Have you ever delayed medical care because you didn’t want to have to hassle with the insurance company? Or thought a doctor’s visit was covered – only to get sideswiped by a bill that you weren’t expecting? Sad to say, we’ve all been there at some point. Varicose veins insurance coverage can be particularly confusing, but don’t let that stop you from getting the treatment you want and need!
Varicose Vein Removal and Insurance Coverage
Don’t immediately think that your insurance company will deny varicose vein removal. Although some vein removal treatments happen purely for cosmetic reasons, there are various medical reasons for removing varicose veins.
These reasons range from threatened circulatory health to life-threatening issues. Most insurance companies will cover vein removal for medical reasons. They use the term “medically necessary” to describe these circumstances.
What You Can Expect From Your Insurance Company
Most insurance companies will ask for a venous ultrasound before determining whether or not they’ll cover vein removal costs. Insurance companies look at a range of data to determine if varicose vein removal is medically necessary.
One of the things that an insurance company will look for on your ultrasound is whether the damaged vein or veins are causing swelling, ulcers, heaviness, or backward blood flow (also called reflux).
They’ll also look at how big the vein is and the reflux measurements. If vein diameter and reflux fall into a predetermined range, vein removal may qualify as medically necessary.
After they’ve taken a look at the ultrasound, they’ll also consider whether or not you’ve had persistent symptoms that interfere with daily activities or impair mobility, including
- leg pain
- aching
- cramping
- burning
- itching and/or swelling during activity or after prolonged standing
Or if you have any of the following conditions:
- Recurrent episodes of superficial phlebitis
- Non-healing skin ulceration
- A bleeding vein
- Stasis dermatitis
- Dependent edema
Having one or more of these symptoms and conditions will get you one step closer to a decision of medically necessary vein removal.
Even if the insurance company decides that vein removal is medically necessary, that doesn’t mean they’re going to cover all of the costs! Your specific policy’s deductible, co-pays, etc. will determine how much they pay versus how much you pay.
It also doesn’t always mean that you’ll be able to have varicose vein removal immediately. Many insurance companies require patients to undergo a conservative treatment or non-operative management first like
- requiring you to wear compression stockings anywhere from 6 weeks to 3 months.
- walking regularly (the same circulatory advice as for spider veins!)
- avoiding sitting or standing for long periods, especially in your job
- frequently elevating the affected leg
Varicose Veins Insurance: What You Can Expect From us
The first thing you need to do is make an appointment for a consultation. There’s a fee for all new consultations that we charge to your insurance company.
An ultrasound requires an additional fee that will also go to your insurance company.
Dr. Norton will provide a detailed treatment plan and send documentation to your insurance company. You will then make an appointment (all insurances require a date of service). We then request that they provide us with pre-authorization (aka pre-notification, pre-determination, pre-certification) to treat you.
We don’t want you to worry about any unexpected costs, so we’ll wait for approval from your insurance company before you start treatment.
Once your approval arrives, we’ll put together an estimate of your out-of-pocket costs. Out-of-pocket costs differ with every plan. We make every effort to provide accurate out-of-pocket cost information – but sometimes an insurance company gives us incorrect information that can cause estimated figures to be inaccurate.
For this reason, we recommend you call your insurance company to verify that the information we’ve received about your estimated costs is correct. Keep in mind that the insurance company determines actual out-of-pocket costs AFTER the claim is processed.
What Else Do You Need to Know About Varicose Veins Insurance Coverage?
As we all know, insurance policies can be tricky to decode. It’s hard to keep track of all of the details they contain.
For example:
1 Your insurance plan may require you to get a referral from your primary care physician to see a vein specialist.
That doesn’t mean that you can’t make an appointment with one. It means that if you want your insurance to cover the costs of your visit and treatment, then you need to have a referral.
2 You may have a co-pay or co-insurance to pay.
A co-pay is a set amount of money that comes out of your pocket at the appointment. Co-insurance is a percentage of the fee (determined by your contract with the insurance company) that you pay out of pocket to the provider.
3 The amount of coverage your insurance company offers you may differ depending on whether or not you use an in-network provider vs. an out-of-network provider.
Many insurance companies have networks of doctors that have agreed to participate in your insurance company’s networks. These doctors are considered in-network and are covered by your plan. If you choose a doctor outside of the network, your insurance company may require you to pay some percentage (up to 100%) of the doctor’s fees out of your pocket. (You can read about health insurance options like this here.)
(If your insurance requires you to use an in-network provider, please feel free to contact us to find out if we’re in their network!)
How to Get Varicose Veins Covered by Insurance
Since each insurance company – and policy – is different, the most effective way to get the cost of varicose vein removal covered by insurance is to schedule a consultation with Dr. Norton and the team here at Denver Vein Center.
We’ll make sure you understand your insurance policy, varicose veins coverage, and what you may owe out of pocket. We conduct the insurance qualifying tests in-house and work directly with the insurance company. This saves you hassle, time, and money.
Insurance Coverage Can Be So Confusing!
That’s why we include assistance with decoding insurance plans as a part of the service you receive from Denver Vein Center. Our team will work one-on-one with you to make sure you understand what’s covered by your insurance policy and what is not, as well as ensure that you have the best chance of getting your procedure approved and covered. Contact us for a consultation!