If you’re suffering from varicose veins, you probably just want to get rid of them. But you definitely do not want to be saddled with unexpected medical bills.
Knowing that varicose vein surgery is the most effective way to relieve the pain and discomfort that comes with varicose veins, you may be wondering, “Is varicose vein surgery covered by insurance?”
The good news is that yes, all major insurers in the United States cover varicose vein surgery. The confusing part is that the surgery must first be deemed medically necessary. And there is no standard definition for when varicose vein surgery is medically necessary. Therefore, it is very important for you to understand the particulars of your individual insurance policy so you can take full advantage of your coverage.
Is varicose vein surgery cosmetic?
Insurers do not make a habit of covering medical procedures that they consider to be cosmetic in nature. For example, spider vein treatments are rarely covered by insurance because they are almost always labeled cosmetic. However, varicose vein surgery is different.
Varicose veins are caused by an underlying medical condition called chronic venous insufficiency (CVI). CVI is a progressive condition that can cause symptoms such as pain, swelling, itching, and leg fatigue. If left untreated, CVI gets worse over time and the symptoms can become quite disruptive to your daily life. Plus, rare but serious complications can arise including venous ulcers and deep vein thrombosis (blood clots).
It is for these reasons that varicose vein surgery is not considered cosmetic.
When is varicose vein treatment medically necessary?
Different insurers have different diagnostic criteria to determine if your varicose vein surgery is medically necessary. That’s why prior authorization is required before the procedure will be covered. This authorization process includes a diagnostic exam called a venous ultrasound (a.k.a. venous mapping).
Venous ultrasound is a non-invasive, painless exam. It will allow your doctor to measure your veins and record how bad your CVI is. This information is then submitted to your insurance provider along with your doctor’s recommendations.
Don’t worry, your venous ultrasound and your initial consultation with your doctor should both be covered by your insurance. Just double check that your doctor is in-network with your insurance policy.
What is conservative treatment?
Some insurance companies will ask you to try conservative treatment for your varicose veins before they will approve you for varicose vein surgery. Examples of conservative treatment include wearing medical-grade compression stockings and/or taking over the counter medication (e.g. Tylenol) to help with the pain.
It’s important to let your doctor know what conservative treatments you have already tried and whether you are still experiencing problems such as leg fatigue, pain, swelling, or itching due to your varicose veins. Also, let your doctor know how these symptoms affect your daily life.
Is laser treatment for varicose veins covered by insurance?
Laser ablation surgery is one of several procedures your doctor may use to treat your varicose veins. Other options include radiofrequency ablation, ultrasound-guided sclerotherapy, and vein glue. All of these procedures produce similar results and have similar recovery times. Your doctor can discuss the pros and cons of each with you.
Most insurance will cover laser ablation surgery; however, your individual policy may differ. Your doctor can help you determine which varicose vein surgery options are covered by your insurance.
How much will varicose vein treatment cost me?
Every insurance policy is different. Even different policies offered by the same insurance company may offer different levels of coverage.
In some cases, your entire varicose vein surgery may be fully covered by your insurance provider and cost you nothing out of pocket. In other cases, you may be responsible for copays, deductibles, or coinsurance. Your doctor’s office can help you sort through these variables, but it would be a good idea to speak directly with your insurer ahead of your first appointment so you know what to expect.
No matter what insurance plan you are on, the first step in getting treatment for your varicose veins is to schedule a consultation with a vein specialist. Only then can your doctor help you navigate your treatment options and insurance coverage.
