When Will Insurance Cover Varicose Vein Treatments?
One of the most common questions we’re asked at Capitol Vein and Laser has nothing to do with veins or lasers, but with insurance. More directly, “Will insurance cover varicose vein treatments?” While there is unfortunately no blanket answer to every scenario, “yes” is far more common than not.
The factor that ultimately determines whether or not insurance will cover the removal of varicose veins is whether the procedure is deemed “cosmetic” or “medically necessary.” Cosmetic procedures, which are done with the intention to change one’s appearance, aren’t typically covered by insurance. Medically necessary procedures, which (as the name suggests) are performed to address an issue that is affecting a patient’s immediate health, are covered by most insurers. Varicose veins are tricky because they can fall into both categories, so it’s important to recognize if yours could qualify as “medically necessary” to remove.
In order for veins to necessitate medical treatment, they must meet four criteria:
1. They must cause pain or other uncomfortable symptoms. These include heaviness, aching, swelling, cramping or burning.
2. The symptoms must affect your everyday life. For example, someone who works in retail and can no longer stay on their feet all day, or those who work at desk jobs and experience swelling and cramps by end of the day. Many mothers we see with significant varicose veins state it’s difficult to “keep up” with the children due to leg swelling or aching that occurs throughout the day. If symptoms impact your daily life to some degree, that’s a medical condition.
3. Conservative management of symptoms is typically requested by most insurance plans. In fact, some insurance plans won’t cover vein treatments if the patient doesn’t first attempt to address their symptoms at home utilizing exercise, leg elevation, anti-inflammatory medication and/ or compression hose.
4. Venus reflux (ineffective venous circulation due to valve incompetence) must be documented by an ultrasound. Ultrasounds are performed within the office and involves assessing circulation and measuring veins. This is accomplished by applying warm gel to the leg and sliding a probe along the skin that allows visualization of veins using sound waves. This diagnostic test takes approximately 30 minutes per leg and is painless. Venous ultrasounds are covered by most insurance plans and is the final step in securing a medically necessary diagnosis.
So, do your varicose veins qualify? Again, it depends on your insurance provider and plan, but if your condition meets all four of these criteria then it is likely your procedure would be covered.
Because most varicose veins are a medical condition AND they are progressive in nature (meaning they will worsen over time) we recommend scheduling a medical consultation and baseline exam. Insurance plans will cover the initial consultation as long as your plan deductible has been met.
If you have any questions about this subject, don’t hesitate to reach out to us at 866-695-8346 or contact your health insurance company to learn more. We’ve handled thousands of different cases and are happy to discuss your situation at length. Take the first step to healthier legs today.