Can I file an appeal if my insurance company refuses to cover my vein surgery?

I pay $1,000 a month for my insurance policy with BCBS, yet they will not cover ANY of my vein issues. I am in terrible pain all the time, my knee and calf are very swollen and it's affecting my walk. I have been diagnosed with venous reflux. Can I appeal the insurance company's decision? If so, how do I do that?

Answers from doctors (8)


Center for Vein Care and Surgery

Published on Apr 04, 2013

Yes, you can appeal. Contact your insurance provider directly to find out about their specific appeals process. Your physician may also write an appeal letter on your behalf.

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Answered by Center for Vein Care and Surgery

Yes, you can appeal. Contact your insurance provider directly to find out about their specific appeals process. Your physician may also write an appeal letter on your behalf.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Mar 11, 2013

Have you been to a clinic and received a denial from the insurance company? If not, that is the first thing you need to do. An appointment has to be made, the clinic has to request benefits and the denial has to be received. Then, you may file an appeal, such as a letter. Sometimes additional clinical info or tests are necessary, but those are requested by the insurance company. The clinic may also help with the appeal process as well, if needed.

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Answered by Intermountain Vein Center

Have you been to a clinic and received a denial from the insurance company? If not, that is the first thing you need to do. An appointment has to be made, the clinic has to request benefits and the denial has to be received. Then, you may file an appeal, such as a letter. Sometimes additional clinical info or tests are necessary, but those are requested by the insurance company. The clinic may also help with the appeal process as well, if needed.

Published on Jul 11, 2012


Vein Specialists

Published on Mar 08, 2013

As a vein specialist, I have taken on this responsibility for my patients. Blue cross is generally pretty good about covering these procedures, with the exception of Anthem Blue Cross. I would ask your vein specialist to make the appeal and set up a peer-to-peer. Endovenous ablation is not an experimental procedure and has been the gold standard for the treatment of symptomatic superficial venous insufficiency since 2002 (two years after the introduction).

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Answered by Vein Specialists

As a vein specialist, I have taken on this responsibility for my patients. Blue cross is generally pretty good about covering these procedures, with the exception of Anthem Blue Cross. I would ask your vein specialist to make the appeal and set up a peer-to-peer. Endovenous ablation is not an experimental procedure and has been the gold standard for the treatment of symptomatic superficial venous insufficiency since 2002 (two years after the introduction).

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Mar 06, 2013

Yes, you certainly can appeal. Call/write the insurance commissioner in your state. Insurance commissioners want to hear from patients who have been denied services they are paying for.

Answered by Laser Vein Center (View Profile)

Yes, you certainly can appeal. Call/write the insurance commissioner in your state. Insurance commissioners want to hear from patients who have been denied services they are paying for.

Published on Jul 11, 2012


Advanced Vein & Laser Centre, Ltd.

Published on Mar 06, 2013

First, read your policy guidelines, which are accessible online. You should be able to see the "guidelines and criteria" that must be met to qualify for treatment. Vein size, reflux from the junction, conservative treatment documentation and symptoms are the usual criteria that they look for. If you have met all of these, then you have a reason to appeal. I would think that the physician's office where you were evaluated would be very helpful in an appeal.

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Answered by Advanced Vein & Laser Centre, Ltd.

First, read your policy guidelines, which are accessible online. You should be able to see the "guidelines and criteria" that must be met to qualify for treatment. Vein size, reflux from the junction, conservative treatment documentation and symptoms are the usual criteria that they look for. If you have met all of these, then you have a reason to appeal. I would think that the physician's office where you were evaluated would be very helpful in an appeal.

Published on Jul 11, 2012


Advanced Vein Center

Published on Mar 06, 2013

If your employer is self-funded, then take it up with HR. If not self-funded, contact the insurance commissioner of your state.

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Answered by Advanced Vein Center

If your employer is self-funded, then take it up with HR. If not self-funded, contact the insurance commissioner of your state.

Published on Jul 11, 2012


Heart and Vein Center

Published on Mar 06, 2013

You should certainly write a letter. Did you ask why the procedures are not covered? Did your doctor include all the pertinent information that BCBS needs to consider the procedure necessary?

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Answered by Heart and Vein Center

You should certainly write a letter. Did you ask why the procedures are not covered? Did your doctor include all the pertinent information that BCBS needs to consider the procedure necessary?

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Mar 06, 2013

You can certainly appeal their decision but you will probably be denied. The best chance of a successful appeal is if your physician calls for the appeal and, better still, if he asks for a doctor-to-doctor review where he can speak directly with the reviewing physician. I have been very successful with these kinds of appeals.

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Answered by Vanish Vein and Laser Center

You can certainly appeal their decision but you will probably be denied. The best chance of a successful appeal is if your physician calls for the appeal and, better still, if he asks for a doctor-to-doctor review where he can speak directly with the reviewing physician. I have been very successful with these kinds of appeals.

Published on Jul 11, 2012


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