Insurance Coverage of Varicose Veins : ADLs

It was mentioned in a previous blog that we would go into more detail on ADL’s; specifically what they are and how they are affected by your varicose vein pain?

What Are Activities of Daily Living?

To start with, ADL means “Activities of Daily Living”. Insurance companies are not in the business of paying for cosmetic treatments; therefore, an expectation is put in place before consideration of varicose vein treatment. One of those expectations is that your activities of daily living are affected. This tends to be hard for one to understand exactly what “affected” means; many of us will do our best to get through our responsibilities whether it is leg pain, headache, back ache or other ailments that come our way. Even though we are working through some of this pain there are times we are unable to complete some things or do some things on the timeframe needed because of the leg pain we’re experiencing. When asked, “how are your ADL’s affected?” some responses are as follows:

“At the end of a long day I am unable to do the dinner dishes before I have to sit and elevate my legs.”

“My job requires me to sit for long periods of time and makes it very difficult to do my work without standing and walking around.”

“After chasing my children around in the morning it takes some rest before taking them to the park or caring for them such as bathing or dressing.”

“I am unable to complete my chores around the house without sitting and elevating my legs.”

“I would like to do more yard work but after a short period of time I have to take a break.”

“My life could use more exercise but my leg pain limits how far I can walk before heading home.”

“My job requires me to stand for long periods of time; I am in a great deal of pain by the time break is called. The pain is effecting how I do my job.”

This list could go on and on in different ways of how your daily activities are being affected and from this list you may realize that you do experience heaviness, achiness or tired legs that limit what you do throughout your day. You may get cramps in your legs at the end of the day or at bed time that wakes your from your sleep, especially after a long day on your legs

Do You Relate?

If some of this is starting to resonate with you it’s time to schedule an appointment to assess your vein anatomy. At this appointment we will be able to evaluate your vein sizes for an appropriate treatment plan, which is also a requirement your insurance company will need. We will also be able to explain further insurance requirements which may include compression stockings, Nsaids and leg elevation. We are here to help you understand the process better and work directly with your insurance to help you overcome the pain.

2017 Love Your Legs Screening Event

Real Men take care of their health . . . and ask for directions



Men don’t usually admit to being in physical pain—just like they don’t discuss emotions or ask for directions. Remember the old book Real Men Don’t Eat Quiche? Well, what if a guy likes quiche? Anything with bacon, pie crust, and melted cheese sounds pretty manly to me. Just as Real Men (and Real Women, for that matter) don’t let anyone tell them what to eat based on a fad, Real Men should notice aches and pains enough to take charge of their continued good health.

Not for Women Only



Varicose veins apply to men, too. It’s a major myth that vein disease happens only to older women who’ve had lots of babies. Young, physically fit males can also be at risk. In fact, the biggest single risk factor for varicose veins is family genetic history, and 40% of men will develop vein disease over time. Really, this makes sense if you think about it. All human beings have the same circulatory system in their legs; therefore, anyone can have the same vein problems. Varicose veins may become a serious health issue, causing thickened discolored skin, major swelling, and weeping sores on the ankle and foot.

What’s a Guy to do?



So if being male won’t save you, and youth or physical fitness alone won’t save you, are varicose veins inevitable? No way—take control! Notice the early signs of vein disease, and treat symptoms before they get worse. Do your legs ache or feel tired at the end of the day? Do they feel restless, twitchy, or “heavy”? Are your legs ever slightly swollen or sore? These are all early signals of vein disease.

Choose the Experts



IVC specializes in diagnosing, managing, and treating varicose veins. The Valentine Free Screening Event is a great opportunity to be scanned at one of only two accredited vein treatment centers in the state. If you have signs of vein disease, you can speak with the experts and check out your options. Do something good for your health, and have fun doing it. Since the Event theme is famous old-Hollywood couples, take your sweetheart and earn some bonus points. It’s a great party, complete with fabulous food, live music, and a deluxe gift.

Go with your Sweetheart, or Go Stag



What type of guy came to this year’s Valentine Event? Several couples attended together; either both were screened, or one had an appointment and the other tagged along for moral support. A husband commented, “Just coming here is like being on a date!” His wife agreed: “Music, food, chocolate? I’m happy…” Another man came in solo but credited his wife with motivating him to be checked. He said, “I’m here ‘cuz my wife wants me here. ‘Happy wife, happy life!’”

Of course, some men do take charge of their health and come in under their own steam. One man said, “I heard your ad on the radio, and your description sounded like how my legs feel. I’ve had some leg aches, so I wanted to check it out.” Another man commented, “Yeah, I’ve known I had vein disease for a long time. Time for me to do something about it.”

And he’s right—it IS time to do something about it. Don’t suffer in silence. Just like Real Men can eat quiche, Real Men take action to stay healthy. Ask for directions , and take care of your health.

P.S. Several other conditions can affect men and their vein health. For more details, phone us at 801-379-6700, or watch for another blog coming soon!

Varicose Vein Procedures: Endovenous Thermal Ablation

Endovenous Thermal Ablation

The first procedure typically performed is the venous ablation. This is where the vein is burned with either laser or radio frequency catheters. During this procedure, the patient is sedated with valium, nitrous oxide, or both. The patient can choose the level of sedation they prefer.

During this procedure, the sonographer will map the vein to be ablated and mark a location that appears to be a good access point. What we look for is whether the vein is straight and has a large diameter, which makes accessing the vein easy. Veins will sometimes spasm or be a smaller diameter early in the morning when the patient hasn’t been standing or active all day, or when the leg is cold. In these cases, we use gravity, a Nitroglycerin patch, and a blanket to help warm up the leg and increase the diameter of the vein.

Once a location is marked, we prep the leg with a cleansing/sterilizing solution and set up the procedure using sterile technique. We ask that the patient not touch the sterile field, so to prevent infection. When the physician enters the room, he will also dress in a sterile gown and will don sterile gloves. We take every precaution to keep the patient safe and infection free.

At this point, the physician will access the vein and start the procedure. Once the vein is accessed, a “guide” wire is inserted and the sonographer will follow the wire up the vein to make sure we are in the vein and not in the surrounding tissue. After that, the catheter, with the heating element, is inserted and once again the sonographer follows the catheter with ultrasound to make sure it is in the vein to be treated.

Once the catheter is an acceptable distance from the deep venous system, we need to numb around the vein. This is two-fold: The first reason is to numb and protect the tissue surrounding the treated vein from being burned. The second is to compress the vein around the catheter so the walls of the vein will be treated.

Once this all complete, the catheter is slowly removed and the vein will be ablated. We close the access point with steri strips and the procedure is finished. The patient is then required to wear a compression stocking for one week.

Introducing Cody Jarrett, PA-C

As a new provider at IVC I would like to introduce myself. My name is Cody Jarrett; I have worked in healthcare for roughly 12 years. My healthcare experience began at LDS hospital and Intermountain Medical Center as I completed the radiologic sciences program at Weber State University where I received a Bachelor of Science in Advanced Radiologic Sciences. After roughly 3 years as an x ray technologist I applied to Physician Assistant programs. I was accepted and completed the Physician Assistant program at Duke University receiving a Master of Health Sciences degree.

I have worked with Utah Radiology Associates since graduating in 2011. I have predominantly worked in the hospital setting at Utah Valley Hospital performing minor interventional procedures using fluoroscopy and ultrasound guidance. As I became more experienced with some of the treatments offered by IVC that are performed in the hospital setting such as vertebroplasty and DVT lysis, I began to transition to be a provider at IVC.

One of the common questions I have noticed as I see patients at intermountain vein center is the concern of superficial venous thrombosis or SVT after treatment. It is important to understand the difference between a superficial venous thrombus vs a deep venous thrombus. A deep venous thrombus or DVT is a more concerning blood clot that has more potential to travel in the venous system. It almost always requires some form of anticoagulation. A DVT is not commonly seen after treatment of superficial veins. A superficial venous thrombus is essentially a small blood clot that has formed as a result of a procedure such as ambulatory phlebectomy , sclerotherapy, or endovenous ablation. These small clots are considered a benign condition and will typically resolve on their own without systemic anticoagulation. SVT can cause discomfort typically in a small area around the actual SVT site. We recommend using ice and/or heat as well as an anti-inflammatory such as ibuprofen for symptomatic relief. SVT symptoms will generally last 1-3 weeks.

Insurance Coverage of Varicose Vein Treatment

Getting treatment for varicose veins can be daunting and sometimes frustrating. We hear you and want to help.

Does this scenario sound familiar:
Physician: How long have you suffered symptoms?
Patient: Explains reason for visit.
Physician: Well, I know we can help you with that. What insurance do you have?
Patient: Gives insurance information
Physician: Oh, I’m sorry to tell you that not all these procedures are covered by your insurance.

If this has happened to you then you are not alone. Most insurance companies have complex policies that are difficult for even their own employees to understand let alone the layman. So, what is it that you need to know about insurance coverage for varicose vein treatment and whether or not your insurance will pay? Three things: symptoms, anatomy and conservative measures.

Varicose Vein Symptoms

Insurance companies are not in the habit of paying for cosmetic procedures; therefore, if you simply do not like the way your legs look then you will have to dig deep into those pockets to pay for those treatments on your own. However, many of our patients are not aware they are experiencing symptoms from their varicose veins because they did not know what to look for. Most patients experience aches and pains in their legs, along with heaviness and sometimes swelling. Another symptom commonly associated with varicose veins is itching. The insurance companies like to quantify these symptoms by determining how they affect your life on a daily basis (Activities of Daily Living). Read about Activities of Daily Living.

Vein Anatomy

We know you have no control over your vein anatomy but regardless the insurance companies have limitations on what they will and will not treat. When you come to an appointment at IVC, you will have a complete ultrasound that we call a “vein mapping”. This vein mapping allows us to determine which veins are healthy and which veins are not. It also allows us determine the diameter of the diseased veins and their shape so we know which modality we should use for treatment. You may hear us mention that a vein size is too small to be covered by your insurance. Most of the time, these smaller veins are not causing the symptoms you are experiencing; therefore, it is not detrimental to your health to not proceed with treating those veins.

Conservative Measures for Varicose Veins

Okay, now we have established that you are experiencing the symptoms the insurance wants for treatment and your vein anatomy meets their policy requirements. What are conservative measures and why do you need to do them? The majority of insurance companies are going to require a patient to have a trial period of wearing prescription strength compression stockings for at least three months prior to approving treatment. The styles really have come a long way from when our grandparents wore compression socks, but they still are tight and can be uncomfortable so the three months can sometimes feel like a lifetime. Insurances also like to see that you tried taking anti-inflammatories to alleviate symptoms. Some require these medications to be prescription strength and others require OTC. Either way, the insurance companies want to determine whether your symptoms can be managed by conservative treatment with medications and compression before they opt to pay for other forms of treatment.

Once you have completed your conservative measures trial period, then it is time to submit your clinical for prior authorization and move forward with treatment. Having insurance does not guarantee they will pay so it is very important to choose a clinic that will walk you through the process. Do not be afraid to ask questions to be informed as much as possible because ultimately the buck stops with you.

What Is a Nurse Practitioner?

A nurse practitioner is a registered nurse with extra schooling and opportunities to provide health care, diagnose, and treat patients. There are different levels of nursing and they all have different amounts of schooling and opportunities for providing care. First you have a licensed practical nurse (LPN), second a registered nurse (RN) and third a nurse practitioner (APRN) and now a Doctor of nursing practice (DNP). I will discuss the schooling and the privileges of each of these nurses.

First Level – Licensed Practical Nurse

A licensed practical nurse (LPN) has the following job duties. They can care for patients basic needs with their normal daily activities such as bathing and dressing, and they can take vital signs. They can also obtain medical histories, draw blood, give injections and discuss health care with patients. There are other things they can do, it just depends on the facility they work in. They also report patient status to a registered nurse or a doctor. To obtain a degree as an LPN it will require one year of schooling. The classes will be in nursing, biology, pharmacology and supervise clinical experience. Many LPN’s work in Doctor’s offices or clinics and they help with patient flow and obtaining histories.

Second Level – Registered Nurse

A registered nurse (RN) has the ability to perform all of the duties of an LPN and they can also do many other things. They can administer oral and intravenous medication according to a medication administration record. They can administer treatments, perform diagnostic tests, coordinate care plans, and analyze results. They also instruct patients on illness management and they oversee the work of medical assistants, nursing aides, and LPN’s. Most RN’s work in hospitals and they can help assist doctors with minor procedures. RN’s have at least 2 years of schooling and some have 4. The privileges between the two are not any different. The 4 years of schooling lets you have the opportunity to work in management positions and to further your education and get a master’s degree.

Third Level – Nurse Practitioner

A nurse practitioner (APRN) can perform any of the things that an LPN or RN can do and they have many other responsibilities. A nurse practitioner can work side by side with a doctor and help them with seeing patients. They can perform physical exams and diagnosis and treat patients. They can prescribe medications, and perform many procedures on their own with some minimal supervision. A nurse practitioner can have their own office and see, diagnosis and treat patients. To become a nurse practitioner you need to have a bachelor’s degree in nursing and then get accepted into a program for nurse practitioner’s. There are many specialities you can go into as a nurse practitioner. These range from pediatrics, geriatrics, and family practice to acute care, women’s health and mental health practitioners.
In the past 10 years or so the nursing community has developed a Doctor of nursing practice (DNP) degree and they have an additional 2 years of schooling beyond the master’s prepared APRN. The rights and privileges are the same for the APRN and the DNP.

The differences between the levels of nursing depend on how much schooling you have and the privileges you get after obtaining the appropriate degree. It will take more schooling to have increased privileges and opportunities for growth and advancement.