Dealing with treatment of varicose veins can be tricky when it comes to prior authorization with an insurance company. There are many guidelines that need to be followed and they are specific to each insurance company. Examples including vein size, types of veins, pain level, compression stockings and Nsaid use are just a few that each insurance will look for at the time a prior authorization is submitted.
At IVC we are very aware of the importance of obtaining the correct measurements and making the patient aware of their responsibility before an authorization can be obtained. No one wants to go into a procedure without being sure that the insurance will pay their part. We want our patients to be relaxed on their procedure date, not stressed about whether they will have an issue with their insurance later on. Because patient care is so important to us, we pride ourselves in knowing what the insurance company needs, we have an open relationship with many insurance companies who appreciate our clinical notes and ultrasound reports and have open communication with us to explain any changes because we are not trying to sneak past their requirements.
Knowing Your Out-of-Pocket Expense
Not only can you have the confidence in our authorization department, we offer what many clinics do not, knowing what your out of pocket cost is before starting the varicose vein treatments. Knowing what your portion of the treatment will cost you will help you decide if the treatment is possible, and prepare with your HSA or Flex Spending accounts. You will hopefully better understand what your deductible, co-insurance and out of pocket max are and how they apply to the treatments you receive at IVC.
Getting started with your new patient appointment will not only educate you on insurance requirements and cost but will also get you started with those requirements and be ready if your deductible is met for the year.
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.
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.
When it comes to insurance we all have a lot of questions. Do you ever feel that you never get a straight answer? Welcome to the game. For the next few weeks I will be your coach and will provide you with insurance insight that pertains to varicose vein policies. This week I will share general requirements that many of the insurance providers enforce through their guidelines. In the following weeks I will highlight an individual insurance plan.
I’m sure you have questions regarding your deductible and if it will apply to the procedures. You may also wonder what your responsibility will be. All of these questions will be answered during your new patient appointment.
Many insurance companies require conservative measures, such as compression stocking usage. The use of anti-inflammatories and pain meds are required; exercise and being as active as possible is also encouraged. And what about symptoms? Swelling, achiness, PAIN, etc. Ay yi yi. The list goes on and on. I promise I will not leave you hanging. I will address all these things and more in the following weeks and be specific as to which insurances require all or none of these conservative measures and symptoms.
Whether you are playing “Shoots and Ladders” or friendly rounds of fantasy football, all games have rules. I hope to share the rules to the “insurance game” in a way that is easy to understand and help you maneuver through the field of policy madness.