Varicose Veins May No Longer Be Covered by Medicare! – Happel Laser & Vein Center
Guide to Varicose Veins Insurance Coverage for Medicare and Commercial Insurance
The Changing Varicose Vein Reimbursement in the Pittsburgh Area and the U.S.A.
Optimist: I’m optimistic about the future of varicose vein healthcare coverage for Medicare.
Pessimist: Things can’t get any worse.
Optimist: Nah, of course they can.
The optimist is correct.
Novitas, which is the company in charge for Medicare in eleven states including Pennsylvania, is considering recommending discontinuing varicose vein treatments for most Medicare patients in the future.
That is big news!
On January 18 2019, all of the vein doctors of America were put on notice that Medicare was considering not covering varicose veins– ever – again!
And wow again.
The vein doctors in this country went nuts.
Even though they only announced this three days ahead of time, the American College of Phlebology reacted immediately. The other major venous societies in this country have also been made aware of the impending doom if this is not challenged.
As soon as they were notified of this change in policy, an emergency conference was called. The short notice of this announcement of this meeting in Mechanicsburg, PA was surprising to the vein doctors.
A doctor representative was sent on very short notice to object to this drastic change in policy.
Medicare in the state of Pennsylvania may never cover most varicose vein treatments again.
It has hit the fan.
Medicare stopped covering support stockings in 2012 and now unless the doctors can put up a strong enough battle, they will stop most varicose vein treatment coverage in the future.
A Medicare panel has voted against coverage for leg vein treatments. This is not an idle threat.
For varicose veins – is insurance coverage nearly over?
Not yet, but it’s heading in that direction.
What Are Varicose Veins?
“Varicose veins are the result of an improper selection of grandparents.”
– The father of modern medicine, William Osler (1849-1919)
Bulging and twisted varicose veins in your legs are not normal.
Varicose veins become more difficult and painful to treat as they enlarge.
Insurance will pay less and less in the future as your deductibles and hidden costs increase.
Preventative care of varicose veins before they become symptomatic is not a covered service by any health plan. Your varicose veins must be symptomatic. If they do not have any symptoms – no matter how large they are – insurance companies, consider them cosmetic.
Learn how to choose the right varicose vein clinic to make sure that you receive all the vein care that your insurance policy covers.
Unsure About the Changes Resulting from the Repeal of Obamacare?
Insurance companies have targeted chiropractors, pain clinics, and vein centers.
Payment for these services is being pushed to the back burner. Insurance companies are throwing the baby out with the bath water. They are rationing health care in these fields to increase their profits.
Because they can get away with it. They are the judge and jury. Even the cities of Pittsburgh and Philadelphia cannot stand up to their power as seen in past legal disputes.
These medical services are not as critical to a society as heart attacks, cancer, and joint disease. Insurance plans have arbitrary guidelines.
Many of their restrictions in vein disease are not based on medical necessity or your health concerns.
They are financially based.
Business’s primary reason for existing is making money.
When medicine becomes a business, the mission becomes distorted.
If your insurance company will not suffer financially by restricting services, they will do it.
Don’t believe those warm and cozy TV commercials with the soothing female voice reassuring you that they have your best medical interests at heart.
Examples of Tactics Used by Insurance Companies When Covering Varicose Veins
As of December 30th, 2016, members of BC/BS of North Carolina will be limited to one vein treatment per leg per lifetime. Sclerotherapy is limited to three sessions per lifetime.
The Medical Director at Blue Cross/Blue Shield of North Carolina made it crystal clear that this is not a clinical or medical decision. It’s purely financial.
These restrictions aren’t on their website listing their most recent Medicare 2016 policy for coverage of varicose veins by their company.
In the Pittsburgh area, Highmark, Medicare, the Health Plan of the Ohio Valley and almost half of all insurance companies will not cover ultrasound guided sclerotherapy any more. Highmark stopped covering ultrasound guided sclerotherapy in 2012.
These companies believe that doctors will ultimately just do these treatments and not charge for them. Explaining the restrictions and billing the patient separately is complicated and time consuming.
On the other hand, Cigna and other major insurance companies do cover ultrasound guided sclerotherapy.
Listening to patients complain about the high cost of their premiums and the diminishing coverage is difficult. It wears you down. Adding out-of-pocket charges to what insurance companies don’t cover is confusing for the patient and the doctor’s billing departments.
Vein disease is incurable. If you live long enough, you will make new veins.
For recurrent varicose veins, it is mandatory that ultrasound guidance be used to hold the disease in check for as long as possible and provide as complete a treatment as possible.
Policy statements by these company’s state that ultrasound helps target the diseased veins making the treatments more effective. Multiple clinical trials like the REVATA trial and evidence based medicine have proven its effectiveness.
These insurance companies still won’t pay for it.
United Healthcare, Highmark, and Coventry Insurance will not cover varicose veins that do not originate from the saphenous veins.
One company made up its own rule with no medical data to support it that measurements of reverse flow in the great saphenous vein had to be documented at an arbitrary point below the sapheno-femoral junction.
This makes no medical sense at all. It’s irrational and unsupported by any medical evidence at all.
Highmark Blue Cross/Blue Shield will not cover patients who have an accessory saphenous and great saphenous vein as the source of their varicose veins within a three-month period.
That makes no medical sense. If more than one vein in a leg is diseased, waiting will not fix it.
Stockings used to be covered by Medicare. In 2012, that all changed. Medicare, social security and the United States government are in debt over 19 trillion dollars. Medicare punishes doctors by reimbursing percentage points less for not strictly complying to their ever-changing rules.
There are not separate pockets of money saved up for each of these programs. It all comes out of the same pocket.
BC/BS of Illinois, Texas and Louisiana insurances are health plans that many employers in the Pittsburgh area choose for their employees. They all require three visits by the physician before definitive treatment can be started.
This is described as physician guided medical supervision. It is a complete waste of time and effort. This approach has been discredited by separate consensus articles in the U.S. and Great Britain in their NICE guidelines.
What You Can Do to Get Insurance Approval When You Are Denied?
Call your insurance company and complain.
It often helps.
Your insurance company will be more likely listen to someone who purchased their product. Doctors are looked at as the enemy.
You pay the salaries of the insurance company employees.
Peer-to-peer review used to be an option in cases of a dispute. That means that doctors could call the insurance company to speak to their physician to argue their patient’s medical necessity. That no longer exists.
Doctors who are employed by health insurance companies merely read off of a list of approved services in these discussions. There is no longer any dialogue.
Sadly, it’s their way or the highway when your doctor pleads your case.
You, on the other hand, as the policyholder have great power. Use your leverage when you know you are right.
These days, you must be your own varicose vein patient advocate.
Symptomatic Varicose Veins Need Treatment Despite What Medicare Wants
My intention in writing this blog post is to educate you about the recent changes and trends in healthcare coverage for people who suffer with varicose veins.
I just hope that all my efforts have not have been in “vein”. (Pun intended)
The trend in varicose vein health insurance coverage is clear.
Health insurance companies are paying less and less for varicose vein care.
Some plans don’t cover varicose veins at all.
Unfortunately, this is the new world that we are facing with new and ever increasing restrictions regarding venous treatment.
Insurance companies are legally allowed to cover whatever they want.
Calling your insurance company and complaining does work when you are denied coverage. You must be your own patient advocate. These insurance companies will often listen to you, the policy holder, because you pay their salaries.
Let your voice be heard.
The squeaky wheel really does get the grease in many of these cases.