Patient With Vein Disease, Before and After Treatment By Dr. Lori Greenwald at Vanishing Veins
In our first insurance blog we explained the difference between insurance benefits and insurance coverage for your varicose veins.
Most importantly, we talked about deductibles and how you can figure it out. Please understand that your deductible is the amount of money you must pay before your insurance will pay anything. This amount is determined by the type of medical insurance policy you have.
After way too many years of dealing with insurance companies, I must emphasize how important it is to understand the difference between coverage and benefits. Benefits mean that IF you meet certain insurance mandated criteria, you are ELIGIBLE for coverage. Coverage is not equal to payment. This applies to any treatment, not just vein treatment. Payment is never guaranteed. (It’s in the fine print).
One other scenario is that your policy does not include benefits for vein treatment. This can also apply to other medical issues. This is often times referred to as an exclusion.
Even if you do not have the benefits for vein treatments, your consultation and ultrasound would be medically indicated if you have leg symptoms.
Remember that is why our experts at Dr. Greenwald’s vein center, Vanishing Veins, are always here to help you.
In this blog we will answer the second most frequently asked question.
How soon after my initial consultation will I be able to have my varicose veins treated?
Once your treatment plan has been developed and discussed with you, prior authorization is required.
We will submit all the appropriate documentation on your behalf and obtain the authorization.
However, prior to doing this, we must follow the specific guidelines set forth by your insurance company to document the “medical necessity” of your varicose vein treatment.
Each insurance company has their own medical policies that must be followed.
Our insurance experts know the majority of the policies. If they don’t know your particular policy’s guidelines, our insurance experts will contact the insurance company for you.
In almost all cases, the insurance companies mandate a “trial of conservative management” which must be done prior to even submitting for authorization.
In general the trial of conservative management is 6-12 weeks, again depending on your insurance policy.
During that time you will be advised to wear compression hose, elevate your legs, take Advil or another non-steroidal anti-inflammatory medication, exercise and lose weight if needed.
These measures often improve your symptoms to some degree however it is only a quick fix and not definitive treatment.
We understand that this seems like a waste of time and a run around. However, not going through this trial will essentially guarantee that your treatment will not be authorized.
We will explain all of this to you at your consultation. We can even fit you for compression hose, saving you another step. Your follow up appointment will be made after the time of your “conservative treatment” has passed. After your follow up visit, we will then be able to submit all the necessary documentation to your insurance company.
In general, it takes 4 weeks to get approval for your treatment. We take this into account when scheduling your treatments.
We know how confusing and frustrating this whole process is. At Dr. Greenwald’s vein center, her staff are experienced and truly experts at taking care of you and doing their best to make sure you get the insurance benefits you are paying for.
Next week: What happens if my insurance company denies my claim?
