To answer this common question in short, most instances of varicose vein treatment can be covered by most medical insurance plans if you work with a board certified phlebologist, have a proper diagnosis, and your “pre-certification” letter to your insurance company is written in the right way. We explain this in more detail below and what you need to do to get the process started.
Medical Necessity Versus Cosmetic
The bottom line for most insurance companies on whether or not they’ll cover a particular varicose vein treatment is whether the procedures proposed are medically necessary. If the proposed procedures are simply cosmetic, then most insurance policies will not cover the treatment.
What Makes Varicose Vein Treatment a Medically Necessary Or Not?
While insurance policies vary in what they consider “medically necessary” varicose vein treatment, here is a general list of criteria that usually must be met for the proposed treatment(s) to be covered by insurance:
– Documentation of the existence of varicose veins and chronic venous insufficiency (veins can’t perform normal functions) with 3D duplex ultrasound.
– Ongoing moderate to severe symptoms of venous disease exist. Varicose vein disease symptoms include leg pain, abnormal swelling in the legs and feet, burning in the legs, itching in the legs, throbbing veins, abnormal leg fatigue, leg skin breakdown, leg ulcers, and restless leg syndrome.
– Duplex ultrasound proof of venus reflux. This is blood flowing the wrong way in a vein. Usually, the threshold is the blood must flow the wrong way for at least one-half second (500 milliseconds). If there’s good evidence of venus reflux, almost all insurance companies will cover procedures to ablate the vein (cause it to collapse) or remove it.
– The venous valves that prevent the back flow of blood are not functioning properly.
– Symptoms still persist after reasonable “conservative therapy.” Conservation therapy includes, but is not limited to, the taking of pain medications, elevating legs while sitting, thigh level medical grade compression stockings, and lifestyle changes such as increased exercise and losing weight.
– Clots are discovered in the varicose veins. This can lead to very serious complications, including life threatening conditions, and should be coverage by all insurance policies.
Does Medical Insurance Cover Spider Vein Removal and Treatment?
Spider veins are special case because spider veins all by themselves are usually not considered “medically necessary” by insurance companies. However, you should be aware that many people who have spider veins, also have underlying chronic venous insufficiency. If this is the case, then the spider veins can normally be treated along with treatment for the more medically serious chronic venous insufficiency. If underlying vein disease is not found, and your spider veins are not interfering with the normal functioning of your life, then spider vein treatment may be considered “cosmetic” treatment and you would have to pay out of pocket. The only way to know for sure if your spider veins are a symptom of a more serious underlying vein disease is to get a duplex ultrasound in a respected vein clinic like Metro Vein Centers.
Why It’s Important To Get a Board Certified Phlebologist To Do the Initial Exam
As you may have already surmised, the issue of whether or not your insurance pays for your varicose vein treatment will depend in large part on what the doctor presents to them. Sometimes, in fact, it can come down to semantics so you want to be working with a doctor who knows exactly what terminology to use and how to present your overall case so you can get your insurance to pay for the procedure. This is NOT to say the doctor should “lie” or “fudge the truth” so your insurance will be for an unnecessary procedure(s). However, the medical facts of your case can be presented in a number of ways and you want to make sure you are working with a professional who knows how to communicate to your insurance company what you’re medically up against! The best option you’ll have in this case is to work with a board certified phlebologist who has extensive specialty training and experience in dealing with vein disease and all the “red tape” involved in getting your varicose vein treatment procedures paid by your insurance company.
Contrary to popular belief, most varicose vein treatment procedures are NOT considered cosmetic by most insurance policies, if they are diagnosed and documented in the proper way. To be more clear, most varicose vein treatments are actually medically necessary BUT they usually must be PROVEN to be so by proper documentation of your condition. Metro Vein Centers has the top board certified phlebologists and other vein disease specialists in the country. They are also very adept at documenting cases for insurance purposes. You may want to give them a try with a free consultation.