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Sep 20 2017

What happens if my insurance company denies my procedure claiming it’s not medically necessary?

By: Alethea Maddox

 

By Alethea Maddox, Practice Manager for Vanishing Veins and Vivesse Med Spa

You’ve done everything right.

You’ve contacted your insurance company and asked if treating varicose veins is included in your coverage! It is.

Great!

You’ve set up an appointment with Dr. Lori Greenwald here at Vanishing Veins. You get evaluated and now your insurance company tells you this: “We’re sorry Mrs. Smith but we don’t think treating your varicose veins is medically necessary and we will not cover the recommended procedures.”

Wait! What?

While this doesn’t happen often, it can happen. So, it’s important for us to spell-out this scenario for you as well.

During your medical examination at Vanishing Veins, we will do an ultrasound. We will also measure your veins and check for certain pulses in your legs. However, if the varicose veins in your legs are not showing certain criteria (and they vary depending upon the insurance company) your claim could be denied. Meaning, the insurance company doesn’t think treating your varicose veins is medically necessary.

This is when we fight for you.

We understand your varicose veins are painful and impacting your life and we will go to bat for you. Generally, what happens next is we will schedule a peer-to-peer review with your insurance company. What this means is our physician will speak to the insurance company and explain the need for the procedure. We will state facts, review your ultrasound results and explain why this procedure is important and how it would improve your quality of life. The insurance company will then make their decision.

In the event they deny your procedure, we have many payment options available for you.

Our goal is to really have you feeling better. We don’t want you living with the pain and tiredness anymore. We want you to feel your best because that’s what you deserve.

Next week on Insurance 101 (part 4) Are spider veins ever covered by insurance?

In our first insurance blog post, we explained the difference between insurance benefits and insurance coverage for your varicose veins. To read that blog click here. In our second blog, we talked about how long treating your varicose veins could take. To read that blog, click here