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Does Aetna Health Care Cover Varicose Vein Surgery?

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Procedures for varicose veins that are considered medically necessary are covered by Aetna. The company lists these procedures, under a specifically described medical need, for those covered by their insurance plan:

  • Great saphenous vein or small saphenous vein ligation / division / stripping.
  • Radiofrequency endovenous occlusion (VNUS procedure), and endovenous laser ablation of the saphenous vein (ELAS) (also known as endovenous laser treatment (EVLT).

The following criteria for varicose veins are required before medically covered treatment can be performed:

  • Reflux must be documented at 500 milliseconds or greater and the size of the vein must be 4.5 millimeters or greater in diameter.

If the veins are actively causing patients different symptoms, insurance will consider the procedure a medical need. Aetna describes some of the symptoms resulting from varicose veins as:

  • An ulceration, intractable, that is secondary to venous stasis or more than one instance of hemorrhage from a ruptures vein.
  • A single hemorrhage from a ruptures vein that is considered severe and requires a blood transfusion.
  • Any other varicosities that result in either of the previously stated instances, and symptoms that continue to exist after a 3 month trial of conservative management (this can include anything your doctor suggests as treatment before taking medical action – (prescription medicine, certain topical treatment, compression socks, etc.)

If pain and swelling are extremely severe and reoccurring, and in-turn interfere with daily activities, the treatment is considered medical and treated by Aetna.

If you have previously undergone any of the procedures mentioned, and are still suffering from persistent varicosities, treatment is often suggested again – because Aetna suggests that conservative management is not likely to be successful in this situation.

Cosmetic

If any varicose vein treatment is not considered a medical necessity, it is not covered by Aetna insurance. A proper assessment alongside a number of different ultrasound tests will determine if the procedure is needed for medical purposes.

In the case of spider veins or small veins that only have an effect on appearance; Aetna does not cover the medical procedure.

In general, if quality of life is not at risk, then the procedure for varicose veins is considered cosmetic. Aetna may provide partial coverage or even determine a case as medically necessary when you think it isn't. The best thing to do is get an assessment done when you’re ready to have treatment. Then, contact Aetna to see what they will cover.

The specifics of what is and is not covered by Aetna for varicose vein surgery is detailed and specific. If you have questions that pertain to your individual case that were not mentioned here, please call us at (855) 690-0565 to learn more about Aetna insurance and varicose vein treatment.

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