Most carriers (including Medicare) provide coverage for the VenaCure EVLT® procedure. In the event that your carrier does not cover the procedure, you may find it helpful to contact your carrier’s customer service representative. S/he may be able to answer this question for you. If a written request is needed, AngioDynamics (parent company of VenaCure EVLT products) will provide an introductory letter for this purpose. One of our goals at AngioDynamics is to assist patients in obtaining coverage for the VenaCure EVLT procedure for resolution of venous reflux disease. Coverage for the VenaCure EVLT procedure is subject to the terms of your coverage policy. Co-payments and deductibles may be applied.
You should begin by reviewing the ‘explanation of benefits’ (EOB) for a reason for the denial. If the EOB does not explain the reason for denial, you should contact the claims department and request an explanation. All insurance carriers and payers have an appeals process. Inquire into the process for appeal, including where and to whom the appeal should be sent.
Most carriers require a period (3-6 months) of conservative therapy (compression, elevation of legs, possibly weight loss) before providing coverage for the VenaCure EVLT procedure.
No. Carriers will cover the VenaCure EVLT procedure only when medically necessary. Patients must demonstrate symptomatic venous reflux disease. That is:
1. Pain, swelling, leg cramps, ulcers, bleeding from varicosities
2. Presence of reflux on ultrasound scan
Varicose veins are permanently enlarged veins located beneath the skin that have dilated and become tortuous in response to abnormally high venous pressures seen in venous insufficiency. They are typically blue or purple, measure 3-8 mm in diameter, and have a twisted, ropy appearance. They affect an estimated 10% to 60% of the adult population. Varicose veins are not really the problem in themselves, but more a symptom of the underlying venous insufficiency.
To think of varicose veins as the main problem when you have them is sort of like thinking that the problem with getting the measles is only the spots. The spots are an indication that there is an underlying viral infection. If you want to cure the spots, you have to treat the virus. Treating the spots alone is pointless.
The biggest contributing factor in the development of varicose veins is heredity or family history. The risk of developing varicose veins is >90% when both parents have varicose veins, 25% for males and 62% for females if one parent is affected, and 20% when neither parent is affected. Other risk factors include prolonged standing or sitting, pregnancy, hormonal influences, and local trauma. The incidence increases with age.
Varicose veins are irreversibly damaged and are not assisting in blood circulation (in fact they actually impair blood return to the heart). The body will not miss them when they are removed, and they are not suitable for use during heart bypass procedures.
Venous insufficiency is usually an “insidiously progressive condition”. This means that they are a little worse this year than they were last year, and will be a little worse next year than they are now. In five or ten years, they will be a much larger problem. Because untreated venous insufficiency tends to progress over time, the appearance continues to deteriorate. You can expect worsening symptoms including leg tiredness, heaviness, aching, throbbing, tingling, burning, itching, numbness, swelling, restless legs syndrome, etc. More serious complications such as dermatitis, phlebitis, blood clots, hemorrhage, and non-healing venous leg ulcers can occur if symptomatic veins are left untreated too long.
The good news is that varicose veins are generally not a life-threatening or limb-threatening condition. The bad news is that their symptoms will tend to bother you more and more on a daily basis (leg tiredness, heaviness, aching, throbbing, tingling, burning, itching, numbness, swelling, restless legs syndrome, etc.) Whether you should have your veins treated depends upon several things including how severe your venous disease is, how quickly it is progressing, what sorts of other health conditions you have, etc. This decision is best made during consultation, as all the variables can be evaluated and discussed.
Effectively treated varicose veins do not come back. The predisposition to form varicose veins cannot be cured, however. Over time, patients may develop new varicose veins in the same or in other areas. Because we treat the “source” of these veins the progression is greatly slowed. New veins that form tend to be less severe and are more easily dealt with. Usually a “touch-up” treatment to remove new veins will be needed periodically.
When venous insufficiency or varicose veins are left untreated, the high venous pressures cause progressive edema and inflammation in the legs and ankles. This inflammation eventually results in a condition called lipodermatosclerosis, or fibrosis in the skin and subcutaneous tissues. If the veins are still not treated, the skin actually breaks down, forming an open sore or ulcer. Venous ulcers are dreadfully painful and can be open for years at a time. They are difficult or impossible to heal using conventional measures. They usually occur in the ankle or lower leg and can range from dime-size to completely encircling the leg. Venous ulcers affect 4% of people over the age of 65. It is impossible to predict which patients will develop ulcers or how long it will take for them to heal.
Pregnancy does not cause varicose veins in the legs, but each pregnancy makes existing vein problems a great deal worse. If pregnancy did cause leg varicose veins they would be much more common in women than in men. Extensive population studies (including the Edinburgh Vein Study published in 1999) have proven this is not the case.
Elevated hormonal levels, expanding circulating blood volume, and the enlarged uterus all combine to exacerbate any existing venous insufficiency – the underlying cause of varicose veins. This severe venous hypertension creates a state in which new veins are recruited and existing varicose veins become larger and more symptomatic.
The leg pain and edema from these engorged veins tend to make pregnancy terribly uncomfortable. If the source of the venous insufficiency and existing varicose veins are eliminated before the first or any subsequent pregnancy, less damage will have been done to previously normal veins and to surrounding tissues. Treatment of mild disease is more straightforward, leading to shorter operative cases and quicker recovery.
If you are currently pregnant or trying to become pregnant, operative treatment cannot be performed. Wearing compression stockings and elevating your legs are your only options. We therefore recommend varicose veins be treated before becoming pregnant.