Health insurance is complicated and when it comes to vein treatment it can be even more complicated. Different insurance policies have different rules on what they cover and some insurance companies can be inconsistent. My staff spends a lot of time working with insurance companies getting authorizations, eligibility verifications, and filing claims. It’s a lot to keep up with. Here are some general guidelines that may be helpful to understand how insurance coverage works with varicose vein treatment.
Getting an appointment to see a specialist for varicose veins is no different than seeing any specialist. Your insurance company should cover an appointment to evaluate your varicose veins or spider veins as a “diagnostic” appointment. This includes an examination and often an ultrasound. If you have an HMO you will need a referral to see a specialist. And remember! With all appointments and procedures, deductibles and copays apply so be sure to check with your insurance company.
Vein ablation procedures
The typical procedure for removing varicose veins is ablation (Radiofrequency ablation or endovenous laser ablation). For insurance to cover these procedures, they usually require an authorization. Insurance companies have different requirements to grant an authorization but they typically require that your specialist documents the following:
- Failure of conservative therapy using compression stockings
- A minimum size of the veins along with an ultrasound study and report
- Failure of pain treatment with non-prescription drugs
Once you have authorization, your procedure should be covered. Again, it’s important to check with your insurance company about what you owe for deductibles, co-pays, co-insurance, etc.
Spider vein treatment
The typical procedure for removing spider veins is sclerotherapy. Insurance rarely covers this procedure on its own because it is cosmetic. However, many insurance companies will authorize spider vein treatment along with an authorization for vein ablation.
Different companies have different requirements
- Medicare does not require an authorization and is a relatively easy insurance provider to work with. If you need to have a vein related procedure using Medicare, chances are they will cover you.
- HMOs and PPOs have different requirements per plan. It is important to work with your provider and your insurance company to make sure you are covered before getting any procedures.
- Medical typically does not cover any kind of vein related procedures. If you have Medical, you should probably expect to pay out of pocket.