Insurance is great when it covers an illness or condition. But as we all know, it can be tricky sometimes when it comes to something, like vein treatments, that can be done for cosmetic-only reasons. Because of that, many patients ask us if insurance will cover their treatments. The good news is that insurance does cover varicose vein treatment if it is deemed “medically necessary.” So just what qualifies your varicose veins to receive this “medically necessary” designation?
Medically Necessary Criteria
There are three criteria that must be met for your vein treatment to be deemed “medically necessary.” Check this list and see if you may qualify:
1. Leg Pain and Other Symptoms
If your varicose veins are causing pain in your legs, including restlessness, burning, or cramping at night. If they feel heavy, or you experience swelling, get repeated blood clots, or have any ulcers (open wounds) on your legs from ruptured or bleeding veins, or skin discoloration around the ankle, these are all signs that you need medical treatment.
2. Symptoms Affect Your Daily Life
If pain from your varicose veins keeps you from doing daily things like cooking, chores, exercise, or even from doing your job because you must be sitting at a desk, driving in a car, or on your feet all day, you may qualify for insurance coverage to treat them. For example, if you have to change positions for comfort more than 20 times a day including elevating legs, massaging them, or taking over-the-counter anti-inflammatories, your varicose veins are interfering with your daily life.
3. Venous Reflux Must Be Documented
Documentation must be confirmed through an ultrasound exam. Ultrasound exams let doctors “see” blood vessels that are below the skin and not visible to the eye. They check for venous reflux or venous-valvular incompetence (the valves within the veins are not working properly). Ultrasounds are necessary to accurately assess the cause and extent of the varicose veins and to formulate the best treatment plan.
When Won’t Insurance Cover Vein Issues?
Insurance will usually cover varicose vein treatment if it is causing physical issues like those listed above and have ultrasound findings that meet insurance criteria. If your varicose veins are not causing any symptoms, and do not have ultrasound findings consistent with venous reflux, most likely the insurance company will not consider your condition severe enough to warrant treatment. Spider veins, (small clusters of tiny blue or purple veins on the surface of the skin) though they are unsightly, are not considered a medical concern and therefore, are not covered by insurance. Insurance companies consider them to be a cosmetic problem only.