Like most insurance coverage policies, the terms that recognize a treatment as a medical necessity vs a cosmetic procedure will determine if coverage is offered and if so, how much.
In order to be covered for treatment of varicose veins, Anthem Health Care Insurance lists the following procedures as covered with a medical need:
- Endoluminal radiofrequency ablation (also known as VNUS Closure™ System or Venefit™ Procedure)
- Endoluminal laser ablation (also known as EVLT™ or ELAS)
- Endovenous thermal ablation (EVTA) which includes radiofrequency and laser ablation
- Endoluminal cryoablation
- Echosclerotherapy (also known as ultrasound-guided sclerotherapy)
- Mechanochemical ablation (for example: ClariVein®)
A medical need is also described as:
Saphenofemoral or saphenopopliteal reflux demonstrated by Doppler or duplex ultrasound scanning and One or more of the following criteria (a, b, or c) are met:
- Symptoms of venous insufficiency or recurrent thrombophlebitis are interfering with activities of daily living
- They persist despite appropriate non-surgical management
- They persist despite a trial of properly fitted gradient compression stockings for at least six weeks or there is ulceration secondary to stasis dermatitis or there is hemorrhage from a superficial varicosity.
Procedures considered a cosmetic need are not covered by Anthem. The following describes procedure and methods that are not considered a medical necessity:
Treatment using sclerotherapy or various laser treatments (including tunable dye or pulsed dye laser, e.g., PhotoDerm®, VeinLase™, Vasculite™) of the telangiectatic dermal veins (e.g. reticular, capillary, venule).
These procedures are most often used to treat spider veins and 'broken blood vessels,' which are considered cosmetic, and not covered by insurance.
The specifics of what is and is not covered by Anthem 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 Anthem insurance and varicose vein treatments.
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