Varicose veins and spider veins are common and frustrating problems for which we provide various treatments. Patients who are interested in exploring what those are often have questions about whether or not their vein treatment would be covered by insurance. The best answer is “maybe.” An insurance company like Medicare may cover vein treatment if considered medically necessary. For treatment to be considered medically necessary, a patient may have to provide a fair amount of documentation to prove their case. Here, we discuss some of the main criteria insurance companies look at to evaluate coverage. Keep in mind that every insurance company may have slightly different qualifications and coverage amounts, so it is important to discuss these with your provider directly.
Criteria for medically necessary vein treatment
- Varicose veins are causing significant pain and other symptoms.
Insurance companies do not cover treatments performed for cosmetic purposes. They may look at covering care for varicose veins that are causing persistent swelling, burning, night-time cramping, heaviness, and frequent leg pain. Other symptoms that may warrant coverage include skin discoloration, a bleeding vein, recurrent phlebitis or blood clots, and ulceration of the skin over the vein.
- Symptoms affect daily life.
A patient may need to prove that their symptoms are so severe that they are affecting their ability to perform their job or live their normal life. An example of this may be a teacher or grocery checkout clerk who cannot stand for the long periods their job demands but must take breaks to sit or elevate their legs. The symptoms of varicose veins force some people to have to cut back on the number of hours they work because working long shifts worsens pain. An insurance company may cover vein treatment for a person whose varicose vein symptoms prevent them from cooking and performing household chores.
- Conservative treatment for 6-12 weeks.
Many insurance companies also require patients to try conservative vein remedies for several weeks before they will approve interventional procedures like sclerotherapy. These remedies may include medication, weight loss, exercise, elevating the legs, and wearing compression stockings. Some companies go so far as to require 6 to 12 weeks of wearing medical grade compression stockings before they will consider vein treatment. Due to this criterion, patients are encouraged to keep prescriptions for compression stockings, doctor’s notes, and a daily diary of their symptoms and treatment methods to provide their insurance when the time comes.
- Ultrasound imaging must confirm venous reflux.
Ultrasound imaging is commonly used as a diagnostic tool in vein treatments. This screening helps the vein specialist identify where blood is pooling in a vein and can be a helpful guide during treatment. In the case of insurance coverage, a company may require imaging to confirm that venous reflux is occurring.
The Vascular Institute of Virginia offers professional vein treatments in a comfortable, friendly environment. To schedule your consultation at our Fredericksburg or Woodbridge office, contact us at 703-763-5224.