RESUMO
GOALS/PURPOSE: Severe cases of varicose veins can cause psychological distress as well as physical symptoms including skin discoloration, wounds and burning sensations. One intervention, endovenous laser/radiofrequency ablation, is variably covered by insurance. Insurance coverage for this procedure was assessed for all indications of endovenous laser/radiofrequency ablation as medically necessity criteria. METHODS: A cross-sectional analysis was conducted of 57 insurance policies for endovenous laser/radiofrequency ablation. The insurance companies were selected based on the greatest state enrollment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were then extracted from the publicly available policies. RESULTS: Fifty-seven (57) insurance policies were assessed, with 36 (63.2%) of these policies providing coverage for endovenous radiofrequency or laser ablation. Six indications existed for coverage, with the most common indication being the demonstration of valvular reflux (n=29, 80.6%). Of the 29 companies that indicated coverage for valvular reflux, 19 (52.8%) specifically required saphenous reflux. Significantly more companies required saphenous reflux vs other specified types of valvular reflux (52.8% vs 8.3%, p<0.001 for saphenous vs junctional reflux and 52.8% vs 16.7%, p <0.003 for saphenous vs nonspecific). Prior to proceeding with endovenous laser or radiofrequency ablation, up to 33% of insurance companies required a trial of conservative management as medically necessary. CONCLUSION: There is a great discrepancy in insurance policy criteria for coverage of endovenous laser/radiofrequency ablation for the treatment of varicose veins, particularly regarding the requirements for valvular reflux and a trial of conservative therapy.
