Is varicose vein treatment covered by health insurance?
Yes, varicose vein treatment is usually covered by health insurance, but certain parameters must be met.
One of the criteria needed by insurance companies for varicose vein coverage is that the varicose veins are symptomatic, i.e. causing symptoms. Since varicose veins can cause a number of symptoms, there are a number of symptoms which meet insurance company criteria. Typical varicose vein symptoms are:
- Restless Legs
- Darkening of the skin in the legs
- Thickening of the skin in the legs
- Ulcerations or sores that do not promptly heal in the legs
So if you have varicose veins and some of these symptoms, your varicose veins are considered “symptomatic” which fulfills that insurance company criteria. Since this is not a complete list of all possible symptoms that can be caused by varicose veins, if you have other symptoms than those listed, speak with your vein specialist and get their opinion about whether your symptoms might be caused by your varicose veins.
Most insurance companies have size criteria for coverage of varicose veins with small veins generally not being covered. The size criteria differ with each insurance company but the usual lower limit for coverage is 3-6 mm (approximately one eighth to one quarter of an inch). Usually treatment of very small veins such as “spider” veins is not covered, however some insurance carriers do cover treatment of “spider” veins if they have caused bleeding.
Trial of conservative therapy:
Each insurance company defines a trial of conservative therapy a bit differently but most include use of graduated compression stockings (graduated compression means tighter in the foot and ankle area and getting less tight as you proceed up the leg and thigh). Some insurance companies also want patients to have tried exercise and elevation. The length of this conservative trial differs by insurance company but generally is in the one to three month range. While these measures can temporarily make the legs feel better, they do not ultimately correct the condition so they are usually not a good long term solution. Since these measures do not correct the problem, some insurance carriers will waive the conservative trial mandate if your varicose veins are causing severe problems such as skin changes or ulceration.
So if your varicose veins meet your insurance companies criteria, treatment will be covered. If you are unsure, make an appointment with a vein specialist who can help you make this determination
Author: David Calcagno, M.D.
- Board certified in general surgery, vascular surgery and phlebology (the care of venous disease)
- Graduated with a degree in chemistry from Tufts University and received medical degree from Duke University
- Completed general surgery residency at Cornell New York Hospital and from there went on to complete a vascular surgery fellowship at Mayo Clinic
- Following fellowship served as Chief of Vascular Surgery at Georgetown University Medical Center and since then has been in the Central Pennsylvania area practicing vascular surgery where he has served as the President of the Medical Staff for Pinnacle Health (now University of Pittsburgh Medical Center).
- In 2007 co-founded the Calcagno and Rossi Vein Treatment Center which in December 2020 became the 100th location for Center for Vein Restoration.