Varicose Veins: Does Insurance Cover Removal?
Medical Industry is Turning to Independent Review Organizations (IROs) to Help Determine When Varicose Vein Removal Surgery is Medically Necessary
Portland, OR (PRWEB) April 11, 2005 -- In today’s age of beauty and fashion,
men and women are seeking ways to eliminate the ugly varicose veins they tend to
get with age, weight and heredity. While vein removal might seem like an
optional, cosmetic surgery, many people in their twenties and older frequently
suffer from swollen and painful legs as a result of varicose veins. In advanced
cases, patients can also experience leg ulceration, skin breakdown, superficial
phlebitis and, in rare instances, bleeding.
“There are a multitude of
causes that contribute to a patient’s inclination to get varicose veins,” said
to Dr. Skip Freedman, medical director at AllMed Healthcare Management, a
leading Independent Review Organization (IRO). “Typically, physicians prescribe
basic solutions, such as compression stockings that squeeze the leg and may
alleviate many of these symptoms. But, these solutions don’t work for all
patients.”
According to Freedman, the stockings don’t make the
twisted-looking and bulging veins go away, and, oftentimes, patients find them
difficult to put on, hot to wear or not suitable for their lifestyle. If, after
several weeks, patients are not getting varicose vein symptom relief from
compression stockings, they are probably going to consider surgery. Why? With
varicose veins, the damaged veins cannot pump blood back to the heart, causing
the patient’s symptoms. Surgery either removes the varicose vein and its
tributaries, or cauterizes the vein to prevent blood flowing through it. Yet,
except in well-documented cases, most healthcare plans consider varicose vein
surgery cosmetic.
In order for varicose vein surgery to be covered:
-
A patient’s physician needs to conduct a physical exam, as well as document the
patient’s history
- The patient must follow the conservative treatment plan
and wear the compression stockings for several weeks
- The physician must
track all of the patient’s general health, medical history, symptoms and tried
treatments to help prove the need for surgery.
Dr. Freedman added that if
the patient rejects the conservative vein treatment or if further proof is
needed, a physician could conduct an ultrasound to measure the speed of blood
flow through the veins and observe the patient’s vein structure and determine
the reflux (backflow) of blood. This test can also determine if there are other
conditions with the leg and provide the insurance carrier the medical evidence
need to cover the varicose vein surgery. Another advantage of this approach,
said Freedman, is that it eliminates those patients with spider veins looking
for payers to cover a procedure that’s purely non-medical and cosmetic.
More information about the medical necessity review services offered by
Independent Review Organizations (IROs) can be found on AllMed’s web site at http://www.allmedmd.com.
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Source : http://www.prweb.com/releases/2005/4/prweb226894.htm