Vein treatment can be a somewhat lengthy process. After a patient is diagnosed and a treatment plan is formulated, insurance approval must be obtained before procedures can be performed. Our prior authorization experts work directly with insurance companies to coordinate treatment and billing in the manner that best utilizes patients’ insurance coverage so that our patients pay as little money out-of-pocket as possible. Prior authorization can take as little as two, but sometimes up to six weeks or more, depending on the insurance carrier.
Our typical patient requires a combination of treatment methods to eradicate problem veins. Because most patients need a combination of treatment methods, vein treatment usually requires multiple visits to our office. We want to ensure that our patients’ vein issues are fully resolved, so we monitor our patients’ progress over several weeks following their laser procedures, and complete six week and three-month follow-ups as well.
Insurance Coverage for Your Treatment
We work with most major insurance carriers, including Blue Cross Blue Shield, Cigna, United Healthcare, Rocky Mountain Health Plans, EBMS, Aetna, Cofinity, and Medicare. Unfortunately, we are unable to accept Medicaid as a primary or secondary insurance (this includes Medicare-Medicaid and Medicaid Prime plans).
Many factors that play a role in whether and how much your insurance will pay for treatment of superficial venous insufficiency or varicose vein disease. As with any insurance carrier, the key is documenting the Medical Necessity for treatment. This means that we need to show that treatment is necessary for medical reasons, and not for cosmetic purposes. Because every insurance company differs in their coverage of superficial venous insufficiency, we have compiled an extensive database of information on the larger insurance carriers, and can often give you detailed information specific to your insurance company’s requirements.
One primary factor that insurance companies consider when determining if you will be approved for treatment is your symptoms. Since insurance companies do not reimburse for unnecessary or cosmetic procedures, they require that you have at least one of the following symptoms in your leg(s):
Chronic aching, pain, pressure, heaviness or fatigue of the legs, ankles, or feet
Foot or leg swelling
Restlessness of the legs, especially when at rest
Ulcers, or open wounds that are slow to heal, on the legs or ankles
Skin changes on the legs and ankles, such as chronic redness, brown spots, and/or a thickening and hardening of the skin on the legs and ankles
The major insurance carriers are also much more likely to approve treatment if these symptoms interfere in your life in some way, such as causing you to have to take frequent breaks during the day to elevate your legs for you to complete your work and perform your daily activities of living.
Insurance carriers also usually want to know that you have tried other methods of controlling your symptoms, such as periodically elevating your legs, wearing medical grade compression stockings for a period of 6 weeks to 3 months, and taking over-the-counter pain medications such as Acetaminophen (Tylenol), Ibuprofen (Motrin/Advil), or Naproxen (Aleve), without attaining sufficient relief of your symptoms. If you have not tried any or all of these methods before your ultrasound mapping appointment, you may need to complete a trial of conservative measures such as these before your insurance will consider your treatment. We will be happy to discuss the specific requirements of your insurance company, as well as make recommendations on compression hosiery that will meet your insurance company’s needs if a trial period of compression stocking use is necessary.
The vast majority of our patients at Vincent Vein Center can use their insurance benefits towards the treatment of their venous insufficiency. We will be happy to give you more information that is specific to your insurance coverage once we have been able to evaluate your insurance coverage.
Vincent Vein Center also employs staff members who are specifically devoted to checking benefits and attaining pre-approval for your treatment. Once we’ve diagnosed your condition and determined your care plan, we’ll explain to you what insurance will and will not cover (Medicaid not accepted), and we’ll obtain any necessary authorizations before you begin treatment. Our goal is for our patients to fully understand their financial obligations, if any, prior to beginning treatment.
View our FAQ page for more information about vein disorders and treatments from Vincent Vein Center.