Dr. John Happel | Sep 22, 2018 | 0
Insurance Coverage for Laser Treatment of Varicose Veins
Some Deceptive Ads Say 95% of Veins are Covered
When you see advertisements in Pittsburgh, saying that 95% of veins are covered by insurance, you need to examine your health insurance policy. Insurance companies consider that most abnormal veins are cosmetic.
Many insurance companies only cover varicose veins if they are large, bulging and really hurt. Technically the pain from your veins has to interfere with your activities of daily living.
Have You Tried Support Stockings First?
Most insurance companies also require that you have tried conservative medical management before any treatment is considered. That means heavy, hot and difficult to pull up medical compression support stockings.
This requirement for a medical trial of compression support stockings is not supported by the scientific vein literature. Nevertheless, insurance companies will not pay for treatment of your varicose veins unless you have worn these heavy compression support stockings for over three months.
If you want your varicose veins fixed, you must know the basics of your plan because not all health insurance plans are equal. At the very least, you must know what your deductible is just like with your car insurance and with your home insurance.
What is Co-Insurance?
You must also know what your co-insurance percentage is with your plan. Many plans pay 80%, which means that you will be responsible for 20% of the final bill. It is important to know that deductibles and co-insurance are two separate things.
Many people do not know the difference between them and do not understand what coinsurance means. The cost of these two items could surprise you whenever you have their varicose vein procedure done. Obamacare has radically changed health coverage throughout our country.
Higher Deductible Health Insurance Plans are on the Rise
Many employers are switching to cheaper health plans with higher deductibles. Employer mandates force all employers with 50-99 employees to provide full health care by 2016 or pay penalties.
In 2015, larger companies with one hundred employees or more must offer 70% of their employee’s coverage (instead of 95% of their employees) but in 2016, the higher percent will kick in.
Those companies which don’t provide health insurance will be fined $2,000 per employee up to $3,000 when the employee buys it themselves if the company’s plan is not affordable.
The more you or your employer pays each month in premiums, the less you will need to pay after your procedure is done. Employers are changing to cheaper plans at a faster rate. Many people who have had their health insurance provided by their employer have never used it before.
Some people mistakenly believe that they have “good insurance” and everything will be covered 100%. They are the ones who are unhappy. Medical bills start coming in. Confusion and anger follow.
Just because a facility or doctor tells you that your procedure is a covered service does not mean that you will not get a bill.
That is important.
Many people think because they hear that it is approved by their insurance and it is covered that they will owe nothing.
This simply is not true.
If you have a deductible and a co-insurance, you will get a bill.
Also, make sure that the doctor providing your varicose vein procedure is in network. If the doctor does not participate with your plan and has not signed a contract with your insurance plan, you will pay more out of pocket costs.
Insurance Coverage for Laser Treatment of Varicose Veins
What does this all mean to you?
As costs increase, your health plan may eventually not cover your varicose vein procedure at all. In South Carolina, if you have Blue Cross/Blue Shield insurance, even the largest and most painful varicose veins are not covered.
The trend is for less coverage for varicose veins.
Already one of the largest health insurance companies serving the Pittsburgh area refuses to pay for laser of the anterior accessory saphenous veins, which cause 25% of all varicose veins. Refusal by your insurance company to cover procedures that your doctor recommends and knows is necessary is becoming more common lately.
We are also seeing denial letters from some companies for sclerotherapy if the saphenous vein is normal. This is absurd and unfair. It makes no medical sense at all.
Under Obamacare, higher deductibles will become more common. That is true even if you have a private commercial health insurance plan.
Your employer may switch you to a cheaper plan. It will probably be unfamiliar to you.
There is a shift of health care costs from the employer to you. Knowing how much you will owe will save you a lot of stress and grief.
Never assume anything. Beware of advertisements for vein treatments. To be completely honest, if you see an ad that says 95% of veins are covered, do not go to that vein center. That is deceptive advertising.
There is something wrong. Only when your veins are large, bulging and interfere with your lifestyle and daily activities, will insurance companies get involved. Most veins are not in that category.
As the insurance companies restrictions grow, less vein procedures will be covered. That is true even if your vein procedure is medically necessary. It is already happening. To quote a line from the movie, The Cable Guy, the future is now.
Read and understand your health insurance policy carefully before you have any elective medical procedure. Ask those financial questions before your procedure to prevent surprises later.
We accept and participate in the following insurance plans.
- Health America
- Health Assurance
- Health Plan of Upper Ohio Valley
- Medical Mutual
- Mon-Valley Health Plan
- United Health Care
- Western Pennsylvania Electric (WPEE)
- All BC/BS plans