Ask your vein specialist about insurance coverage and payment options during your first consultation. You may be surprised to find that your insurance covers many varicose vein treatment procedures when deemed "medically necessary." Additionally, most vein clinics will offer you a variety of payment methods for those treatments that insurance doesn't cover.
For a general guideline as to what varicose vein treatments you can expect your insurance to pay for, read on.
Vein Treatments: HMOs & PPOs
Both HMOs and PPOs have two categories under which vein treatments may fall:
- Cosmetic procedures
- Medically necessary procedures
The majority of vein treatments fall under the category of cosmetic procedures, and as such, will not be covered by insurance providers. Insurance companies cover some, but not all, vein treatments when they are deemed "medically necessary".
Each insurance company is allowed to establish its own rules about which treatments are medically necessary and under what circumstances. The rules are often complex and include very specific medical criteria that must be met, and they may restrict treatment to only certain veins or certain procedures.
Check your insurance company's website for their policy on vein treatment or ask them to send it to you. Then you should share the information with your vein specialist.
Insurance companies' criteria for whether vein treatment is "medically necessary" may include one or more of the following:
- Limiting: Your vein problems limit your day-to-day activities.
- Complications: Complications such as vein swelling (thrombophlebitis), ruptured or bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary.
- Pain: You must be experiencing pain as a result of your vein disorder.
- Failure of conservative therapy: Other methods of treatment, such as the use of compression hose, have failed to provide adequate relief after a specified period of time.
Medicare and Vein Treatments
Medicare may reimburse vein specialists for "medically necessary care," but not for "cosmetic care." For example, Medicare does not cover:
- Treatment of spider veins (telangiectases)
- Sclerotherapy for cosmetic purposes
Medicare will cover these treatments for varicose veins when deemed medically necessary:
- Ligation with or without stripping
- Endovenous radiofrequency ablation
- Laser ablation
Medically necessary signs and symptoms include significant pain and swelling, ulceration and others. Medicare will consider treatment of varicose veins medically necessary if a six-week course of conservative therapy (including compression stockings, weight loss, exercise, and periods of leg elevation) doesn't work.
These are not the only vein treatments Medicare covers, and the list of specific criteria that make treatment medically necessary is fairly long and detailed. Contact your vein facility to determine whether they participate in Medicare and whether your treatment may be covered.
Reviewed February 7, 2017