I have always been told by my doctor that my veins are only cosmetic and my insurance company doesn’t cover cosmetic procedures. If I have treatment, will I be stuck with an unexpected bill?
The majority of insurance companies including Medicare recognize the importance of surgical procedures to eliminate varicose vein disease with symptoms. Each carrier administers unique requirements that must be complied with to deem the procedures as medically necessary. That is where a misconception can happen. If medical necessity is not established, the carrier will likely presume that the procedures are being performed for cosmetic reasons. An experienced phlebology practice will be able to advise the patient in specific requirements and thus avoid the ‘cosmetic’ label when being performed for a medical condition.
Benefits vary with each insurance plan and it is important that you understand your policy. A highly experienced vein practice will help a patient understand their benefits, and guide them in specific medical necessity and coverage policies. Avoiding an unexpected bill involves a coordinated effort of meeting medical necessity, using therapeutic options that the insurer recognizes, and acquiring approval for services before treatment is rendered. Seasoned vein practices understand nuances of insurance carriers and should be able to avoid an unforeseen financial burden.
I don’t want surgical stripping, are there other procedures my insurer will cover?
There are many treatment options available today including the nearly obsolete practice of surgical stripping. Once a consultation for venous services is completed, a physician will describe and recommend treatment options best suited for your specific venous concerns and ultrasound findings. Alternatives to surgical stripping are minimally invasive and performed in an outpatient surgery or office setting. These modern choices generally offer less pain and limited disruption of routine activities, and include thermal ablation (cautery), ambulatory phlebectomy, and sclerotherapy services.
While many procedures for varicose vein disease are covered by insurers, some procedures fall under excessive scrutiny regardless of established medical need. Sclerotherapy as a sole treatment for any venous condition can prove very difficult to get insurance approval.
Sclerotherapy is one of the most commonly performed cosmetic procedures, and can be perceived as purely cosmetic or as a unique medical option. Sclerotherapy is generally covered when used in combination or as supplemental treatment following other large vein procedures. Thermal ablation, phlebectomy, and surgical stripping rarely fall into question.
What if a vein specialist is out-of-network? Can I still see the doctor who makes me feel most comfortable?
Selecting a provider can be tough, but yes you have the ability to choose the doctor to perform your procedures. An in-network provider does not necessarily mean that your experience or outcome will meet your satisfaction, yet it may prove to be less expensive. Choose the provider that makes you most comfortable, and who can deliver the results you are searching. Realize that an out-of-network provider has the ability to reduce your out-of-pocket expenses, as they are not contracted with your carrier. In these instances, seeing the out-of-network provider has the same out-of-pocket impact as seeing an in-network provider. It pays to do your research and become comfortable with the provider and the expenses of having treatment for your varicose veins.
