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.

How long will my treatment plan take?

Every patient at IVC is unique. Therefore, everyone is not going to be the same. Most patients will have a treatment plan that will take anywhere from 6 to 8 weeks up to 14 to 16 weeks depending on how many veins need treatment. The initial plan may change after the first couple of treatments and could be shortened or lengthened compared to the initial plan. Follow-up appointments are how we determine what needs to be done next and if we need to change the treatment plan. Varicose vein treatment is not something that can be treated all at one time so expect anywhere from 8 up to 16 weeks for completion of your treatment plan.

Why must I have an ultrasound after every procedure?

It is very important to utilize ultrasound after each procedure to check the areas that have been treated for two things. First, we are checking the area of treatment for successful vein closure. Second, we are looking for any problems or complications from the procedure, such as blood clot in the deep or superficial system. This follow up ultrasound also gives us an idea of the remaining problems that need to be treated and allow us to adjust your treatment plan accordingly.

Why do I see so many different doctors during the course of my treatment?

At IVC we currently have 7 different doctors that treat varicose veins. All of them are Interventional Radiologist. They are radiologist in the classic sense that read X-rays and MRI’s, but they have also done additional training to do minimally invasive procedures that use various imaging techniques to accomplish it. Our doctors perform a wide variety of procedures in all areas of the body. IVC is not the only location they do procedures in, they also work in two different hospitals. Just about every day they are working in a different location. A doctor may only rotate to IVC 2-3 times a month.

 

Because of this the majority of our patients will choose a day that works for them to have their procedure on and simply have whatever doctor is working that day perform their procedure. Hence most patients will end up seeing several different doctors to perform their procedures. This generally works out for most patients because there is very little difference in technical expertise from one doctor to the next.

 

Some patients prefer to have one doctor perform all their treatments while at IVC. This is a perfectly acceptable way to proceed through the treatment process, the only challenge is matching the patients schedule up with the preferred doctor. In most cases this will prolong the overall treatment process, but if the patients don’t mind then we can accommodate.

What should I expect after sclerotherapy?

After sclerotherapy patients will often encounter some focal tenderness at the injection sites and along the course of the treated vein. This will feel like a bruise and can last for up to one month after the procedure. Hard lumps are also associated with the sclerotherapy. This may be noted along the course of the treated veins. This is the vein essentially turning into scar tissue and then the body will reabsorb this portion of the vein. Often times a skin discoloration or a bronze stain is noted in areas where veins are close to the surface of the skin. In most instances this is temporary lasting three to four months, however, in a small percentage of patients the staining can be permanent. This is a small risk associated with sclerotherapy.

Why veins in the feet are are not treated.

In the feet there is very little muscle and fat tissue surrounding the veins. The arteries, veins and nerves are all very close together in the feet. With all of these vessels being in very close proximity there is a high risk of causing problems to the artery or nerve when the vein is treated. If veins are treated in the feet, irritation and inflammation in the foot can cause spasm in the artery or nerve that can cause permanent problems. These problems can include necrosis or tissue death, chronic numbness and the possibility of foot drop or the inability to lift the toes up when walking.

How do you determine which veins to treat?

In addition to obtaining a detailed medical history and physical examination, we perform a comprehensive ultrasound evaluation that will help identify the sources of venous disease. The comprehensive ultrasound will be very detailed and will evaluate the deep system for any blood clots or other problems, and the superficial system for blood clots and venous disease.

The veins that can be treated have reflux or blood that is allowed to flow backwards. There are small one way valves in the venous system that stop the blood from flowing down the vein rather than up towards the heart. When these valves are not working you are diagnosed with varicose veins. Varicose veins or veins with reflux are ones that can be treated.