Q: HOW HAVE TREATMENTS EVOLVED IN RECENT YEARS?
A: Until recently, vein ligation and stripping was the standard for treating venous reflux in larger varicose veins. These veins are treated by making an incision over the vein and tying off the vein. If the majority of the valves in the vein are healthy, ligation can be used to isolate the faulty valves and the remaining vein may be left in place to continue circulating blood. If the vein is heavily damaged it is usually removed, or stripped. To strip a vein, incisions are made at the groin and near the knee and the vein is grasped and removed. Most people are able to return to their normal daily and recreational activities within a few weeks. Vein ligation and stripping is effective in producing positive long-term results in 85% of people. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection.

While vein ligation and stripping are out patient procedures, they are not usually done in the office setting since a general anesthetic is utilized. Since an incision is required in the groin, with dissection of the sapheno-femoral junction this is an operation that needs to be done in a formal operating room where vascular surgery can be performed if there are any difficulties with the dissection of the femoral vein. Recovery time is significantly longer for vein compared to the newer techniques, such as EVLT.

In recent years, physicians and companies have developed new techniques that are less invasive and that can be done in the outpatient setting. There is some suggestion that the rate of varicose vein recurrence is significantly less with endovenous ablation of the saphenous vein, such as EVLT, compared to traditional vein ligation and stripping.

Q: WILL MY VEIN TREATMENTS BE COVERED BY INSURANCE?
A: Most insurance providers have two categories under which vein treatments may fall:
Cosmetic Procedures
Medically Necessary Procedure

Many vein treatments will fall under the category of cosmetic procedure, and as such, will not be covered by insurance providers. However, EVLT and phlebectomy are more likely than injection treatments or surface laser therapy to be covered as a "medically necessary procedure".
Insurance companies use varying criteria in order to determine if vein treatment is to be considered "medically necessary." These criteria may include one or more of the following:
Lifestyle Disruption: the daily activities of the patient must be disrupted significantly.

Pain: The patient must be experiencing pain as a result of their vein disorder.
Failure of Conservative Measures: Other methods of treatment, such as compression hose, have failed to provide adequate relief.

Vein Size: Bulging veins larger than 4 mm are often considered medically significant.
Complications: Complications, such as phlebitis, bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary.

Q: WHAT IF I DON’T HAVE VARICOSE VEINS, BUT I JUST HAVE SPIDER VEINS: IS THIS COVERED BY INSURACE?
A: Spider veins are generally not symptomatic, and thus they don’t meet the definition of “medically necessary” for insurance company coverage. Sclerotherapy and surface laser therapy are still an option, but this is often paid “out of pocket” by the patient when the treatment is desired. Medicare will generally not reimburse for cosmetic Sclerotherapy or surface laser treatments for spider veins and telangectasias. Since most insurance companies and payers such as Medicare do not cover cosmetic procedures, we offer patients a variety of payment methods.