By Daniel R Gorin, MD, RVT, FACS

Like almost everyone you know, you have one of those new health insurance policies with a huge deductible. The months go by, and by the fall, you find that you have spent well over $1,000 on healthcare, and your deductible is used up for the year. This is the perfect time, you think, to have something done about those uncomfortable varicose veins that have been bothering you for years. Your insurance will cover the treatments, and you won’t have to pay anything out of pocket.

This is a great plan, right?

Over the past few years, there have been significant changes in health insurance, which have affected almost everyone. Most people are now covered by high-deductible plans, and often have to cover several thousand dollars of health care costs before their insurance kicks in. This has had the desired effect of having patients think more carefully about how they spend their healthcare dollars. Many patients, however, are putting off nonemergent medical care until they meet their deductible. This often turns out to be a poor strategy, particularly when it comes to the care of venous disease. More and more, vascular specialists are seeing patients show up in the last few months of the year, hoping to have evaluation and treatment of their venous disease before the end of the year, when their deductible restarts. For a number of reasons, they invariably wind up disappointed, and either delay their care further, or face increased costs to get the care they need.

There are a number of factors in the insurance coverage and care of patients with venous disease that cause particular problems with care that is delayed until an insurance deductible is met.

Almost all healthcare insurance companies require that patients with symptomatic venous disease and varicose veins complete a trial of “conservative treatment” prior to allowing them to have their veins definitively treated. This means a trial with a prescription strength “Class II” compression stocking. Most insurers require a six-week trial, although some require three months or more. This means that patients need to be seen and evaluated, have stockings prescribed, and then they need to be reevaluated after their trial period is done to document that they still have symptomatic venous disease. This is despite that fact that several trials have shown that essentially no patients are cured of their venous disease by using a compression stocking. What has been shown, however, is that patients who notice that wearing a stocking makes their legs feel better almost always improve a great deal once they have their veins treated. The requirement for a trial of compression stockings does significantly delay treatment for most patients, however.

The care of venous disease usually involves a number of steps, and often- takes three to six months to complete.

Patients need an initial evaluation, an ultrasound, and usually a stocking trial and reevaluation before treatment even begins. Treatment commonly involves a number of minor procedures for each leg, spaced at least a couple of weeks apart. It is a rare patient that can simply have an office evaluation, and then one procedure, and be completely treated.

In addition, vascular specialists who treat veins are usually very busy, with packed schedules that are full for weeks or even months. This is particularly true in Massachusetts, where some insurance providers require that a physician who wants to treat venous disease have their vein center formally accredited by the Intersocietal Accreditation Commission (intersocietal.org). Getting formally accredited is fairly time-consuming and expensive, and has decreased the number of physicians in our state who treat varicose veins. You may be able to find a physician who will treat you outside of an accredited vein center, but all of the most experienced and best-trained vein specialists practice in accredited vein centers.

Lastly, because most people now have high-deductible plans, large numbers of patients are waiting until the last few months of the year to see a specialist about their varicose veins. This means that veins specialists’ offices are seeing a huge rush of patients during that time. It winds up being simply impossible to get almost anyone fully treated before they begin a new year on their insurance plan, and start with a new four-figure deductible.

What can you do? If you have significant varicose veins, with tired, itchy, achy legs, ankle swelling, skin changes, or restless legs, get in to see a specialist early. The initial evaluation is not that costly. You can be evaluated, complete your stocking trial and ultrasound evaluation, and know exactly what will be needed to treat your venous disease. That will give you plenty of time to plan the best time for you to be treated.

Daniel R Gorin, MD, RVT, FACS, is a physician with Southeastern Vein Specialists. He can be reached at (508) 775-1984 or southeasternveinspecialists.com.