If you are worried about the cost of treating your varicose veins, you may be surprised to know that health insurance plans may cover the costs!
Learn more about the six steps you can take to have your varicose vein treatment covered, as well as additional conditions that are typically covered by insurance companies.
What does the term medical necessity mean?
Medical necessity refers to medical care that is necessary and appropriate to diagnose or treat a verified medical condition. In other words, the treatment needed is deemed medically and clinically appropriate for the patient's specific condition.
Why is medical necessity important to consider?
Medical necessity is an important distinction because it indicates what type of services or treatments insurance carriers will cover. Not only does it help patients determine the most affordable care options available, but it also encourages medical providers to consider alternative treatments that may achieve the same results.
Is varicose vein treatment covered by insurance?
In most cases, varicose vein treatments approved by your vein doctor or vein specialist will be covered by most major insurance companies, as the underlying conditions that cause varicose veins, such as chronic venous insufficiency, are deemed medically necessary.
It is important to check with your specific insurance provider to determine what limits, exclusions, or restrictions exist before treatment, as coverage can vary greatly.
What types of varicose vein treatment does insurance typically cover?
Insurance providers will generally cover the costs of varicose vein treatments once it is determined medically necessary to treat the condition. Treatments that are typically approved include endovenous laser ablation, radiofrequency ablation, sclerotherapy, and vein stripping.
Always keep in mind that policies vary, so it's important to check with your insurance company to discuss the approved treatment options and whether a co-pay or deductible is in place. Many patients will also speak to their vein clinics as they are often familiar with insurance policies and carriers.
When does insurance cover varicose vein treatment?
Whether insurance carriers will cover vein-related procedures will generally depend on the type of insurance plan and the severity of the condition. Some insurance plans may require that all noninvasive treatments be exhausted, such as lifestyle changes or compression therapy, before approval.
What makes varicose vein treatment medically necessary?
Varicose veins develop due to weak or damaged valves and vein walls. Our veins have one-way valves that keep blood flowing back to the heart. When these valves become damaged, blood can flow backward and pool in the lower extremities. This backward blood flow is known as venous reflux and impacts circulatory health.
Often, the weakening of the vein walls and valves is caused by a common underlying condition known as venous insufficiency, which is a condition that may require medically necessary treatment.
Also, for a vein condition to be considered medically necessary, several criteria must be met:
- Varicose veins have led to venous ulcers.
- The size or diameter of the varicose vein is greater than 3 millimeters.
- Uncomfortable symptoms such as swelling, leg pain, cramping, heaviness, fatigue, or even restless legs are interfering with your normal daily activities.
- The presence of blood clots or deep vein thrombosis (DVT) is related to a diseased vein.
- Varicose veins have ruptured or bleeding, which is a very dangerous condition that requires immediate medical attention.
- Alternative treatments such as compression stockings, leg elevations, exercise, weight loss, and lifestyle modifications have not relieved your symptoms.
How to seek insurance coverage for varicose vein treatment?
To ensure that you seek out the available insurance coverage for your varicose vein treatment options, you will need to consider the following steps:
1. Have a current form of medical insurance.
The first and most essential step is to ensure that you have an up-to-date medical insurance policy in place to cover varicose vein treatments.
2. Your varicose veins are deemed medically necessary.
Maintain documentation that shows that conservative treatment options have failed, such as leg elevation, lifestyle modifications, exercise, and compression therapy, which is the use of compression socks and compression stockings.
3. Check that your vein doctor is considered to be an in-network provider with your insurance company.
If your doctor is an in-network provider, this will ensure that they can accept payment directly from your insurance provider. It will also mean that your doctor's office will be familiar with what needs to be in place for treatment to be covered.
4. Determine the type of treatment needed.
Once it is determined that vein procedures are medically necessary and that your doctor is in-network, you and your vein specialist can determine the best course of action.
5. Contact your insurance provider after determining the type of treatment.
Let your insurance company know that you are seeking treatment for varicose veins and have consulted with a doctor on what procedures are best. Gather all details regarding your policy, including co-pays or deductibles that will be applied.
6. Keep medical documents organized.
Your insurance provider will let you know whether you will need to submit a claim, or if your doctor's office can submit the claim for you. Maintaining documentation from visits and venous ultrasound examinations can help expedite the process.
Before moving forward with any medical procedure, it's important to know what insurance coverage you have in place. By following the six steps above, you will ensure that you are maximizing coverage and avoiding unnecessary out-of-pocket costs.
If you have any questions about your insurance plans or which treatment options are right for you, our team at iThriveVeins is here to help!
At iThriveVeins, we offer complimentary vein screenings that can determine what treatment options are eligible under your health insurance plan.
Contact us today to begin your journey to better vein health and beautiful legs!
Frequently asked questions
Out-of-pocket costs for treating varicose veins can be expensive and varies based on the severity of your condition, as well as what type and frequency of treatment is needed.
In San Diego, on average, treating a single varicose vein can range from $350 to $500 per session. For more extensive or frequent procedures needed, patients may spend between $1,200 to $5,000 or more in total. Costs can also vary greatly among providers/locations/ and types of procedures.
Generally, vein treatments are considered cosmetic when related to superficial veins that are not causing swelling, pain, or other medical concerns. Common cosmetic treatments that restore the appearance of the skin include sclerotherapy and laser treatment.
Cosmetic vein procedures are not deemed medically necessary, so health insurance plans will not cover these costs.
Generally, spider veins are considered to be cosmetic, and will not be covered by insurance. However, your vein specialist will be able to determine if your spider veins are related to the presence of varicose veins that may be a symptom of underlying vein disease.
If spider vein treatment is only desired to improve the appearance, most insurance companies will classify this as cosmetic and will not be eligible for coverage.