Will Your Insurance Cover the Treatment of Varicose Veins?

I’ve had many patients tell me that they were reluctant to see a doctor for their varicose veins because they thought varicose veins were a “cosmetic” problem, so their health insurance plan wouldn’t pay for treatment. It is true that most health plans won’t pay for treatment of spider veins, but they will authorize treatment of varicose veins if we can demonstrate “medical necessity.” If you have large, bulging veins on your legs or thighs, you probably have a problem called venous insufficiency, which meets the criteria for medical necessity for insurance plans.

vericose vein treatmentVeins collect blood from the tissues and send it back to the heart. The veins have one-way valves, basically made of two flaps, to keep the blood going the right direction. In the legs, the blood must fight gravity and go uphill to reach the heart. For a variety of reasons, including heredity, prolonged standing or lifting, pregnancies, and female hormones, the valves can give way and allow the blood to flow backwards through the vein. This backward flow increases the pressure in the vein, especially when standing, and the vein eventually swells and becomes a varicose vein. Symptoms associated with varicose veins include pain, heaviness, itching, and even Restless Leg Syndrome. Given enough time, the veins can become quite large and lead to swelling of the legs, with purplish discoloration of the lower legs and ulcers.

An ultrasound of the veins can be done in the office to show which veins have gone bad, to demonstrate medical necessity and to plan treatment. All insurance plans require a venous ultrasound before they will approve treatment of varicose veins.

Symptomatic treatment includes thigh high compression stockings (knee high stockings can impede blood flow and make things worse) and leg elevation when at rest. Symptomatic treatment does not take care of the primary problem, which is the backwards flow of blood in the veins due to incompetent valves. To really treat the disease, the malfunctioning veins must be closed off or removed.

The main superficial vein in the legs is the great saphenous vein, which runs on the inside of the thigh from the groin down to the ankle. It is the most common vein to “go bad,” usually producing varicose veins on the inner calf. In the old days, we used to surgically remove this vein through incisions, a so-called “vein stripping.” We no longer need to perform this procedure, as we can close this vein from the inside using a laser or radiofrequency, an “endovenous ablation.” This is done in the office entirely under local anesthesia, by threading a small fiber into the vein through a small puncture, similar to placing an IV catheter into a vein. The bulging varicose veins are also removed at the same time through small nicks in the skin (microphlebectomies), also under local anesthesia. The leg is wrapped in gauze, followed by an elastic wrap and a thigh-high compression stocking. The patient is sent home with instructions to walk frequently the next few days. Aspirin, acetaminophen or ibuprofen may be used for soreness and discomfort. The dressing may be removed in 48 hours and the leg washed with a bath or shower. The compression stocking should be worn while the patient is upright during the day for the first two weeks after surgery.

There will be some bruising after the procedure, but this disappears within a few weeks. Once the small nicks in the skin heal, no are no residual scars.

Veins other than the great saphenous vein can be treated in a similar manner, and includes the anterior accessory vein and the front of the thigh, and the small saphenous vein on the back of the calf.

Patients frequently ask if there will be problems if these veins are removed or ablated. The answer is that we have more than enough veins in our legs to get the blood back to the heart. The veins involved with varicosities are not working correctly anyway, so their removal can actually help with venous return. The great saphenous vein is frequently removed when performing coronary artery bypasses in open heart surgery, and patients do fine without this vein. Cardiac surgeons would not want to use enlarged varicose veins for these bypasses, so you don’t have to worry that removing or ablating these veins might interfere with possible heart surgery in the future.

If you have large, bulging, varicose veins, you more than likely meet the medical necessity requirement of health insurance companies. To start the process, you would need to come in for an evaluation by a trained physician along with a venous ultrasound performed.

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