Spider veins, also known as roadmap veins, are very tiny superficial blood vessels that increase in size over time and commonly occur on the legs. Sclerotherapy is considered the gold standard in treating people with spider veins.
Spider veins are always considered cosmetic from an insurance coverage perspective. Women often experience spider veins on the outer portion of the thighs. Spider veins present in lower ankle area are often a sign of varicose veins underneath.
Varicose veins are larger, dilated blood vessels that can be raised above the skin’s surface and have a rope-like appearance. Laser therapy is a highly effective treatment for varicose veins, in which tiny laser fibers are applied to the vein through a needle puncture. Medical varicosities are greater than 3 mm in size and are often times tortuous in appearance. Varicose veins less than 3 mm in diameter are considered to be cosmetic.
A hallmark of a medical varicosities is the reversal of blood flow known as reflux(flow down the leg rather than back to the heart). Reflux is diagnosed by performing a venous ultrasound evaluation.
Medical or Cosmetic?
The patient must be experiencing symptoms relating to the varicose vein in order for it to be considered medical. It is important to note that a leg may appear completely normal yet have severe dysfunction, as the varicose veins may be deep to the skin. In this case symptoms may be restless leg syndrome, aching, swelling, tiredness and fatigue, change of pigment, tenderness etc.. Most insurance companies require that the patient wear graded compression hose for a period of 6 weeks to 3 months and have persistent symptoms even with their use. A preapproval letter is then submitted to the insurance company on behalf of the patient, in order to obtain medical coverage.
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