varicose veins, the healthcare provider must demonstrate a level of medical necessity. The criteria for meeting medical necessity will include the performance of a diagnostic ultrasound which will measure the performance of the valves of your leg veins known “reflux”and the diameter of the patient’s leg veins. Additionally, the Doctor will ask a number of questions to understand the impact the symptoms are having on your quality of life.
If a primary care doctor suggests that varicose vein treatment is purely cosmetic, it does not mean that they are intentionally attempting to mislead a patient. In fact, the diagnosing and treating of varicose and spider veins is a fairly new specialty in medicine. Therefore, many doctors are simply unaware of the risks associated with neglecting the proper care for varicose and spider veins.
Make a Vein Consultant Appointment
Abnormal veins become more common as people age. Fortunately, there are treatment options and procedures available for those who seek to eliminate their varicose veins. A visit to Rejuveination give a patient a clear diagnosis and possible treatment options for their varicose veins. Contact our office to schedule an appointment and learn more about this condition.
Vein consultants are trained health practitioners that are trained to treat conditions that lead to vein disease. A vein consultant knows how to identify the early signs of vein disease, accurately diagnose patients, and recommend an ideal course of action for treating the affected veins.
After making a vein consultant appointment, your doctor will cover your medical history and any symptoms related to vein disease. They will also examine any abnormalities found around the leg and ankle areas. If necessary, your health provider may suggest an ultrasound to get a better understanding for how medically necessary vein treatment is for you.
After review, your vein consultant will likely recommend a treatment that is best fitted for your needs. Your doctor may recommend one of the following vein treatments or procedures:
- Radiofrequency Ablation
- Ambulatory phlebectomy
Our medical staff will determine which modalities of treatment are right for your condition
Will Treatment Be Covered by Insurance?
Chronic venous insufficiency is a progressive disease that is covered by most insurance programs. This is distinguished from sclerotherapy which is deemed to be a cosmetic treatment. In order for most insurers to authorize the treatment of varicose veins, the healthcare provider must demonstrate a level of medical necessity. The criteria for meeting medical necessity will vary by insurance company. The staff at RejuVeination can assist you with your insurance questions.
Some insurance companies also require a defined period of compression stocking use to control the symptoms found in vein disease before seeking medical help. Since compression stockings help control leg vein symptoms, insurance companies will often specify in the policy that patients must have attempted to control their symptoms with the use of compression stockings for a defined period of time before they will allow you to seek treatment. The period of required compression stocking use can vary between policies, but the most typical mandated time is between 6 weeks to 3 months.
If you meet the requirements for symptoms in your legs and have also used the stockings for a period of time, then insurance plans will examine if you’ve had an ultrasound of the legs to examine the veins. It is a universal requirement by most insurance companies that you must have a leg vein ultrasound prior to being considered for treatment. You do not necessarily have to have a major abnormality on the ultrasound to qualify for treatment.
What Does ‘Medically Necessary’ Mean?
You may have come across the term “medically necessary” when researching treatment options for varicose and spider veins. Your healthcare provider may have even used the term when describing whether or not your insurance will cover treatment options. In order to recognize which treatments and procedures are viable options, it’s important to learn what “medically necessary” means.
According to HealthCare.gov, ‘Medically necessary’ services are health care services, “that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms – and that meet accepted standards of medicine.” According to the Centers for Medicare & Medicaid Services, medically necessary services:
- Are needed for the diagnosis and treatment of a medical condition
- Are provided for direct care and treatment of a medical condition
- Meet standards of quality medical practice
- Are not mainly for convenience of you or your healthcare provider
As for varicose veins, there are criteria for establishing medical necessity. These criteria typically involve measurements of vein reflux, vein size (diameter) and quality of life factors. When varicose veins form, blood flow pools within the vein. The blood pool causes the veins to swell and twist within the leg. The formation of swelling from blood pooling in varicose veins is often seen as the second sign of vein disease. Since vein disease is a recognized diagnosis, your insurance will most likely cover procedures done to treat varicose veins once the criteria for medical necessity are met. Each insurer defines their own specific criteria for medical necessity of this condition.
When your healthcare provider submits your diagnostic reports for pre-authorization, your insurer will make a determination of medical necessity. Because this condition is progressive, although you may not qualify for coverage initially, you may qualify at a later point if the symptoms have advanced.