Feel Confident Navigating the Waters of insurance Coverage When Seeking Care for Your Vein Problems
Insurance coverage these days is a tricky endeavor and something that is not always easy to navigate. Many people believe that varicose veins are only a cosmetic problem and not a medical diagnosis. Therefore, many people believe that insurance companies will surely not your varicose veins treatment. Yet most insurance carriers do, IF some of the following criteria are met. The good news is that most vein specialists have insurance specialists as part of their practice to help with all of the subtleties of coverage and authorizations, making the process less stressful for the patient to determine what is and isn’t covered by insurance.
- Signs and Symptoms- Patients wanting to get their varicose veins treated must have symptoms associated with them. They must have pain, aching, heaviness, tiredness, itching, restlessness, and/or swelling. Or they must have a non-healing ulcer, skin changes (brown ankles), or spontaneous bleeding from a superficial vein to be eligible for treatment. Without any of these signs or symptoms most insurance companies will consider varicose veins to be cosmetic and will not cover any treatment. Patients should always consult with their vein specialist to determine if their symptoms fall within the standards required for insurance coverage.
- Compression Stocking Wear- Most insurance companies require patients to have worn compression stockings (at least 20-30mmHg) for a certain period of time (2 weeks up to 3 months) to see if it will help with their varicose veins and the symptoms that they are experiencing. These need to be prescribed by a healthcare provider and documentation that they were purchased may be required. Wearing compression stockings will not treat varicose veins, but may give temporary relief from symptoms while you are
wearing them. Your symptoms will be followed by your healthcare provider for submission to your insurance company. **Compression stockings are not safe for all patients, please consult with your healthcare provider before purchasing/wearing compression stockings.
- Other Conservative Measures- Some insurance companies require patients to try other conservative measures like: leg elevation, walking, calf pump exercising, weight reduction or taking a non-steroidal anti-inflammatory (like Ibuprofen). Like the compression stockings, these conservative measures won’t treat varicose veins, but simply relieve the symptoms. **Before trying any of these measures, consult with your healthcare provider as some of these measures may not be appropriate for you. Especially before taking multiple doses of non-steroidal anti-inflammatories as these can cause stomach upset.
- Interferes with Daily Activities- Most insurance companies want to know how the pain, swelling, heaviness etc. is affecting your daily life functions. Must you sit down at your job after standing for an hour, because your legs hurt? Is it hard to cook all the meals at home, because your legs start to swell from standing for so long? When driving for long periods of time for your work, do your legs ache? These are some of the problems that varicose veins can cause that affect a patient’s life.
- Reflux on an Ultrasound Exam- The veins in our body carry de-oxygenated blood from our tissues and organs back to our heart and lungs to receive more oxygen. However, when the blood starts flowing in the wrong direction it’s called reflux. To determine if the veins in your leg have reflux, a non-invasive ultrasound is performed. The test is not painful and takes about 45 minutes to complete. Having reflux in your saphenous vein(s) is one of the parameters that distinguishes cosmetic varicose veins from medically necessary (and covered by insurance).
While every insurance carrier is different, most companies do cover the treatment of varicose veins when diagnosed by a vein specialist who will set the course of treatment by accepted and proven methods. Here are a few tips for understanding your individual policy:
- Make sure that the treatment you are receiving is not considered experimental. Not all proposed vein procedures are covered by all insurance companies, so make sure the procedures prescribed for you are included in your plan. Again, insurance specialists at the vein care practice should be able to help with understanding this issue.
- Having a pre-authorization of the procedure(s) being performed will also allow you to know what treatments your insurance company will and will not pay for. However, please check the benefits of each individual plan as some plans do have exclusionary clauses.
- If your plan does have an exclusionary clause, contact human resources at your job and discuss your options for switching insurances or have them call the insurance directly.
There should always be a way for you to have the vein care you need by the vein specialist you choose.
Call To Action
If you are uncertain if your vein treatment will be covered by insurance—make an appointment with a highly-qualified vein specialist and have peace of mind that their team will address your insurance concerns.