Does Insurance Cover Sclerotherapy?

Sclerotherapy is a minimally invasive medical procedure used to treat varicose, spider veins, and other symptoms of vein disease. This outpatient technique has recently gained popularity for its safety, effectiveness, and quick recovery time. As more and more people seek this treatment option to improve how their legs look and feel, a common question arises: Does insurance cover sclerotherapy? In this blog, we will delve into the factors determining insurance coverage for sclerotherapy and provide insights to help you make informed healthcare decisions.

What is Sclerotherapy?

Sclerotherapy is a safe, effective, non-surgical, minimally invasive treatment option that can help rid individuals of leg problems such as pain, aching, and swelling, as well as the unsightly appearance of varicose veins and spider veins on the legs. Visual sclerotherapy works exceptionally well on smaller varicose veins and spider veins. Per Cleveland Clinic, 50 percent to 80 percent of injected veins are eliminated during a single sclerotherapy session.

During the sclerotherapy procedure, a qualified healthcare professional injects a sclerosing solution (often concentrated salt water) directly into the vein using a fine needle. The solution irritates the vein lining, causing it to swell and become inflamed. This inflammation triggers the vein walls to stick together, sealing the vessel shut. Over time, the closed vein becomes scar tissue and is gradually absorbed by the body—and the problem vein fades away, relieving the symptoms of vein disease.

According to WebMD, sclerotherapy has been used since the 1930s and has been proven effective.

What is Ultrasound-Guided Foam Sclerotherapy?

To treat complex varicose veins, a qualified vein care physician will employ an imaging technique called ultrasonography. Using high-energy sound waves to visualize tissues, ultrasound technology helps the physician guide the insertion of a needle precisely into the targeted vein. A sclerosant, transformed into a foam, is then injected into the affected vein, triggering a reaction leading to its closure. Over the course of a few weeks, blood naturally reroutes through healthier veins as the body absorbs the closed vein.

Beyond its cosmetic benefits, ultrasound-guided foam sclerotherapy effectively alleviates physical symptoms of vein disease, such as aches, pain, feelings of leg heaviness, and fatigue. Per a National Library of Medicine (NIH) study, complete elimination of varicose veins and reflux elimination at 90 days was 87 percent using foam sclerotherapy.

What to Expect After Sclerotherapy Treatment

After sclerotherapy, patients can drive themselves home and resume their regular daily activities immediately, with few restrictions. Walking is encouraged, and patients are instructed to wear support hose (compression stockings) on their treated legs.

Patients can anticipate some temporary side effects that may occur at the injection site, including stinging or pain, swelling of the ankles or feet, bruising, itching, and raised red areas around the injection sites. These side effects typically subside within a few days. However, some effects, such as brown lines or spots near the treatment area, may take three to six months to disappear.

Following post-treatment care instructions, such as avoiding sunlight, hot baths, and certain medications, is vital to reduce the risk of complications and promote effective healing. Patients should also know the potential need for additional treatments and maintain open communication with their healthcare provider to address concerns.

Ultrasound-Guided Foam Sclerotherapy at Center for Vein Restoration

At Center for Vein Restoration (CVR), our board-certified vein care physicians are experts at using advanced treatment options for varicose veins, such as ultrasound-guided foam sclerotherapy, to eliminate varicose veins close to the skin's surface. This non-surgical, minimally invasive, outpatient procedure offers swift recovery, allowing patients to resume normal activities quickly, with few restrictions—showcasing CVR's dedication to optimal vein health and complete patient satisfaction.

Factors That Determine Insurance Coverage for Sclerotherapy

Finding the right vein treatment shouldn't stress you out. At Center for Vein Restoration (CVR), we believe everyone deserves access to quality vein care. That's why CVR works with many insurance companies and guides you through the process—making it simple and straightforward. We understand what the insurance companies require for coverage and are experts at navigating the insurance process.

While specifics may differ among insurance plans and providers, common factors influencing coverage include:

1. Medical Necessity: Insurance companies typically base their coverage decisions on the medical necessity of a procedure. If sclerotherapy is deemed medically necessary – for instance, to alleviate pain or prevent complications – there's a higher likelihood of insurance coverage. A physician's evaluation and documentation play a crucial role in establishing the medical necessity of sclerotherapy.
2. Diagnostic Testing: Insurance companies often require specific diagnostic tests to justify the need for sclerotherapy. Doppler ultrasound is commonly used to assess the extent of venous insufficiency and guide treatment decisions. Insurance coverage may be more likely if these tests confirm the medical necessity of the procedure.
3. Cosmetic vs. Medical Purpose: One of the primary considerations in insurance coverage is whether the procedure is performed for cosmetic reasons or medical necessity. Sclerotherapy intended for cosmetic improvement may be less likely to be covered, as insurance policies typically prioritize treatments addressing underlying health concerns.
4. Vein Size and Severity: The size and severity of the treated veins can influence insurance coverage. Larger varicose veins, especially those causing pain or discomfort, are more likely to be considered medically necessary. Smaller spider veins, primarily treated for cosmetic reasons, may have a lower chance of coverage.
5. Insurance Policies and Plans: Different insurance companies and plans have varying coverage policies. Reviewing your specific insurance policy to understand the extent of coverage for sclerotherapy is essential. Some policies cover the procedure outright, while others require pre-authorization or have particular limitations.

Navigating Insurance Coverage

Getting the insurance coverage you deserve for medical procedures you need can be a complex journey, with various factors influencing the amount of benefits provided. At Center for Vein Restoration, we understand the intricacies of insurance coverage. These are the critical steps needed to secure insurance coverage for vein treatment:

1. Consultation with a Vein Physician: The first step in understanding your insurance coverage for sclerotherapy is to consult a qualified healthcare professional. At CVR, our vascular specialists can assess your condition, determine the medical necessity of sclerotherapy, and provide guidance on navigating the insurance process.
2. Verification of Insurance Coverage: Contact your insurance provider to verify coverage details for sclerotherapy. Inquire about pre-authorization requirements, documentation needed, and any potential out-of-pocket costs. Understanding your policy's specifics can help you plan for the financial aspect of the procedure.
3. Documentation and Medical Records: Accurate and detailed documentation is crucial when seeking insurance coverage for sclerotherapy. Ensure your healthcare provider maintains comprehensive medical records, including diagnostic test results, images, and a clear rationale for the procedure's medical necessity. CVR has a proven track record of helping thousands understand their insurance coverage. They'll do the same for you!
4. Appealing Coverage Decisions: If your initial request for coverage is denied, you have the right to appeal the decision. Work closely with your healthcare provider to gather additional evidence supporting the medical necessity of sclerotherapy. Insurance companies may reconsider their decision upon receiving a well-documented appeal.

Insurance Coverage for Sclerotherapy: The Bottom Line

While the question of whether insurance covers sclerotherapy doesn't have a straightforward answer, understanding the factors influencing coverage can empower individuals seeking this treatment. The specifics of coverage depend on individual insurance plans and the medical necessity of the vein treatment. Typically, insurance does not cover treatment it considers "elective," that is, cosmetic. However, coverage may be possible if the procedure is deemed medically necessary, such as in the case of varicose veins causing pain and itching.

Insurance For Vein Care Got You Stumped? Let CVR Simplify the Process

If you're considering varicose veins treatment, working closely with your Center for Vein Restoration healthcare provider is crucial to ensure a smooth process. Thousands of others just like you have overcome the insurance hurdle with CVR by their side. We're here to guide you every step of the way—and it all starts with scheduling an appointment!

Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.

CVR accepts many insurances, including Aetna, Amerigroup, Anthem, Blue Cross/Blue Shield, Cigna, MultiPlan, Medicaid, Medicare, and more. Let our experience work for you to access the advanced vein care you need.