Are Procedures to Remove Vericose Veins Covered by Most Insurance Providers?
- Asked by MGrenter in Seattle, WA
- 2 years ago
They do not bother me, aside from the fact that I hate having them on my legs. They've gotten really bad since I had a baby six months ago.
Insurance coverage for Varicose Veins
Most insurance providers have policies in place to address treatment of symptomatic varicose veins and venous disease. The key word is symptomatic. Insurance coverage is based on Medical Necessity. For most insurance companies the following are necessary for coverage: 1] Symptomatic varicose veins 2] Visible varicose veins on standing digital photographs 3] Ultrasound demonstration of venous reflux or blood flow in the wrong direction which in turn causes increased venous pressure in the superficial veins 4] Evidence of failed conservative therapy. Conservative therapy for most insurance companies includes: leg elevation, limitation of standing activities and wearing of MEDICAL grade support hose. Most insurance companies would like for patients to have a formal evaluation in regard to symptomatic varicose veins--this initial evaluation is covered by most plans. More invasive treatment may require predetermination by the insurance provider prior to the proposed therapy. Spider veins in general are not covered by insurance payments. It is difficult to determine if a patient has underlying venous reflux without a formal ultrasound evaluation. If you have spider veins at the surface, you may have underlying venous reflux which can be progressive.
Many insurance companies we deal with do not cover the vein treatment unless a vascular surgeon assess the area and deems it to be medically necessary, and even then sometimes it is denied depending on the carrier. With lupus, vein removal must be done with great care as things could get worse in some cases. See a Board Certified Dermatologist for this treatment.
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Varicose Veins and Insurance, Venous Reflux, VNUS Closure
Like most questions on this site, it depends. Chronic venous insufficiency, of which varicose veins are one consequence, is the most common disease in North America. In fact, if you add up diseases 2-5, they don't exceed CVI. It affects one in eight Americans, with over half being symptomatic.
Symptoms occur often and can range from pain, fatigue in the legs, bursting feelings, itchiness, burning and swelling all the way up to ulceration and skin breakdown.
Seeing a vascular specialist allows one entry into the system. A duplex ultrasound should be performed (a noninvasive pain-free test) that evalutes the patient's venous valves. Most PPO's allow treatment for symptomatic legs that have 500 milliseconds of reflux. That means the blood is flowing the wrong way in the veins for over half a second (away from the heart).
If this is present, insurance will often cover an ablation procudeure to rid one of reflux and removal of the varicose veins (often called microphlebectomy).
If reflux is not present (which it almost always is with large painful veins) the treatment may be considered cosmetic and then it's on the patient to cover the cost of laser/sclerotherapy or surgery. Hope this helps.
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Symptomatic varicose veins are covered
If your veins are not bothering you (not painful, itchy, tender, achy, etc), then it is unlikely that insurance will cover for treatment of these veins. I have had good success in getting my patients' varicose veins treatment covered by insurance ompanies as long as they satisfy the insurance company's criteria. Every insurance varies but generally they include:
1) have moderate to severe symptoms;
2) failing a trial of conservative therapy for 1-3 months (pain medication, compression stockings, weight loss and exercise);
3) documented ultrasound study showing venous reflux (blood flowing in the wrong direction causing the varicose veins).
Insurance coverage for Varicose Veins.
Some insurances do cover varicose vein treatment but not spider veins. A patient must have a significant venous disease to qualify for treatment coverage
Varicose veins medically covered?
Most insurance carriers require pre certification for this problem. Depending on the procedure being perfomed. Usually testing such as an ultrasound needs to be performed to confirm the veins are varicose before treating them. It has been my experience that many insurance carriers do cover this surgery.
Most insurance will not cover "cosmetic" treatments.
Most insurance plans have specific exclusions for cosmetic procedures. Each plan may use different language, but the end result is the same. Unless you are having a lot of pain that interferes with your daily activities, your insurance plan will probably consider any treatment for varicose veins as cosmetic, and as such it will not be covered. It sounds as though you would not qualify for insurance reimbursement - regardless of how ugly they are.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.