Insurance: Does it cover Varicose Vein Treatment?

Insurance coverage of elective procedures has been as diverse among insurance companies as the number of states in the union. Each company has its own policies and levels of coverage that are usually spelled out in the benefits booklet that each member has. These benefit description booklets are not always clear however. It can be very difficult to tell whether your insurance will cover a planned vein procedure or not.

Many companies require a pre-authorization to be in place before the procedure is performed in order to cover it. Some do not give pre-authorization at all, but rather they instruct you simply to read the benefits guide and find out if it is covered or not. Even others have a clear covered/not covered list of procedures. Some only cover part of the procedure leaving the patient to care or the remaining portion.

Varicose Vein procedure coverage is even more complicated by the fact that until recently this problem was generally thought to be entirely cosmetic and therefore not medically necessary. We now know that many varicose vein sufferers can have numerous issues including pain, skin changes, ulcers, and swelling. Current advanced therapies are allowing treatment to be down as an outpatient and are having good results. All of this has led to wider and wider insurance acceptance and approval of treatment of varicose veins.

Medicare has recently accepted endoluminal ablation (the procedure that has replaced traditional vein stripping surgery) as a covered procedure. Medicare generally sets the standard for insurance coverage and many other companies have begun covering it as well. All in all about 75% of insurance companies are now viewing severe varicose vein treatment as necessary.

There are exceptions. Most insurance will not cover spider vein treatment as this is still viewed as cosmetic. On occasion however coverage is granted. This seems to be without rhyme or reason. Patients who have not been through a trial period of conservative treatment using compression socks are also more likely to be denied coverage. This can be reversed however if the patient follows through on the trial period recommended by their carrier.

Many vein treatment centers offer insurance pre-authorization as a courtesy to their patients. However, it is the responsibility of the patient to explore this on their own and it is a good idea to check for yourself before committing to an expensive procedure.

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