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What are varicose veins?

Venous disease can cause dilated, or enlarged, varicose veins that look like blue or purple twisted ropes and bulge on the surface of the skin. Varicose veins are equal to or greater than three millimeters in diameter and can be associated with serious chronic venous disease.

What are the signs and symptoms of venous disease?

Venous disease may result in a variety of signs and symptoms including skin irritation (itching or burning), leg swelling, pain and aching, fatigue, heavy or restless legs, and leg cramps. Signs may or may not include abnormal-looking veins, such as varicose veins that bulge on the surface of the skin, loss of hair on the lower legs and ankles, discoloration of the skin, redness, or irritation in the ankle and lower leg. The most severe sign of chronic vein disease is an open sore in the ankle or lower leg area.

My doctor said varicose veins are just a cosmetic problem, is that true?

Varicose veins are NOT just a cosmetic problem, they are definitely a medical problem. Tiny spider veins are typically a cosmetic problem. Although some patients with varicose veins may not experience or complain of pain, many may experience other symptoms that they may associate with “just getting older”….tired, heavy, achy legs. Patients with venous disease need to understand that it is a progressive and chronic problem. They may eventually develop complications which may include tired, heavy legs; swelling of the ankles; infection (cellulitis); clotting (thrombophlebitis); skin changes (stasis dermatitis)and itching; venous stasis ulcerations or poorly-healing wounds. Early detection and treatment may prevent many of these complications.

I had a vein stripping in my leg years ago and now my symptoms are back. What do I do now?

In the past, vein stripping of the saphenous vein was a common procedure for treating varicose veins. It is typical to see varicose veins return after the procedure. An ultrasound examination can show exactly what has been done in the past and can determine which veins are now causing problems. Based on the ultrasound results, Dr. Coates can offer treatment options that best suit your situation.

Don’t I need all of my veins to get blood from my legs back to my heart?

The veins we treat are not providing effective return of blood to the heart. You have many veins in your legs that will function appropriately almost instantly after the diseased veins are closed. Treating the diseased veins and redirecting the blood flow actually improves venous blood flow back to the heart.

What if I need my leg veins for a heart bypass surgery or leg artery bypass surgery?

The veins we treat are diseased, have failed, are too big for use, and would not function properly for use as a bypass graft on the heart or in the legs.

How long after the procedures do I need to wear compression stockings?

Compression stockings should be worn continuously for the first 48 hours after a radiofrequency ablation procedure and then during the day for the next two weeks.

Do I need to stop my blood thinners or other medications before the procedure?

No. Some patients may have a little more bruising afterward if they are on Aspirin, Plavix, Coumadin, Xarelto or Eliquis. However, many patients on these medicines do not have more bruising. Any other medications can usually be continued.

How long does the radiofrequency ablation procedure take?

Radiofrequency ablation takes about 30-45 minutes to perform. If microphlebectomies are also performed that day, it may add another 30-45 minutes. Including pre-treatment and post-treatment preparations, patients can expect to spend approximately two hours at our facility.

What is the recovery time?

Recovery time depends on the procedure and the patient. However, the procedures performed are all minimally invasive, and patients are able to walk in and walk out. Most patients can return to work or normal activities the very next day.

What do I need to remember the day of my procedure?

On the day of your procedure you will want to dress comfortably, take your normal prescribed and over-the-counter medications, and eat as you normally would. However, do not drink a lot of water, soft drinks, tea or coffee as you will be lying down and not able to get up during the procedure! Remember to bring your prescription stockings to the office; we will apply these after the procedure. Also, you may need to arrange for someone to drive you home.

How often will I need to follow-up with the doctor?

Depending on the severity of the vein disease, the follow up recommendations are highly individualized. Since venous problems are chronic and progressive, and early detection and treatment reduces long term problems periodic follow up is important. Most vein patients should be reevaluated at least annually.

Will my insurance pay for treatment of varicose veins?

First, Dr. Coates and Andi have worked with all of the major insurance carriers over the last dozen years and are very familiar with the “ins and outs” of dealing with insurance companies! Reimbursement depends on your particular insurance company, as well as, the terms of your individual policy. Each policy is different and the philosophy of each insurance company is also different. We will work with you to understand how your particular plan will “cover” or “pay for” the treatment of your varicose veins. Just like any other medical problem you may see a doctor for--you are responsible for any co-pays, deductible and co-insurances that are part of your insurance plan. Those copays, co-insurance/deductible amounts are due on the day you see the doctor. Varicose veins, tired heavy achy legs, restless legs, ulcers and bleeding from a vein are all good reasons to see a doctor. Medical insurance will cover the cost of the initial visit and diagnostic ultrasound (subject to copays/coinsurance, etc). Secondly, Coates Vein Clinic is in network with most insurance plans (BCBS, Aetna, Cigna, UnitedHealthcare, Humana, Tricare/Veterans, and Medicare). Being in network is important to the patient because it means our clinic has agreements with various insurers. This means most insurance plans covers most of the cost of treatment other than deductible and co-payments a patient may have. What are some of the In’s and Out’s of working with the insurance companies?

• Establish Medical Necessity
• Compliance with Conservative Therapy
• Obtaining Prior Authorization for a Treatment or Predetermination of Medical Necessity

What does “medical necessity” mean?

Most insurance require documentation of "medical necessity". This is a way to differentiate between a cosmetic treatment and a treatment that is medically necessary for the patient. Generally patients who have symptomatic varicose veins (those that cause symptoms: such as leg pain, complaints of achiness, heaviness, cramping or swelling) and are inadequately relieved with conservative therapy, will qualify for insurance coverage of treatment.

At the time of your initial visit, Dr. Coates will evaluate your vein problems. Based on your history, and presenting symptoms, he will perform a diagnostic ultrasound if he deems it to be medically necessary to do so. It is with the ultrasound that he is able to see the venous anatomy in your legs and where there may be problems. It is based on the results of the ultrasound that he will be able to discuss with you the treatment options. Insurance companies want to cover treatment for or pay for only medically necessary problems. They have “medical policies” that detail specific criteria for what is considered medically necessary treatment. A patient must meet these specific criteria in order for the insurer to consider the problem to be medically necessary and therefore eligible for their “covering” or providing benefits for the problem. While it may be confusing, the good news is that Coates Vein Clinic, pllc has been working with insurance companies for over a dozen years getting our patients cared for.

What does "conservative therapy" mean?

Insurance companies may require a "trial of conservative therapy" for 1-6 months prior to approving treatment. Usually conservative therapy means participating in regular exercise, elevation of the legs, weight loss attempts, and wearing medical grade compression stockings for 1-6 months. While there is no evidenced based medicine to support this, insurance companies have this requirement, and your compliance is compulsory.

How does one obtain prior approval or get predetermination of medical necessity from the insurance company?

Generally, if the ultrasound of your veins is abnormal, and you are having a medical problem(s) or symptoms (tired, achy, heavy, pain, swelling, skin changes, leg ulcers, etc.,) and the symptoms are unrelieved by a trial of conservative therapy, this will meet the criteria for medical necessity and most insurance companies will eventually approve the recommended treatments. All that is required is to submit to the insurer the required documentation and wait for their response. It may take up to 30- 45 days to get a letter of prior authorization or predetermination of medical necessity. Often we will schedule your procedure/s presuming the insurer will authorize treatment. Generally, if Dr. Coates thinks your treatment is medically necessary so will your insurer. He is familiar with the medical policies and will only recommend treatment that you truly need. Medicare does not require prior authorization for the treatment of varicose veins. It requires the treatment be medically necessary of course, but there is no additional paperwork that is required prior to getting the care you need.

Will Insurance cover “cosmetic treatments”?

We are not aware of any insurance company that will pay for cosmetic treatments. Although spider veins may be uncomfortable or painful, their treatment will not qualify for insurance coverage.

What if I need to contact the doctor after hours or on the weekend?

After hours, on holidays, and during the weekend, the office number will be answered by Dr. Coates. We encourage our patients not to hesitate to call with any questions or concerns.