Billing and Insurance for varicose vein & spider vein removal
Because the venous procedures we do here at the Advanced Vein Clinic are treating the medical cause of varicose veins, you will find varicose vein removal usually covered by insurance. Many physicians only treat the veins cosmetically; our veins specialists treat the source of the varicose veins. Some insurances require preauthorization which will be completed by our staff.
Usually one Diagnostic Ultrasound per leg is all that is needed to begin a treatment plan. If the insurance company determines that further treatment will not be covered due to not being medically necessary, the initial diagnostic ultrasounds are generally covered.
These insurances may cover your procedure:
- All Highmark Blue Cross and Blue Shields
- * Anthem BCBS
- * PPO blue
- * Freedom blue
- * Security blue
- * Federal blue
- All savers
- Aetna Better health
- Beaver Valley Prime
- Gateway -but needs referral
- Gateway Medicare Assured
- Health America
- Health Assurance
- Humana military
- Medical Mutual
- Medicare Railroad
- Pa health and wellness
- Private Insurances
- Out of State Blue Card Program
- Tricare for life
- Tricare Military insurance
- United Health Care
- United Healthcare Community
- United Mine Workers, UMR
- Upmc PPO
- Upmc for you
- Upmc for Life, out of network
- Western Pennsylvania Electric (WPEE)
Insurances NOT currently accepted, or are out of network.
- Aetna Better health
- Military – Tricare
- United Community
- UPMC PPO only
If insurance does not cover treatment patients have the option of self-pay for treatment.
Most insurance carriers cover our varicose vein treatments. Individual co-pays, deductibles and coinsurances apply. Our staff is happy to assist with questions you may have.
What does the term “medically necessary” mean?
This information is all well and good. It’s always interesting to know the underlying cause of a problem. But what does it have to do with your varicose veins on your legs? What’s the practical application? By itself, this information doesn’t mean much. When measured, however, it can go a long way towards proving that a procedure is medically necessary.
In regards to your varicose veins here’s how the process works. First you’ll need to have physical symptoms. Cosmetic symptoms by themselves aren’t enough to conclude that a treatment is medically necessary. No matter how unsightly your leg veins are it won’t help in establishing medical necessity. Also note that psychological distress caused by the symptoms also doesn’t influence a “medically necessary” determination.
Symptoms of leg vein disease that support a “medically necessary” insurance determination.
- Feelings of heaviness or fatigue
- Achiness or pain
- Edema (excessive swelling)
- Chronic cramping.
- Restless Leg Syndrome (RLS).
- Open ulcers, especially those found on the insides of the ankles.
Any of the above symptoms help establish a case for medical necessity. These will be recorded in your medical notes and submitted to your insurance company.
How to get insurance to pay for varicose vein removal?
Medically there has to be “proof” that your vein disease is bad enough to treat.
Unfortunately, regardless of how much your physical symptoms bother you, this alone won’t qualify you for treatment. Your insurance company will want the type of concrete measurements that only an ultrasound exam can provide. During your exam, your Registered Vascular Technician (RVT) will take the following measurements:
- Vein size, specifically vein diameter. Ultrasound can be used to take a “slice” image of a vein will look like an “O” on the ultrasound screen. This allows your RVT to measure the width of a diseased vein. Anything above 5 millimeters, which is slightly less than the diameter of a pencil, will qualify.
- Degree of venous reflux. This refers to the amount of blood that’s flowing in the wrong direction, back down the leg. If this reversed flow lasts longer than ½ second then you’ll qualify for treatment.
If you’ve got physical symptoms then your ultrasound exam will usually be covered. Similarly, it’s also highly likely that the exam will demonstrate that treatment is medically necessary. If you think that your symptoms are bad enough to treat there’s a good chance that your insurance company will pay for treatment. All in all, it’s really no different than proving that treatment is medically necessary for other conditions.
Are compression stockings or other post-treatment supplies covered under my insurance plan?
Coverage for compression stockings or other post-treatment supplies for varicose veins can vary depending on your specific health insurance plan. Some insurance plans may provide coverage for these supplies, while others may not. Here are some points to consider:
- Medical Necessity: Insurance coverage for post-treatment supplies like compression stockings may be contingent on medical necessity. Your healthcare provider may need to provide documentation to justify the need for such supplies based on your condition and the type of treatment received.
- Coverage Limits: Some insurance plans may have specific limits on the number of compression stockings or other supplies that are covered within a certain time period. Make sure to check your policy’s details to understand any such limitations.
- Network Providers: Your insurance plan may require you to obtain compression stockings or other supplies from specific providers within their network to be eligible for coverage. Confirm whether there are any preferred suppliers for these items.
- Out-of-Pocket Costs: Even if compression stockings or supplies are covered, there might be co-pays, deductibles, or coinsurance that you need to pay out of pocket.
- Pre-Approval: In some cases, your insurance plan may require pre-approval or pre-authorization for coverage of post-treatment supplies. Check with your insurer about their requirements.
Does insurance cover the removal of varicose veins if they cause pain or discomfort?
Insurance coverage for the removal of varicose veins depends on the specific policy and the medical necessity of the procedure. In many cases, if varicose veins cause pain, discomfort, or other symptoms, insurance may cover the removal or treatment procedures. However, insurance providers often require
documentation from a healthcare professional indicating that the procedure is medically necessary.
Patients should consult their insurance provider and healthcare provider to determine coverage eligibility. It’s essential to understand the policy terms, required documentation, and any pre-authorization requirements to ensure insurance coverage for varicose vein removal procedures.
What documentation do I need to provide to ensure insurance coverage for varicose vein procedures?
To ensure insurance coverage for varicose vein procedures, you typically need to provide the following documentation:
- Referral or Recommendation: A referral or recommendation from your primary care physician or specialist indicating the medical necessity of the varicose vein procedure.
- Medical Records: Detailed medical records that document your symptoms, previous treatments, and the impact of varicose veins on your health and daily life.
- Diagnostic Tests: Results of diagnostic tests, such as ultrasound or Doppler studies, showing the extent of the varicose veins and their impact on your circulation and overall health.
- Conservative Treatment Documentation: Evidence that you have tried conservative treatments, such as compression stockings, lifestyle changes, and elevation of legs, and that they have not provided significant relief.
Will insurance cover follow-up appointments and post-procedure care related to varicose vein treatments?
Insurance coverage for follow-up appointments and post-procedure care related to varicose vein treatments varies depending on the specific insurance plan. Some insurance policies cover necessary follow-up visits and related care, such as wound care or monitoring. It’s essential to check with your insurance provider to understand the coverage details and any potential out-of-pocket costs for these services.
What happens if my insurance denies coverage for varicose vein treatments?
If your insurance denies coverage for varicose vein treatments, you may be responsible for covering the cost of the treatment out of pocket. Before proceeding with the treatment, you can consider appealing the denial. To do this, you may need to gather additional medical evidence or documentation to support the medical necessity of the procedure. Alternatively, you can discuss other treatment options with your healthcare provider, which may be covered by your insurance.