When Do You Get Original Medicare Coverage For Spider Vein Treatment
As previously mentioned, spider veins are often caused by underlying venous insufficiency. Chronic venous insufficiency is a medical condition in which your vein valves malfunction. These vein valves are usually responsible for smooth blood circulation to the heart. They act as one-way doors to allow blood from the legs to flow to the heart but they prevent blood from flowing back down due to gravity.
When your vein valves malfunction, blood flows back down and accumulates in the leg veins due to gravity. Over time, more blood accumulates in your leg veins, which leads to vein dilation, which leads to the formation of spider veins and varicose veins on the surface of your skin.
Venous insufficiency is a serious medical condition because it leads to complications like severe bleeding, skin diseases, discoloration of the skin, leg ulcers, and deep vein thrombosis. The latter of these complications can also be fatal if the blood clots break away and travel to the lungs, thus inducing pulmonary embolism.
When you go to a vein treatment clinic, the vein doctor will first run diagnostic and imaging tests like Doppler Ultrasound to determine if youre suffering from venous insufficiency. If your spider veins are caused by venous insufficiency, you will receive Medicare coverage. However, if your spider veins are not caused by venous insufficiency, your treatment will be considered cosmetic and wont be covered by Medicare.
What Increases Your Risk
Factors that increase your risk of developing varicose veins include:
- Pregnancy .
- Being female.
- Advancing age.
- Being overweight . Having low muscle mass and high body fat decreases the support for the veins.
- Family history of varicose veins.
- Prolonged sitting or standing.
- Conditions that increase pressure in the abdomen, such as liver disease, fluid in the abdomen, previous groin surgery, or heart failure.
- Injury to the veins.
Which Varicose Vein Treatments Does Medicare Cover
Some of the varicose vein treatments covered by Medicare include:
- SclerotherapyOften considered the treatment of choice for smaller varicose veins, sclerotherapy involves injecting a solution directly into the vein. This solution causes the vein to eventually disappear, forcing blood to reroute through healthier veins.
- Endovenous ablation therapyEndovenous ablation is a procedure used to close off damaged varicose veins. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses heat to break down and close off these damaged veins.
- VenaSealVenaSeal is medical-grade glue thats placed inside a varicose vein using a tiny catheter. It seals the vein wall together in seconds. This procedure is fast, minimally invasive and does not require post-treatment support stockings.
You deserve pain-free legs and the skilled specialists at Carolina Vein Specialists can help with no vein stripping and only the most advanced procedures. We offer leading-edge Medicare varicose vein treatments in our Winston-Salem and Greensboro offices so you can get back to doing what you love quickly. Call to schedule an appointment.
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When Is Medicare Coverage For Varicose Vein Treatment More Likely
Medicare coverage for varicose vein treatment could be more likely if you are experiencing complications. According to the Mayo Clinic, complications could include extremely painful ulcers, blood clots, and bleeding when veins close to the skin burst.
If you are seeking varicose vein repair because you dont like the appearance of varicose veins, Medicare is likely to consider the procedure cosmetic in purpose and consequently not a covered benefit.
Do you have questions about your current Medicare coverage or your Medicare coverage options? I can help you evaluate the coverage options available to you.
- To receive Medicare plan information to review, use the links below you can schedule a phone call with me or have me email you plan options available through Medicare.com.
- If youd like to compare plans available where you live on your own first, use the Compare Plans button on this page.
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What Are The Different Types Of Veins
If you are unsure if you have varicose veins, we have developed a simple self-assessment tool which may be able to help..
- Bulging veins: veins that bulge and protrude above the skin. Often found in your arms, hands and face, not all bulging veins are varicose. However, it is recommended if you see a twisted vein in your leg that you speak with a doctor.
- Reticular veins: smaller than varicose veins, these do not protrude above the skin the way that varicose veins do. Blue or purple in colour , they are most commonly found on the inner thigh, the backs of knees, or the ankles.
- Spider Veins: these are small clusters of fine veins. They are typically considered to be a cosmetic concern.
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How Much Does Varicose Vein Treatment Cost With Medicare
If Medicare covers your varicose vein treatment, there are some out-of-pocket costs you should expect to pay, which may include:
- The Medicare Part B deductible, which is $185 per year in 2019.
- After your Part B deductible is met, you are usually required to pay 20 percent of the Medicare-approved amount for most doctors services. There is no annual limit on how much you could pay for the Part B coinsurance in a given year.
- If your varicose vein treatment requires inpatient care, you will need to meet your Part A deductible before your Part A hospital insurance coverage kicks in. In 2019, the Part A deductible is $1,364 per benefit period.
Speak directly with your doctor for specific cost and coverage information for your varicose vein treatment.
Vein Treatments: Hmos & Ppos
Both HMOs and PPOs have two categories under which vein treatments may fall:
- Cosmetic procedures
- Medically necessary procedures
The majority of vein treatments fall under the category of cosmetic procedures, and as such, will not be covered by insurance providers. Insurance companies cover some, but not all, vein treatments when they are deemed “medically necessary”.
Each insurance company is allowed to establish its own rules about which treatments are medically necessary and under what circumstances. The rules are often complex and include very specific medical criteria that must be met, and they may restrict treatment to only certain veins or certain procedures.
Check your insurance company’s website for their policy on vein treatment or ask them to send it to you. Then you should share the information with your vein specialist.
Insurance companies’ criteria for whether vein treatment is “medically necessary” may include one or more of the following:
- Limiting: Your vein problems limit your day-to-day activities.
- Complications: Complications such as vein swelling , ruptured or bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary.
- Pain: You must be experiencing pain as a result of your vein disorder.
- Failure of conservative therapy: Other methods of treatment, such as the use of compression hose, have failed to provide adequate relief after a specified period of time.
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Private Health Insurance For Varicose Veins
Generally, private health providers only cover treatments performed in-hospital, as they are protected by the hospital insurance.
The minimally invasive treatment options, such as EVLA and those available at The Vein Institute, are performed in a private medical practice. As a result, minimally invasive procedures are only covered by Medicare.
Surgical stripping is performed in-hospital and is as onerous as the name implies. It involves a couple of days in the hospital, general anesthetic and a long, painful recovery time.
Does Medicare Cover Varicose Veins Repair
If you are on Medicare and are considering having your varicose veins repaired, youre probably wondering if your plan will cover the treatment. Medicare coverage varies by state and region, so the only way to know for sure if Medicare will cover your procedure is by having your doctor request a preauthorization the outcome of the preauthorization will provide 100% certainty whether your treatment will be covered or not.
However, in cases where varicose veins repair is covered, patients must meet certain conditions in order for the treatment to be paid for by Medicare. Use the guidelines below to determine how likely it is that your Medicare plan will pay for your varicose veins repair.
Spider vein treatment is generally considered cosmetic and is rarely covered by Medicare. Spider vein treatment is only covered if spider veins are exhibiting dangerous symptoms, such as ongoing and substantial bleeding.
Your varicose vein repair will be more likely to be covered if you are experiencing health issues or degradation in your quality of life due to venous disease. Patients who are experiencing pain caused by venous disease are more likely to qualify for coverage. Additionally, patients who have external bleeding from their varicose veins or external sores that wont heal caused by varicose vein hemorrhaging are likely to have treatments covered.
Size of Veins
Finding a Doctor
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Dr Obinna Nwobi Md Mph
Dr. Obinna Nwobi graduated with highest honors from East Tennessee State University with a dual degree in English and Chemistry. He then received his medical degree on a scholarship from the University of Tennessee College of Medicine in Memphis. He completed his internship and residency in general surgery at the University of Medicine and Dentistry of New Jersey in Newark, before completing a fellowship in vascular surgery at the Albany Medical Center/The Vascular Group PLLC in Albany, NY, one of the largest single-specialty, peripheral vascular centers in the country.
Dr. Nwobi is certified in general surgery and vascular surgery by the American Board of Surgery. Dr. Nwobi also completed a Masters in Public Health from the prestigious Johns Hopkins Bloomberg School of Public Health with an emphasis on health care management and international health. He is married to Ify Nwobi and they have four lovely kids.
Does Medicare Cover Varicose Vein Treatment
Varicose veins, which are also commonly referred to as spider veins, occur when the veins right under the skin become very visible and swollen. This condition most often occurs in the legs, but it can also be seen in other areas of the body. These veins can be unsightly, and many people wish to have them fixed surgically for cosmetic reasons. However, varicose veins can also have other health implications as they can result in severe bleeding, blood flow complications, and more. If varicose veins are causing health complications for you, your Medicare benefits should provide coverage for your treatment.
Why Do Varicose Veins Occur?Your veins are responsible for bringing blood back to the heart from all over the body. These blood vessels are designed to allow blood to travel only in one direction, which helps to maintain proper blood flow throughout the body. This one-directional flow is maintained through the use of valves, which are spaced out through every vein.
Sometimes, the valves in these veins can begin to lose their functionality, especially with age. If this occurs, blood may be allowed to flow backwards in some areas, causing increased blood pressure, swelling in the surrounding area, vein discoloration, itching, and more. The added blood volume in a certain vein can lead to it bulging.
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Does Medicare Cover Venous Insufficiency
If you have venous insufficiency, that means your veins struggle to send blood from the legs back up to your heart. Without treatment, this may weaken the vein walls and damage your valves. Medicare covers venous insufficiency if lifestyle changes dont help.
Part D may include some of the medications your doctor prescribes. Check your plans formulary to make sure your prescription is on their list of covered drugs. Otherwise, ask your doctor for an alternative that your policy does cover.
Does Medicare Cover Treatment For Varicose Veins
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Q: Are Vein Procedures Covered By Medicaid Or Other Insurance
A: Most vein procedures and treatments for venous insufficiency are covered by Medicare and most major insurers. We will check with you insurance company prior to any procedure if you qualify for free treatment.Cosmetic treatments, however, such as sclerotherapy injections for spider veins, are generally NOT covered by insurance.
Prior to your treatment, our office staff will assist you in determining what will be covered, and if there are any out-of-pocket costs for you.If you do not have health insurance or have an extremely high deductible, well discuss affordable payment options with you.
Do I Need To Treat My Varicose Veins
If your varicose veins pose little discomfort and health risk, then treatment may not be necessary. However, some patients find varicose veins unsightly, and wish to have them addressed for aesthetic reasons. If youre experiencing varicose veins or symptoms, or have a family history of the disease, its a good idea to see a professional vein specialist for an assessment. They will advise you whether treatment is recommended and go over all the treatment options with you.
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Will Treatment Be Covered By Insurance
Chronic venous insufficiency is a progressive disease that is covered by most insurance programs. This is distinguished from sclerotherapy which is deemed to be a cosmetic treatment. In order for most insurers to authorize the treatment of varicose veins, the healthcare provider must demonstrate a level of medical necessity. The criteria for meeting medical necessity will vary by insurance company. The staff at RejuVeination can assist you with your insurance questions.
Some insurance companies also require a defined period of compression stocking use to control the symptoms found in vein disease before seeking medical help. Since compression stockings help control leg vein symptoms, insurance companies will often specify in the policy that patients must have attempted to control their symptoms with the use of compression stockings for a defined period of time before they will allow you to seek treatment. The period of required compression stocking use can vary between policies, but the most typical mandated time is between 6 weeks to 3 months.
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American Hospital Association Disclaimer
The American Hospital Association has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
We Work With You To Maximize Your Insurance Benefits
Since most varicose and spider veins are symptoms of vein disease, their treatment is typically covered by common insurance plans. Give us a call at to see if we work with your specific insurance plan.
For patients whose costs are not covered, we offer a range of financing options including CareCredit and HELPcard*, and HSA and FSA accounts may qualify, so financial concerns shouldnt stop you from getting the relief that you need.
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