Insurance

There’s not a day that goes by that we don’t talk with patients about their insurance coverage. We know that it’s important for you to know what your cost is for treatment before even making an appointment with us. We understand. That’s why we make it a priority to get to most current and most accurate insurance coverage information straight from your insurer. The following information will provide a quick lesson in insurance terms.

​Please don’t hesitate to contact our billing specialist, Carle Garland, by email at carle@altoonavein.com, or phone at 814-515-9919, extension 304, to get an answer suited to your specific insurance questions.

Venous insufficiency is a medical disease that causes varicose veins to develop. Varicose veins by definition are veins that have become dilated more than 5 mm. Once the vein becomes that dilated it loses its ability to recoil or retract back to its normal size. Similar to elastic that loses its stretch. The vein walls then lose their integrity and fluid and nutrients leak into the tissues and with time, result in physical symptoms. As the veins dilate, there are one way valves inside them that fail to close properly and this allows blood to flow in the wrong direction back down the vein further increasing the pressure in the vein and further dilating the vein. Insurance plans generally will pay for the treatment of varicose veins that are 5 mm and greater in size with more than one half a second of blood flowing in the wrong direction. This information is obtained by measuring veins by an ultrasound examination.

The initial physical examination and the ultrasound evaluation are generally covered by insurance because we are evaluating patients for medical conditions that have caused physical symptoms to occur that interfere with activities of daily living. The most common physical symptoms that result from varicose veins are pain, heaviness, aching, swelling and skin changes such as itching, dryness, rashes or wounds.

Cosmetic veins are those veins that are smaller than 3 mm and “spider” veins. Research has proven that these veins do not cause physical symptoms that are severe enough to interfere with activities of daily living. They may burn, sting or bleed but generally are not bad enough to cause complications. They are more of an annoyance. Those veins can be treated, but that treatment is not covered by your insurance and you would be responsible for the full payment. All cosmetic services are paid for at the time the service is received.

Each insurance company has guidelines that must be met in order for them to consider varicose vein procedures as meeting “Medical Necessity”.  Medical Necessity is also referred to as having the procedures authorized or approved for payment.

Some of those policy guidelines specify that the patient must have tried rest, elevating the legs, and wearing medical grade compression for a 90 day period in order to alleviate their symptoms.  We also must educate patients on weight management and the need for daily exercise. Also, insurance companies need to know if symptoms are present. Symptoms related to varicose veins would be pain, swelling, heaviness, aching of the legs plus skin changes such as itching, dryness, rashes, or wounds.

When our insurance department makes contact with your insurance to obtain medical necessity approval for your procedure, we must give them all of the above information. If the claim is approved, that does not necessarily mean you, the patient will not have any monies to pay. There are no “Hidden” cost with insurance plans but there are expenses that a patient is responsible for. Understanding those cost are extremely helpful. There are co-pay, deductible, and co-insurance.