by Dr. David Ian Rosen, MD
Vein disease is extremely common: about half the population has some sort of vein issue during the course of their lifetime. About 25 million Americans suffer from vein disease.
The spectrum of vein disease ranges from:
Absolutely nothing visible at the surface but chronic, unrelenting discomfort, heaviness, fatigue, cramps, “restless legs” (especially at night), chronic itchiness and more.
- Spider veins: web-like small red or blue veins at the surface of the skin
- Varicose veins: bulging larger veins at the surface of the skin
- Skin discoloration: red, brown discoloration typically on the lower legs
- Skin thickening/scarring
- Skin ulcers: breakdown at the skin surface leading to chronic open sores
Generally the process starts out as minimally perceptible and worsens, slowly over the course of years. Interestingly, much of the later effects are preventable if dealt with early.
So…why don’t patients choose to deal with this sooner?!
A few key barriers exist that can explain why patients avoid doctors…even nice and capable ones like me! Patients have misconceptions about vein disease diagnosis and treatments. Before learning all the facts, many patients think:
- Assumption: “Treatments are expensive. Insurance/Medicare never cover treatments”.
- Fact: Medicare and most insurance carriers cover the consultation and diagnostic tests relating to vein disease. Depending on the diagnosis, Medicare/Insurance carriers may cover many vein treatments.
- Asumption: “Treatments are very painful and involve invasive things like surgery.”
- Fact: State-of-the-art vein care is both minimally-invasive and maximally-comfortable. Surgery is rarely, if ever, involved. General anesthesia or even sedation is not needed. Procedures may or may not even require local anesthetic, yet still remain comfortable and safe.
- Assumption: “There’s a lot of “down time”. I lead a busy lifestyle and I don’t have time to sit around elevating my legs. I need to work, work out, go out with friends, play with my kids/grandkids…”
- Fact: State-of-the-art vein care for varicose/spider veins requires No Down Time. In fact, it’s safer for you if you keep active. There are few restrictions after procedures are done. Even the most involved procedures are still performed in an office setting. If you are able to do so to begin with, you can drive yourself to your appointments and back to home/work/wherever else you need to get to…without discomfort.
OK…so treatments for superficial vein disease and the resulting effects that can occur over the years is Affordable, Comfortable, Safe and has little, if any, impact on a patient’s lifestyle.
So…When is the best time to start down the road to legs that feel and look better than they have in years? That time is now!
Actually, if Medicare/Insurance carriers are involved, that time is ideally anywhere from 6 weeks to 3 months ago!
Even though many treatments may be covered, obtaining approval for coverage can take a while. Medicare and Insurance carriers have certain requirements that must be met for patients to qualify. As is often the case, rather than merely being a problem located at the skin surface, there must be a demonstrable, diagnosable problem that lies in the superficial veins beneath the skin. This problem is known as Superficial Venous Insufficiency.
Briefly, the superficial veins in the lower extremities are like trees. The “trunks” are known as the saphenous veins. Saphenous veins have valves that ideally channel flow one-way, up and out of your legs and back toward your heart. Valve malfunction leads to wrong-way, downward flow. When this happens, pressure can build up in the “trunk” veins. This pressure, in turn, leads to problems in superficial “branches” that can, over time, become varicose and spider veins.
Aside from finding superficial venous insufficiency, many insurance carriers have size requirements for treating veins of a certain size.
The patients need to be symptomatic: vein issues have had to impact, in some way, on their daily life.
Finally, Medicare and most insurance carriers require patients to have attempted, and failed a trial period of “conservative management” with prescription-grade compression stockings. This trial period can range from 6 weeks to 3 months or longer.
For those patients who only have spider veins and varicose veins that are not related to any underlying superficial venous insufficiency in the saphenous veins, treatments are not likely to be covered…but,then again, there is no barrier for you to get started today!
- “But, Dr Rosen, if my treatments won’t be covered, how can I afford them?”
- I don’t turn anyone away due to financial means. My parents…both Holocaust survivors…came to the U.S. after WWII with little family and nothing but change in their pockets. The world can be harsh enough as it is and I believe that in order to truly fix what’s broken about the planet, we have to approach our interactions with each other with a sense of community spirit: when each of us heals, we all heal in a way. With that in mind, I do my best to make the care I provide comfortable, state-of-the-art but also affordable. If need be, we can set up payment plans. No worries.
So…we’ve learned that, if didn’t already do so weeks to months ago, THE BEST TIME TO GET STARTED ON EVALUATING AND TREATING YOUR VEIN ISSUES IS NOW.
In my practice, everything starts with an Initial Consultation. During your first, 1-hour long visit, I will do a thorough medical history and a focused medical examination. If appropriate, I will recommend a painless, informative Ultrasound study of your lower extremities to search for superficial venous insufficiency as an explanation for your symptoms and superficial signs of vein disease.
Once the consultation is complete, we then have enough information to determine whether, and to what extent, your vein care may be covered by insurance. If it is deemed “coverable”, all of the legwork involved with obtaining the insurance coverage you deserve is handled in my practice by myself and my assistant, Maria Santana.
Nowadays, insurance carriers are willing to cover treatments related to superficial venous insufficiency, namely endovenous ablation techniques, and then the treatment of associated symptomatic surface veins (typically reticular veins, varicose veins). Typically insurance carriers will cover one endovenous procedure per saphenous vein and about 3 sessions per lower extremity of sclerotherapy injections to “clean” up the remaining surface veins. Coverage comes with a few stipulations and some hoops to jump through.
Once patients obtain coverage (praise G-d), the coverage period typically expires after about 6 months to 1 year. No worries…if patients need longer-term treatments it’s usually far easier to get extensions on their treatment period that it is to get the initial coverage.
If patients require more treatments beyond what they were initially approved for, these extra treatments are often covered after submitting the required data to their insurance carrier. Again, it’s typically easier to get additional coverage vs the initial coverage process.
I truly hope that this information has been helpful to you.
To learn more about Rosen Vein Care, visit www.RosenVeinCare.com
To schedule your 1-hour Initial Consultation appointment, call 847-272-8346. We will get you on schedule as soon as possible, typically within a few business days.
I look forward to meeting you and helping your legs to feel and look better than they have in years!
David Ian Rosen,MD
Diplomate, American Board of Venous and Lymphatic Medicine
Founder, Rosen Vein Care