Dr. John Happel | Sep 22, 2018 | 0
How to Stop Varicose Vein Insurance Fraud and Abuse
Why should you care about varicose vein insurance coverage?
- When varicose vein insurance fraud occurs, your premiums go up to compensate for it.
- When a doctor submits a claim for someone’s unnecessary Doppler venous ultrasound, you pay for it.
- When a fraudulent claim is submitted for someone else’s cosmetic spider vein treatment costs, you pay for it.
Patient empowerment can change these wrongs.
The first step is to understand that the problem exists.
Just to be clear: this blog article is a plea for all health insurance companies to reexamine their future varicose vein treatment policies.
This proposal is also an attempt to educate the public on how the system for the reimbursement for venous disease is broken.
On the positive side, it outlines how it can be fixed.
Arbitrary denials for necessary vein procedures should be remedied by a universal plan to optimize patient care. Collaboration for evidence-based standards is needed desperately.
Sample Letter for a National Determination Policy for Varicose Vein Treatments
I am writing in regards to a proposed change, which I believe would be in the best interest of your insurance company and with your insured patients.
Since 2004, the number of procedures for varicose veins has gone up 1600%. Varicose veins have been estimated to occur in well over 25% of people.
An aging population and our obesity epidemic will keep those percentages on the rise.
It is easy to see how patient access to affordable treatment has caused a rapid growth in the field of vein care, especially over the last decade.
As a board certified vascular surgeon trained at the Mayo Clinic, I see patients presenting to my office all too frequently with botched varicose vein procedures.
Self-proclaimed vein doctors or “phlebologists” who have no training at all in venous disease did these vein treatments.
Many are emergency room doctors, family practitioners, radiologists, dermatologists and even gynecologists who have taken weekend courses.
They are attempting to treat advanced venous disease. There is no oversight.
Often patients present for a second opinion after a phlebologist has recommended a laser procedure when their saphenous veins were entirely normal.
This is unethical.
An attempt to remedy this problem is taking place in Massachusetts.
Certification must be obtained by the only accrediting body, the Intersocietal Accreditation Commission, the IAC, or the doctors won’t be paid.
Trained vs. Untrained Varicose Vein Doctors
Unfortunately, most untrained physicians simply do not possess the basic skill sets to perform varicose vein procedures. Many have tried to take advantage of opportunities to increase their knowledge of superficial venous disease and its treatment through weekend courses.
Previously, they never treated a vein in their life. They were never formally trained in venous disease.
Limiting this growing number of procedures to only physicians who can safely perform these procedures would not only be cost cutting but would improve the quality of care at the same time.
The formula is simple: as the accessibility of a procedure increases so does the number of people being treated. Varicose veins are extremely common.
However, an increasing number of vein patients are being treated inappropriately.
That means more claims.
Every unsuccessful and unnecessary extra claim paid also means reduction in care in other medical fields.
How Massachusetts is Taking the Initiative Towards Quality Varicose Vein Care
In Massachusetts, this change six years ago was based on the premise that “Quality is the focus of this initiative.”
As of January 2016, BCBS mandated that in the state of Massachusetts that only vein centers that are accredited by the Intersocietal Accreditation Committee will be eligible to be paid for the removal of varicose veins using Radiofrequency Ablation (RFA) and Endovenous Laser Ablation (EVLT).
Moreover, only trained vascular and general surgeons and radiologists can be reimbursed for these procedures. Minimally invasive office procedures are rapidly replacing the conventional vein stripping method.
Massachusetts BC/BS has mandated that these procedures only be done in vein centers (offices) that have successfully completed and passed a thorough nationally standardized certification process.
In addition, in Massachusetts, the only physicians eligible are board certified vascular surgeons, interventional radiologists and general surgeons.
The American College of Radiology (ACR) or the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) must also approve their treatment sites for ultrasound certification.
The initiative was driven by quality of care. There has been an explosive growth in outpatient venous laser procedures in the last five years.
Because of such an overwhelming influx of all kinds of doctors performing them, no one can be certain that doctors offering saphenous vein laser or radio frequency treatments are legitimately and safely qualified.
That was true until the Intersocietal Accreditation Committee (IAC) started accreditation of vein offices about two years ago. The treatment of varicose veins has moved completely from hospitals to unregulated doctor’s offices.
Safety and the rapid adoption of these procedures by physicians is the reason for the new requirements. Dr. Jan Cook, Regional Medical Director for BCBSMA, said,
“Over the last six years, an increasing number of people have been receiving this procedure with a wide variety of physicians performing it. We became concerned about the quality of the training. We don’t understand the quality of the training of the physicians that are rendering this service.”
Dr. Cook also stated,
“Like other insurers, we use the ABMS as our gold standard. In that world, these specialties (vascular surgery, interventional radiology and general surgery) are the ones who specialize in venous diseases. We need to ensure that our members have the benefit of seeing professionals who can offer them a wide range of treatment options for symptomatic venous disease.”
To remedy this, BCBS of Massachusetts looked to the American Board of Medical Specialties (ABMS) to create new privileging criteria.
Although BCBSMA was challenged legally by at least one physician, Borus Bergus MD, it was dismissed by the Office of Consumer Affairs and its division of insurance stating that Massachusetts BC/BS acted within its contractual rights in its decision to limit which physicians could perform these varicose vein procedures.
In my opinion, all health insurance insurance companies should seriously consider joining Massachusetts Blue Cross Blue Shield in allowing only certified IAC accredited vein centers and appropriately trained physicians to receive reimbursement for varicose vein treatments.
I sent the sample letter mentioned in the second paragraph to insurance companies.
They ignored my recommendations.
Perhaps, the quality and accreditation of vein centers is not really their primary concern.
In Pittsburgh, there are many choices for vein treatment. Only the Happel Laser and Vein Centre is an IAC vein center accredited facility.
All vein procedures are done by a fellowship trained board certified vascular surgeon with over thirty years of experience.
You deserve nothing less.
Call our office for an appointment at 724-969-0600 or contact us here.
We accept and participate in the following health 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