HMO & PPO:
Both HMOs and PPOs have two categories under
which vein treatments may fall:
- Cosmetic Procedures
- Medically Necessary Procedure
The majority of vein treatments will fall
under the category of cosmetic procedure, and as such, will
not be covered by insurance providers. However, surgical procedures
are more likely than injection treatments or Laser/Light therapy
to be covered as a "medically necessary procedure".
Insurance companies use varying criteria in
order to determine if vein treatment is to be considered "medically
necessary." These criteria may include one or more of
Disruption: the daily activities of the patient must be disrupted
The patient must be experiencing pain as a result of their
of Conservative Measures: Other methods of treatment, such
as compression hose, have failed to provide adequate relief.
- Vein Size:
Bulging veins larger than 4 mm are often considered medically
Complications, such as phlebitis, bleeding veins, leg swelling
and leg ulceration make it more likely an insurance company
will consider treatment medically necessary.
Medicare may reimburse vein specialists for "medically
necessary care" but not for "cosmetic care". Medically necessary signs and
symptoms include pain, swelling, ulceration and others. In these cases, after
documentation of venous insufficiency by ultrasound, Medicare will usually
deem endovenous ablation and ambulatory phlebectomy to be medically
necessary. You will have to contact your vein facility to determine whether
they are participating in Medicare and whether your treatment may be
Most vein clinics will offer you a variety
of payment methods. Please ask your vein specialist about payment
options during your consultation. For further insurance information
contact you insurance provider for coverage options.