Insurance Considerations
Will medical insurance cover problems you have with varicose veins?
The answer is. . . perhaps. Insurance requirements vary from company to company, and reimbursement varies from company to company. Most insurance companies do provide coverage for treatment of large (one-fourth inch or greater in diameter) veins in the lower legs – provided you have a convincing story of "incapacitation, pain and suffering."
Spider Veins
As a general rule, medical insurance does not cover 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 to be a purely cosmetic problem. Note that the term “consider” is used in the previous sentence. There have been studies that have shown that many patients with spider veins have symptoms associated with spider veins that resolve with treatment of these veins. However, for financial reasons insurance administrators refuse to acknowledge that various symptoms can be caused by spider veins.
Larger Varicose Veins
Most all insurance companies have at one absolute requirement that patients must meet:
- Ultrasound evidence of venous reflux of either the great saphenous vein (vein along the inner thigh) or small saphenous vein (vein in back of the calf). The duration of the reflux must be at least one-half second. In addition, various insurance administrators may require that these veins be enlarged to some arbitrary diameter.
In addition to the requirement for ultrasound evidence of venous disease, insurance companies also generally require patients to have symptoms related to vein disease. Acceptable symptoms may include:
- Spontaneous bleeding from varicosities
- Recurrent episodes of thrombophlebitis
- Venous ulceration of the lower legs
- Pain such as burning, aching, throbbing, searing pain, intense itching, day cramping, night cramping, heaviness, and tenderness along veins.
The amount of pain a patient must endure to satisfy insurance administrators also varies from insurance company to insurance company. Following are examples of different pain criteria used by the insurance industry:
- Simple pain consistent with venous insufficiency
- Severe pain requiring the use of pain medicine
- Pain severe enough to limit mobility – in other words, crippling pain
- Pain severe enough to limit activities of daily living
If these requirements are met, insurance companies usually require that patients undergo a trial of physician supervised "conservative therapy" for anywhere between two weeks and six months. Almost all insurance plans require:
- Daily use of prescription surgical compression graduated pressure support stockings (with proper instruction on their use). Some policies specify the strength of the stockings that must be worn.
Insurance administrators may also require:
- "Frequent" reclining and elevation of the legs. (It’s useful to have a job like a medical insurance administrator who can do things like this.)
- Weight reduction
- Avoidance of "prolonged immobility where appropriate."
- Daily exercise with a "walking plan"
- Avoidance of prolonged standing
- The use of analgesics or non-steroidal anti-inflammatory drugs
- Treatment of related conditions associated with or causing fluid retention
It must be emphasized -- insurance company requirements vary greatly. It is important to carefully document the amount of discomfort you have for submission to insurance company administrators. It should also be noted that there is no benefit whatsoever for "toughing it out" and going without pain medicine if it is needed to make vein symptoms bearable.
At Willamette Vein Centré we have many years experience in dealing with insurance company requirements and have been extremely successful in securing patients benefits.