Insurance Coverage for Vein Ulcer Treatment

Vein ulcers are a serious complication of venous insufficiency. These open sores typically develop around the ankle and can be very difficult to treat completely. Although treatments are available for both the ulcer and the underlying condition that led to the sore, some patients are hesitant to seek medical help due to the cost of treatment. Fortunately, insurance coverage is often available to help cover the costs of vein ulcer care.

Factors Affecting Insurance Coverage

Insurance companies typically break vein treatments down into two categories; cosmetic treatments and those that are medically necessary. Cosmetic treatments are not usually covered, while medically necessary treatments typically receive at least some insurance coverage. To be considered medically necessary, treatment usually needs to involve one or more of the following:

  • Significant disruption to the patient’s usual lifestyle
  • Pain or discomfort as a result of the condition
  • Size of varicose veins (larger veins are usually considered more serious and in need of medical treatment)
  • Presence of other symptoms, including skin discoloration, swelling or ulceration
  • Conservative treatment (such as compression stockings) hasn’t been effective

The first step in determining whether treatment is medically necessary is an initial consultation with a vein specialist. After the patient’s condition is diagnosed, results will be sent to the insurance company for evaluation. This process could take a number of weeks to complete.

In some cases, insurance companies may want conservative treatment methods tried before moving to more invasive procedures. However, when a vein ulcer is present, this is rarely required. Treatment for a vein ulcer usually begins with treatment of the actual sore, which is often covered automatically by insurance carriers.

Treatment Options

At Advanced Varicose Vein Treatments of Manhattan, Dr. Ronald Lev offers two options in treating vein ulcers:

Apligraf – application of a tissue-engineered product that protects the wound to allow for healing and stimulates the body’s own healing processes

Oasis – an extracellular matrix applied to the wound to protect the wound from infection as it stimulates wound healing

Both of these treatment options may be covered by insurance, depending on the patient’s specific policy. We accept most major insurance carriers and will help patients work with the company to determine the amount of coverage prior to the procedure. 

After the vein ulcer is treated, further procedures may be recommended to prevent future ulcerations from occurring. These procedures may or may not be covered by insurance, depending on whether the carrier deems additional treatment medically necessary. To learn more about vein treatments and potential coverage options, contact our staff at Advanced Varicose Vein Treatments of Manhattan at 212-204-6501.

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