I have Aetna NAP insurance. Do I need to contact them to see whether they cover vein treatments and, if so, what the requirements are for coverage?
Aetna is a commercial carrier with trends like the Blue Cross plans. This means that they generally cover vein treatment when medical necessity is established. The next question is what treatments are covered vs. which are excluded. Despite symptoms that may occur with spider veins, these are considered cosmetic unless actively bleeding. You can review the Aetna website to see general guidance for vein treatment and your specific plan from your employer. Insurance companies want nothing to do with cosmetic treatment. Medical necessity is established by an ultrasound demonstrating the problem, as well as a conservative trial of compression, walking, elevation, etc. If you respond to conservative therapy in a positive way, you will likely respond favorably with treatment.
Published on Jul 11, 2012
Great question. It is always helpful to contact your insurance company about whether they will cover any treatments. Sometimes you may have to press the insurance companies themselves to get them to cover your treatments. Insurance companies don't like to pay for medical care if they dont have to.
Published on Jul 11, 2012
Varicose veins can be covered by insurance companies, but spider veins are never covered because they are considered cosmetic.
Published on Jul 11, 2012
Every office has different policies. In our office, our staff confirms our patients' insurance policies and lets the patient know about the coverage. Every insurance policy is different, with different requirements for coverage. Ideally, the office you are working with will contact the insurance company on your behalf.
Published on Jul 11, 2012
Symptoms (including pain) and insufficiency documented by an ultrasound and physician are just some of the requirements that need to be met for coverage. A period of conservative therapy with stockings for usually 6 weeks is another.
Published on Jul 11, 2012
If you have venous insufficiency causing symptoms in the leg(s), this can be treated with endovenous ablation procedures like VNUS, EVLT or ClariVein, among others. Concomitant spider, reticular and varicose veins can be treated at the same time, or 3 months later if they are symptomatic.
If they are purely cosmetic, they will not be covered by insurance. Insurance companies do not cover cosmetic vein problems. However, as cosmetic procedures go, sclerotherapy is the least expensive of all cosmetic procedures. I charge $500-$700 per session for cosmetic sclerotherapy. Less experienced practitioners charge less.
Published on Jul 11, 2012
Spider vein treatment is a cosmetic procedure that is not covered by insurance. Varicose veins treatment, if medically indicated, is covered by insurance.
Published on Jul 11, 2012
The physician's office can do this. It is easier for them since they will have the correct diagnosis and procedure codes. You can ask the physician to let you know.
Published on Jul 11, 2012
Different insurances cover different types of vein treatments. In order for vein treatments to be covered, certain requirements need to be met, such as types of symptoms, degree of disability from veins and trial of medical management. I would recommend that you see a vein specialist for an evaluation and guidance as to treatment. If you call your insurance company, most likely they will look for a way to deny coverage.
Published on Jul 11, 2012