At the Brigham and Women’s Vascular and Vein Care Centers, we know that the insurance process can be very confusing. Our expert staff will submit your claim and acquire pre-certification for your procedure, when deemed necessary by your insurance provider. Your insurance may require a referral from your primary care provider. Please request this prior to your visit(s) to our specialty clinic. Your insurance carrier and plan specificity will also determine if you have a co-payment and/or deductible which will be collected at the time of your visit(s).
However, because of the many variations in plan benefits, it is best to call your insurance company to confirm the details of your policy and verify your coverage, as well. Questions to consider asking your insurance carrier related to your specific plan are...
- Is BWH covered within your insurance carrier’s network?
- Are varicose vein procedures covered?
- Do visit(s) to a specialty clinic require referral(s)?
- If so, please ask your PCP to fax these to our office
- If you need a referral from your primary care provider and your diagnosis is varicose veins with reflux requiring Endovenous Laser Therapy, please ask for 4 visits: 1 consult, 1 treatment, and 2 follow-up visits. Once you obtain the referral, please have your primary care provider fax it to us at Newton (617) 796-7153 or Foxborough (508) 798-4011.
- Do you have a co-payment?
- If so, what is the amount for a specialty visit and/or procedure?
- Do you have deductible to satisfy before your insurance will pay any portion of your services?
- If so, what amount is left towards your obligation?
- Is a stocking trial period required before they will approve your procedure?
- If so, what is the amount of time required?
These are important questions to understand because once your insurance company has satisfied their obligation, you will be responsible for any balance.
As previously stated, insurance coverage for varicose vein treatments varies depending on your insurance provider and your specific policy. In general, most insurance providers separate vein treatments into two categories, Medically Necessary Procedures and Cosmetic Procedures.
Larger veins that are symptomatic (pain, aching, burning, itching and/or swelling along with additional criteria set by your insurance) are usually considered medically necessary and are covered by your insurance. After documentation of venous insufficiency (the valves in your legs are not properly functioning), which is determined by an ultrasound, most insurance providers will cover this in-office procedure. Many insurance companies do require a stocking trial period before they will approve a procedure. The length of the trial varies depending of your insurance carrier and plan.
Cosmetic procedures, however, are usually not covered by insurance. Treatments for non-symptomatic spider and reticular veins with sclerotherapy and/or our transdermal Palomar laser are not considered medically necessary and, therefore, patients are required to pay out of pocket.
Please contact our Billing and Compliance Analyst at (617) 796-7112 with any insurance or billing questions.
