Insurance coverage for vein treatment depends on two key words—medical necessity. Most insurance companies, as well as Medicare, will consider coverage for vein treatment if all of the following criteria are met:
1) Symptoms related to vein disease are present. Acceptable symptoms usually include one of the following:
- Persistent aching, cramping, burning, itching, or swelling
- Spontaneous bleeding from varicosities
- Recurrent episodes of thrombophlebitis
- Venous ulceration of the lower legs
- Stasis dermatitis
2) The symptoms result in one or more of the following:
- Functional impairment that limits activities of daily living (e.g., inability to perform household chores without interruption, interference with essential job functions)
- The need for daily use of analgesics
- Impairment of mobility
3) There is ultrasound evidence of venous reflux in either the great saphenous vein (the vein along the inner thigh) or small saphenous vein (the vein in the back of the calf); and/or there are large varicosities present. The duration of venous reflux in the great saphenous or small saphenous vein must be at least one-half second in duration, and any large varicosities must be at least one-fourth inch or greater in diameter.
4) A trial of “conservative therapy” has been completed under the supervision of a physician. This may include one or more of the following:
- Daily use of compression stockings (from six weeks to six months, depending on the insurance company) that did not successfully treat the patient’s symptoms
- Periodic leg elevation several times during the course of the day
- Weight loss
- Avoidance of prolonged immobility
- The use of analgesics or nonsteroidal anti-inflammatory drugs
The criteria tends to vary from one insurance company to another. Reimbursement will be based on the patient’s particular benefits at the time services are rendered. At Willamette Vein Centré we have extensive experience in dealing with insurance company requirements, and have been extremely successful in securing patient’s benefits.
As a general rule, medical insurance does not cover any treatment for cosmetic purposes. An exception to this rule is for specific conditions mandated by law–such as breast reconstruction following cancer surgery. Most medical insurance companies consider spider veins and small, superficial reticular veins (less than one-fourth inch in diameter) to be a purely cosmetic problem.