Medical Necessity and Insurance Coverage for the Treatment of Varicose Veins | Premier Vein Clinics | Knoxville, TN

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Medical Necessity and Insurance Coverage for the Treatment of Varicose Veins

Medical Necessity and Insurance Coverage for the Treatment of Varicose VeinsThe most common myth about varicose veins is that they are merely a cosmetic issue. The treatment of varicose and spider veins IS NOT for cosmetic reasons only. If you are still skeptical take a look at this previous blog post where we break down and debunk this myth. There are specific steps and documentation required in order to obtain insurance coverage for treatment of varicose veins, but rest assured, if venous disease is present your treatment is more than likely a medical necessity.

Keep in mind each patient presents a unique case and all insurance plans are not designed alike. Thus, it can never be guaranteed your procedure will be covered by insurance, but you can be confident the staff at Premier Vein Clinics is committed to helping you every step of the way through the claims process and understanding the details of your plan.

Simply put, before approving a procedure an insurance company must decide whether the treatment is in fact “medically necessary”.  For each unique situation, insurance companies will set forth guidelines a patient and provider must meet in order to authorize payment. In regards to treatment of varicose veins this may include a thorough physical exam, diagnostic testing showing evidence of venous disease, and documentation that conservative management techniques have been implemented. In addition, many insurance companies will request proof that the condition is indeed impacting the patient’s activities of daily living.

The ultimate decision of determining medical necessity is up to the insurance company. Navigating insurance plans can be confusing and difficult, but the Premier Vein Clinics staff works hard to ensure all criteria is met for each individual patient policy when seeking approval for treatment of varicose veins. Unfortunately, due to the nature of some policies, regardless of the documentation of the problem at hand, treatment is not covered. It is important for patients’ to gain a general understanding of what your policy includes and what is required prior to authorization of a medical procedure.

If you have large, bulging veins on your legs or thighs and are experiencing symptoms of varicose veins, you may have venous insufficiency, which meets the criteria for medical necessity for most insurance plans. For additional information beyond determining medical necessity for insurance coverage check out this blog post. If you are experiencing symptoms of varicose or spider veins, you do have options!

Take the first step in the process of treating your varicose veins and request an appointment with one of our Premier Vein Clinics physicians today!

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