Varicose Veins: Does Insurance Cover Removal?

PORTLAND, Ore. In today’s age of beauty and fashion, men and women are seeking ways to eliminate the ugly varicose veins they tend to get with age, weight and heredity. While vein removal might seem like an optional, cosmetic surgery, many people in their twenties and older frequently suffer from swollen and painful legs as a result of varicose veins. In advanced cases, patients can also experience leg ulceration, skin breakdown, superficial phlebitis and, in rare instances, bleeding.

“There are a multitude of causes that contribute to a patient’s inclination to get varicose veins,” said to Dr. Skip Freedman, medical director at AllMed Healthcare Management, a leading Independent Review Organization (IRO). “Typically, physicians prescribe basic solutions, such as compression stockings that squeeze the leg and may alleviate many of these symptoms. But, these solutions don’t work for all patients.”

According to Freedman, the stockings don’t make the twisted-looking and bulging veins go away, and, oftentimes, patients find them difficult to put on, hot to wear or not suitable for their lifestyle. If, after several weeks, patients are not getting varicose vein symptom relief from compression stockings, they are probably going to consider surgery. Why? With varicose veins, the damaged veins cannot pump blood back to the heart, causing the patient’s symptoms. Surgery either removes the varicose vein and its tributaries, or cauterizes the vein to prevent blood flowing through it. Yet, except in well-documented cases, most healthcare plans consider varicose vein surgery cosmetic.

In order for varicose vein surgery to be covered:
 A patient’s physician needs to conduct a physical exam, as well as document the patient’s history
 The patient must follow the conservative treatment plan and wear the compression stockings for several weeks
 The physician must track all of the patient’s general health, medical history, symptoms and tried treatments to help prove the need for surgery.

Dr. Freedman added that if the patient rejects the conservative vein treatment or if further proof is needed, a physician could conduct an ultrasound to measure the speed of blood flow through the veins and observe the patient’s vein structure and determine the reflux (backflow) of blood. This test can also determine if there are other conditions with the leg and provide the insurance carrier the medical evidence need to cover the varicose vein surgery. Another advantage of this approach, said Freedman, is that it eliminates those patients with spider veins looking for payers to cover a procedure that’s purely non-medical and cosmetic.

More information about the medical necessity review services offered by Independent Review Organizations (IROs) can be found on AllMed’s web site at http://www.allmedmd.com.