HMO & PPO - Both HMOs and PPOs have two categories under which treatments may fall:
- Cosmetic Procedures
- Medically Necessary Procedures
Surgical procedures that are for symptomatic vein problems are likely to be covered as a “medically necessary procedure.” Superficial asymptomatic vein treatments will fall under the category of “cosmetic procedures.”
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 4mm 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.
Metro East Cosmetic Surgery will offer you a variety of payment methods. Please ask your vein specialist about payment options during your consultation. For further insurance information contact your insurance provider for coverage options.
Typical Patient / Insurance Responsibilities:
• Hair removal – patient responsibility
• Liposculpture – patient responsibility
• Isolaz™ Acne/Facial – patient responsibility
• Cosmetic spider veins – patient responsibility
• Symptomatic varicose veins – accept all insurances
• Removal of unwanted skin lesions – accept all insurances
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Please contact us for more details.
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