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 the following:
- Lifestyle Disruption: the daily activities of the patient must be disrupted significantly.
- Pain: The patient must be experiencing pain as a result of their vein disorder.
- Failure 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 significant.
- Complications: 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 covered.
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.