Insurance Coverage: Where You Fit In
Below you’ll find a comprehensive list of insurance packages that may or may not cover vein sclerotherapy and other services offered at Vein Specialists of Northern California. Read each to find out which procedures you’ll be covered for, and added information about each coverage plan.
Will Your Insurance Plan Cover Vein Removal?
Most insurance companies do not pay for sclerotherapy or any other treatment if it is performed for cosmetic reasons. Some insurance companies do pay benefits if there is pain or discomfort that impedes activity. However, each insurance carrier is different and it is recommended that individuals check with their own insurance carriers to determine if there is coverage. Each patient is given a complete evaluation summary of their proposed plan of treatment at their consultation detailing medically necessary treatment(s) which may be billable to insurance and non-medically necessary treatment(s) which would not be billable to insurance and completely out of pocket.
The following is a list of different types of insurance plans that might help you in determining your benefits:
This kind of health plan is best suited for people who want a lot of options and are willing to pay for it. In other words, it allows you to select any physician or hospital your heart desires. The other good thing about it is that it allows you to self-refer.
- PPO (Preferred Provider Organization
If you use the doctors and hospitals on your list you’ll greatly reduce deductible and co-payment costs and there won’t be as much claims paperwork. However, you may also select your own physician and self-refer (at higher cost). Currently, Dr. Isaacs is a member of Anthem BC, Blue Shield, Cigna, Healthnet, Pacificare and United Healthcare PPO’s. Our office will bill directly for medically necessary and authorized treatments. Patients will be responsible for co-pays and any deductible. Any cosmetic treatment will be the responsibility of the patient.
- EPO (Exclusive Provider Organization)
Similar to a PPO except that the coverage for non-listed physicians and services may be less, and there are more rigorous utilization review requirements.
- HMO (Health Maintenance Organization)
Your selection of doctors and hospitals is strictly limited to those on the HMO list. You also have to choose a primary care physician with whom you have to consult for all referrals regarding specialized care or hospitalization, including a referral for vein treatment. If you receive treatment without authorization from a non-HMO physician you will not be covered. Currently, Dr. Isaacs is not a member of any HMO.
- Point of Service
This is a combination of HMO, PPO and Fee-for-service.
Medicare covers those treatments that are considered medically necessary. Our office will bill directly. Patients are responsible for co-pays and for the full cost of any treatments that are cosmetic. A waiver must be signed by each Medicare patient prior to any cosmetic treatment.
- Medicare HMO
Available to Medicare-eligible individuals, this plan puts you in an HMO (see above) in return for lower rates. The restrictions are the same as in an HMO.
- Medicare Supplement
This policy is added on to Medicare to cover additional costs not included in the standard Medicare policy. Restrictions depend on the plan you choose.