Weekly Blog

Patients living with painful swelling from venous reflux disease, or varicose veins, know all to well that the condition is more than just a cosmetic issue. Varicose veins can lead to swelling of the lower limbs, skin inflammations and leg ulcers. The condition is also progressive–symptoms will worsen over time, if left untreated. Unfortunately, many health insurers see the condition differently. In some circumstances, the insurance company may deny coverage by claiming treatment is an “elective cosmetic procedure”.

The core determinant of the medical necessity for treatment of varicose veins is a diagnosis of superficial venous reflux disease, obtained after an in-office consultation and ultrasound evaluation with a vein surgeon specialist.

CRITERIA ELIGIBILITY

Some insurance companies may also use additional criteria, beyond the diagnosis of venous reflux, to determine if vein treatment is “medically necessary”.  These criteria may include one or more of the following:

1. Lifestyle Disruption: daily activities of the patient must be significantly disrupted

2. Chronic or Recurrent Pain as a result of the condition

3. Failure of Conservative Measures: Other methods of treatment, such as medically prescribed compression hose or stockings, have failed to provide adequate relief

4. Vein Size: Bulging veins larger than 4 mm are often considered medically significant

5. Complications: Episodes of phlebitis, bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary

MEDICARE

Medicare may reimburse vein specialists for “medically necessary care” but not for “cosmetic care”. However, with ultrasound documentation of venous reflux disease, Medicare will usually deem endovenous ablation and ambulatory phlebectomy to be medically necessary. Medically necessary signs and symptoms, such as pain, swelling, disruption of lifestyle and ulceration, will also be documented.

NEXT STEPS

Prime Surgicare participates with most health insurance companies and Medicare. For more information about varicose vein diagnosis and treatment options, please call us at (732) 637 - 6370 to schedule a consultation and examination. You can also obtain additional background information here. To read one of our patient’s stories about this procedure, click here.

MD Note: Our patient, Mrs. Davison, had the unique opportunity to share her traditional vein stripping experience and today’s VNUS Closure procedure, an in-office, minimally invasive treatment. We thank her for sharing her and know it will help other patients in need of treatment. Dr. Seun 8.8.2010    

      In 2002, Anita Davison of Manalapan was suffering from phlebitis in her left leg that made her foot, ankle and leg swollen and painful. The condition also exacerbated her varicose vein protrusion and chronic discomfort. At that time, her doctor performed surgical vein stripping, a procedure where the vein is surgically removed from the leg. The operation requires general anesthesia and post-operative recovery time can be long (up to two months) and painful. In addition, there are stitches to be removed and extensive scarring from the incisions required to remove each affected vein.

            “I clearly recall that my leg was black and blue for weeks and I had long scars where the veins were removed,” Anita recalls. “It took almost two months before I was back to my regular routine.” For this mother of five active children, it was an especially frustrating recovery.

            Eight years later, Anita faced painful varicose veins and swelling in her other (right) leg and dreaded having to face the vein stripping ordeal a second time. As her pain and discomfort increased, her primary care physician referred her to varicose vein specialist, Dr. Seun Sowemimo.

            “He told me about a newer procedure that would get rid of the veins without requiring major surgery,” Anita explains. “I couldn’t believe it when he said I could go back to work the day after the procedure.”

            Dr. Seun recommended the VNUS Closure® procedure, a minimally invasive, office-based treatment option that uses radiofrequency heat placed directly into the wall of the vein in the thigh to eliminate the varicose vein. Heating the vein causes collagen in the wall to shrink and the vein to close. After the vein is sealed shut, blood then naturally reroutes to healthy veins.

            “Dr. Seun patiently answered all my questions in terms I could understand,” Anita recalls. “He had an upbeat, optimistic outlook that made me comfortable and ready to proceed.” After undergoing the hour-long procedure right in Dr. Seun’s office, Anita rested and then headed home. The next day, she was back at work, chasing after a two-year-old who is in her care. About two weeks later, Anita’s procedure and her varicose veins were just a distant memory.

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