I'm on Medcare with United Health Care or Secure Horizons. Will they cover spider veins? I had injections a number of years ago. The procedure worked but it was just too costly. More are back. Thanks!
Insurance Coverage for Spider Veins Treatment?
Doctor Answers 5
Spider vein treatments and Medicare
Medicare does cover medically significant venous insufficiency such as EVLT and VNUS Closure.
Some insurances will cover sclerotherapy but most will not.
5 years ago many insurance companies would cover sclerotherapy treatments. As medicine and insurance policies have changed over time, it has become increasingly more difficult to get this procedure reimbursed by insurance. If you have varicose veins and spider veins and both are symptomatic and a venous reflux exam documents reflux in the saphenous veins, some insurance companies may cover sclerotherapy treatments as part of the whole package of ultrasound, laser closure of the valves and treatment of the varicose veins. You should check with your insurance and with your treating physician.
Insurance Coverage for Varicose & Spider Vein Treatments
Unfortunately neither Medicare or Private Health Insurance will cover the treatment of spider veins, as they are considered a cosmetic procedure and are not considered medically necessary to treat. Varicose vein treatment is often covered by medicare and private health insurance if the individual seeking coverage meets certain criteria that make the veins a medical necessity to treat. But in order for this treatment to be covered, a patient needs to have significant symptoms, have failed a trial of conservative treatment (such as several months of wearing prescription compression stockings), and also have documented venous reflux disease (venous insufficiency) on a venous ultrasound test. Since the insurance coverage criteria vary based on particular insurance plans and the patient's individual condition and symptoms, it is best to get evaluated by a vein specialist (typically a vascular surgeon) to be examined and see if you meet medical criteria for covered treatments. If you do not quality for insurance or medicare coverage, you could consider having the veins treated by paying out-of-pocket. The cost of spider vein treatments is often in the range of several hundred dollars per treatment session. I hope you found this information helpful.
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Spider Veins are Cosmetic
While spider veins can be symptomatic (painful, itchy, achy), treatment for spider veins is considered cosmetic by the insurance companies. Sclerotherapy is still considered the gold standard for treatment of spider veins-- they are very effective in eliminating both the appearance of the spider veins and the symptoms associated with them.
Most patients who get spider veins are genetically predisposed to getting more-- so patients generally need touch up sessions over time.
If you do have significant symptoms or worsening of your veins, you may consider seeing a vein specialist to evaluate your legs. Progressively worsening spider veins in the legs that are not responsive to treatment may be a sign of venous reflux (a problem in the larger surface veins). A vein specialist can perform an ultrasound to determine this. Depending on the severity of your symptoms, surgical treatment with endovenous ablation/microphlebectomy may be covered by your insurance. Once the larger veins are treated, sclerotherapy can much more effectively address the spider veins.
Insurance coverage for spider veins
Spider veins are generally described in "doctor words" as telangiectasias. They can be "red" or "blue." In the United States as well as most other countries telangiectasias are considered NOT medically necessary or cosmetic and therefore treatment of these as well as the "reticular" or feeding veins are usually not covered. It is possible that you could have other signs or symptoms of a deeper more serious problem. For a more detailed answer about what IS medically necessary and therefore covered by insurance read on.
Telangiectasias or "spider veins" can be a sign to ask or investigate symptoms further. The most important thing is to be appropriately classified if you are having any symptoms or problems. Symptoms that are considered to be related and a "reimbursible" reason to visit a vascular surgeon or phlebologist that treats varicose veins are available on the Centers for Medicare Services (CMS or you local intermediaries website as Medicare contracts with other companies based on the area that services are provided in or where you live). In summary they are generally:
Swelling, Itching, Burning, Cramping, Restlessness. Other symtoms include ulceration, spontaneous hemorrhage or recurrent phlebitis.
If they are affecting your daily activities and/or quality of life you do need to see a qualified physician whom could be your family physician and/or a phlebologist or vascular surgeon.
There are many types of high quality compression stockings available and compliance with compression stockings is a requirement for most insurance to pay for a treatment (such as the injections that you had before). The testing as well as the non-operative medical management (office visits) will generally be covered by insurance. The stockings themselves with proper documentation may be paid for by insurance although this requires diligence and usually requres that you have a prescription be appropriately fitted and go through an accredited durable medical equipment company (DME).