“Medical Necessity Criteria”
Comprehensive Venous Diagnosis and Treatment
Insurers often use “medical necessity criteria” to determine whether they will pay for specific treatments for an individual. These criteria sometimes are reasonable, and other times the criteria are inappropriate medically or are written to avoid paying for medically appropriate care. Unfortunately, some insurers are reluctant to adopt evidence-based medical necessity criteria developed by nationally-prominent experts and expert medical societies.
Many insurance companies require a period of “conservative” treatment for one to three months before they will consider a request for approval to treat varicose vein conditions. This “conservative” care often includes local skin care, periodic elevation of the legs above the level of the heart, moderate exercise, calf muscle pump exercises, avoidance of prolonged sitting or standing when feasible, and routine daily use of medical grade elastic compression stockings or an alternate form of compression. We work to educate you about these requirements and to help you meet your insurer’s requirements.
We are actively involved in efforts to convince insurers to use recommendations and guidelines developed by the major national medical societies which are evidence-based and supported by experts in management of venous diseases.