Vein Treatment Insurance FAQs

 

Will my insurance cover varicose vein treatment?

Medicare and all commercial insurance companies cover the diagnosis and evaluation of varicose veins and venous insufficiency. Treatment coverage by Medicare and commercial insurance depends on an in office evaluation by our vein care specialist and what is seen on an ultrasound exam of your legs. Treatment is covered depending on the severity of your vein disease. Some commercial insurance policies specifically exclude varicose vein treatment. Medicare and most insurance companies may first require you to try conservative treatments including the use of compression hose prior to approving laser ablation treatment and other minimally-invasive procedures.

Will my insurance cover a spider vein treatment?

Spider vein treatments are considered cosmetic by Medicare and all commercial insurance companies not covered by insurance.

How much will I need to pay up front for the procedures?

Patients are normally required to pay specialist co-pays associated with their insurance prior to treatment. This depends on the policy. The procedures may apply to your deductible. If you have met your deductible, a co-insurance may apply. We suggest you familiarize yourself with your plan. At Vein911, we will try our best to get the most accurate estimate for your expenses for treatment.

What will be my total out-of-pocket cost for treatment?

Your out of pocket expenses means how much you will have to pay for the treatment in addition to your insurance. The amount of out of pocket charges will depend on your insurance plan, deductible, co-insurance, and/or co-pays. Contact our Patient Relations Specialists for assistance in gaining an understanding of what your plan will provide and your out-of-pocket expenses could be.

If my insurance doesn’t cover this procedure, are there other options?

Yes. Vein911 offers many discount and payment programs for individuals who do not have or do not wish to use their insurance.

Who determines which veins are covered by insurance?

After your initial assessment and ultrasound, Vein911 sends the results and a doctor’s recommended treatment plan to your insurance company. The insurance company will review the plan and determine what treatment options will be covered.

What Is coinsurance?

Co-insurance is a portion of payment made by you. Co-insurance usually kicks in after you have met my deductible. Depending on your plan, your insurance will cover a percentage of your treatment and you will be responsible for the remaining balance. Some co-insurances can be as low as 5%, some can be as high as 50%. Not all plans have a co-insurance.

What a copayment?

A copayment is a fixed amount that is established by your insurance plan that you pay direct to the provider for services. Your co-pay can differ depending on if you are seeing a specialist or a primary care physician. For the most part, co-pays only apply to office visits.

What is coordination of benefits (COB)?

Coordination of benefits is an agreement between your insurers to determine which insurer will have primary responsibility for payment.

What is explanation of benefits (EOB) or Explanation of Payment (EOP)?

An explanation of benefits is a document that is provided to an insured person that notes how a claim was paid or why it wasn’t covered. This document is provided by the insurance.

What is a CPT Code?

CPT stands for Current Procedural Terminology. It is a five-digit code that the medical industry uses for billing purposes. Each time you meet with your doctor or have a procedure performed, the CPT code is sent to your insurance. This makes billing more effective instead of having to write out the name of the entire procedure.

What is a deductible?

A deductible is the portion of your health care expenses that you must pay before your insurance applies.

What is an allowable?

An allowable is the dollar amount that is considered payment-in-full by an insurance company. An Allowable Charge is typically a discounted rate from the providers retail pricing or actual charges. If you have not met your deductible, you will pay the allowable amount of the procedure. For example: Dr. Andrews charges $20 for a procedure. Dr. Andrews decides to sign a contract with Healthy Insurance. Dr. Andrews and Healthy Insurance agree that for that same $20 procedure, Healthy Insurance will pay Dr. Andrews $15. Ms. Doe has Healthy Insurance and has a $30 deductible. Dr. Andrews will perform the procedure on her. Because Ms. Doe has not met her deductible, she will pay the $15 allowable that her insurance would pay if she had met her deductible.

What is the difference between in-network and out-of-network?

Insurance networks will contract directly with doctors to provide services for their insured patients. If the doctor participates in the insurance network, they are considered to be in-network. If the doctor doesn’t have a contract with the insurance provider, they are considered to be out-of-network.

Can I get an estimate for the cost of my treatment?

Yes. Contact Vein911 today to schedule an initial assessment. Our providers will review your case and our Patient Relations Specialist can work with your insurance to establish an estimate of cost. It is important for you to obtain this information directly from your insurance company because payment amount is determined by your insurance company.

Are there other payment options if I don’t have insurance?

Yes. Vein911 offers many discount and payment programs for individuals who do not have or do not wish to use their insurance.

What forms of payment do you accept?

Vein911 accepts cash, debit cards, wire transfer, Visa, MasterCard, American Express, CareCredit, and personal checks.

Do I need a referral from my primary physician to receive treatment?

In most cases you will not need a referral. Some HMO policies require a referral from your primary care doctor to see a specialist.
Contact one of our Patient Relations Specialists to review your specific insurance or schedule a complimentary initial assessment to discuss your situation.

Does insurance consider vein treatment to be “cosmetic?”

Every case is unique. We start every patient encounter with a diagnostic ultrasound that is normally included within most major insurance plans. If we find that you have vein disease during the ultrasound, insurance will most often authorize treatment. If we are only treating spider veins than it will most likely be categorized as cosmetic and not covered under insurance.

Do I need prior-authorization from my insurance company for my treatment?

Some insurance companies do require that you obtain their approval before receiving treatment. The initial visit and corresponding diagnostic visits are traditionally included within most insurance plans. After your initial visit, our Patient Relations Specialists will work with you to ensure we obtain the proper authorizations prior to treatment.

How long does it take for insurance to authorize treatment?

After your initial assessment and ultrasound Vein911 sends the results and a doctor’s recommended treatment plan to your insurance company. The insurance company can take up to 3 weeks to respond to the pre-authorization submission. The team at Vein911 handles this process and works with you to schedule treatment after we have received authorization.

I have not met my deductible for the year. What are my options?

Although Vein911 cannot assist with your deductibles, we do work with our patients to make treatment affordable. Contact us to discuss how we create a payment plan for treatment that will fit within your budget.

I understand I need an ultrasound to determine if the procedure is medically necessary. Is that appointment covered by insurance?

An ultrasound Is considered to be a diagnostic test and in most cases, it is covered by insurance.
Keep in mind that the ultrasound may apply towards your deductible, depending on your policy.

Does Vein911 accept Medicaid?

No, Vein911 does not accept Medicaid.

Does Vein911 accept Medicare?

Yes, Vein911 accepts Medicare.

Do you take my insurance?

Vein911 accepts most insurance plans, including Medicare. Contact our patient Relations specialists to discuss your specific insurance plan.

Can I use my HSA funds to cover my portion of the treatment?

The IRS guidelines for medical reimbursement indicate that if the procedure is only cosmetic and does not meaningfully treat illness or disease, it is not reimbursable. In many cases the treatment of varicose veins will be categorized as treatment of disease. Contact Vein911 today to schedule an initial visit to have one of our doctors review your specific situation.

Can you bill my insurance first and then bill me for my portion of the treatment?

Vein911 currently accepts most insurance carriers. All copays and coinsurance will be collected prior to treatment. Other insurable amounts will be filed on your behalf as a courtesy. Once your insurance carrier has processed your claim, we will send you an invoice for amounts remaining to be paid and/or we will refund you for any extra amounts collected at the time of service.

Does my insurance require a compression hose trial?

Insurance companies offer many different plans and each have their own requirements. At Vein911 we staff Patient Relations Specialists that have specific and timely knowledge on plan requirements. Contact us today to find out about your plan.

Tampa
2815 West Virginia Avenue, Suite A
Tampa, FL 33607

855-396-9911
Vein911, Physicians & Surgeons  Vascular, Tampa, FL