PLEASE CONTACT OUR OFFICE IF YOUR INSURER IS NOT LISTED;
AS CARRIERS ARE ADDED MANY TIMES PER YEAR
Aetna (National Policy)
|BlueCross BlueShield TX
BlueCross BlueShield UT (Regence)
Cigna Health Care
Empire Medical Services NY, NJ
Federated Mutual Insurance Company (Encompass Hth Mgt Systems)
HealthLink MO, IL, KY, WV, AR, Iowa, IN)
Humana (National Recommendation)
Medicare AL (Calhaba)
Medicare AZ, CO, HA, IO, ND, SD, OR,WA,WY,NV,AK (Noridian)
Medicare FL (Firstcoast)
Medicare GA (Cabaha)
Medicare Idaho (Cigna Part B)
Medicare IL, WI, MI, MN (WPS)
EVLA [Endovenous Laser Therapy] Insurance Coverage FAQ
Most carriers (including Medicare) provide coverage for EVLA. We have included a list of payors who have a written coverage policy for EVLA. In the event that your carrier is not on this list, you may find it helpful to contact your carrier’s customer service representative. S/he may be able to answer this question for you. Coverage for EVLA is subject to the terms of your coverage policy. Co-payments and deductibles may be applied.
Q: Will insurance cover EVLA for everyone?
A: No. Carriers will cover EVLA only when medically necessary. Patients must demonstrate symptomatic venous reflux disease. That is:
1. Pain, swelling, leg cramps, ulcers, bleeding from varicosities
2. Presence of venous reflux on ultrasound scan
Q: If I have symptoms of venous reflux disease, are there any other criteria that must be satisfied before I can get coverage?
A: In addtion to medical need, some carriers require a period (3- 6 months) of conservative therapy (compression stockings, elevation of legs, possibly weight loss) before providing coverage for EVLA
Q: What should I do if the claim is denied?
A: You should begin by reviewing the ‘explanation of benefits’ (EOB) for a reason for the denial. If the EOB does not explain the reason for denial, you should contact the claims department and request an explanation. All insurance carriers and payers have an appeals process. Inquire into the process for appeal, including where and to whom the appeal should be sent. If further assistance is needed, you may contact us for assistance.
Call 423-648-4012 to request a FREE vein screening!