Does Aetna Insurance Cover Varicose Vein Treatment: Los Angeles
Medical Coverage of Varicose Veins by Aetna PPO Insurance
- Diagnostic testing and varicose vein treatments for medically-necessary venous disease are covered by most health insurance policies, including Aetna. Insurance coverage is based on your policy and health-related preventative and therapeutic benefits. The first step in assessing coverage is to establish medical necessity vs. cosmetic need. Aetna insurance has established criteria for inclusion: The following procedures are considered medically necessary in patients who meet Aetna insurance medical necessity criteria for varicose vein treatment:
- Valvular Reconstruction
- Ambulatory phlebectomy or transilluminated powered phlebectomy
- Endovenous ablation (EVLT or VNUS)
- Surgical ligation (including subfascial endoscopic perforator vein surgery)
Meeting criteria for medical necessity includes documentation of the following on examination and diagnostic studies:
- Incompetence at the saphenofemoral junction or saphenopopliteal junction documented with ultrasound.
- Ultrasoud documented junctional reflux of 500 ms or greater at the SFJ or SPJ
- Vein diameter greater than 4.5 mm below the SFJ or SPJ
- Intractable ulceration secondary to venous stasis
- More than one episode of bleeding and rupture of a vein
- Symptoms despite conservative treatment such as analgesics, medical compression stockings > 3 months
- Pain and swelling in the legs that interfere with daily activity
Aetna recognizes that varicose veins are quite common and that roughly one quarter of swomen and about one sixth of adult men have problems with varicose veins. Although most varicose veins do not require treatment, symptomatic veins may hinder quality of life.
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