When you have vein disease, it can be hard to know where to turn. If you’re looking for information about insurance coverage for vein removal, this blog will help. The first step is talking with your doctor about the treatment options that are available for you. Your doctor may recommend a few different treatments, including minimally invasive procedures like sclerotherapy or endovenous ablation (EVAR), which use radiofrequency energy to treat varicose veins and spider veins.
But what if your insurance doesn’t cover these treatments? Or what if they do but only partially cover them? It’s important to understand how your insurance works so that you can get the best care possible while keeping costs down.
Read on to learn more ABOUT Is Vein Removal Covered By Insurance, Varicose Vein Removal Cost Ontario and OHIP Coverage List
Is Vein Removal Covered By Insurance
Besides finding a reputable physician to provide treatment, the expense of having venous disease treated is one of the most important factors that patients consider when making the decision to come in for an evaluation. The cost of vein treatment usually depends on several factors, such as what symptoms you are having, what type of treatments you may need, and whether they are considered “medically necessary” by your insurance company.
Venous insufficiency can cause your legs and feet to swell, feel painful, heavy or tired, and can even contribute to cramps and restless legs. It may also cause unsightly ropey varicose veins or discolored spider veins. It’s likely that if you are suffering from any of these symptoms, you are hoping for easy and cost-effective relief; however, it is important to know that insurance companies often make a distinction between treatments that are deemed “medically necessary” and those that aren’t, which can affect insurance coverage. To better understand how insurance companies view treatment, we must answer the question, “What is Vein Disease?
The main responsibility of veins is to return blood from the rest of the body back to the heart. However, there are several challenges these veins face, the most impactful of which is gravity. The blood in your legs has to fight against gravity as it makes its way to the heart. Your calf muscles act as pumps to push the blood upwards in veins, sending it back to the heart. To help with this, veins have one-way valves that when working properly prevent blood from falling backwards, keeping it flowing towards the heart.
Certain risk factors, such as occupations that require long periods of standing or sitting, obesity, pregnancy, or genetic predisposition, can cause the valves in your veins to weaken. In these situations, the blood that should be headed towards the heart begins to flow backwards and can pool in the legs. In turn, the veins become enlarged and lead to the painful condition that many patients know all too well.
What does “Medically Necessary” Mean?
Most insurance companies have certain criteria to distinguish between medical versus cosmetic treatment of veins. They look at the patient’s symptoms, the physician’s exam, and if any underlying venous disease is detected on a venous ultrasound. All of these factors are evaluated when determining if treatment will be considered medically necessary. Most insurance companies also require patients to try conservative measures before approving any procedures. These typically include wearing compression socks, elevating your legs, and taking over the counter medication for pain relief.
Treatment Options
The only way to accurately diagnose your venous disease and to decide whether any procedures are likely to be covered by insurance is to have a complete ultrasound assessment with a registered vascular technologist (RVT). Fortunately, the initial visit is usually covered by most insurance companies.
Contact Heart and Vascular Care today to schedule your consultation. Once our award-winning physicians assess your individual treatment needs, we can further discuss procedure options and insurance coverage.
Varicose Vein Removal Cost Ontario
I was trying on a bridesmaid dress for a friend’s wedding when I noticed it: the blue-green, raised vein on my right calf. I felt self-conscious and annoyed that I was having to deal with varicose veins when I wasn’t yet 30, especially heading into summer with its leg-baring shorts and swimsuits. But the truth is, it wasn’t the first time I’d thought something was wrong with my legs. I’d been experiencing heaviness and itchiness that had been getting worse for about six months, along with general discomfort and pressure on my ankles and calves. Vein issues run in my family. I probably should have reached out to a professional earlier, but that visible blue-green twist was what made me realize I couldn’t ignore the symptoms any longer.
Varicose veins are caused by venous insufficiency or chronic venous disease, which is much more common than you’d think, even among those my age. “About 70 per cent of Canadian women have a symptom associated with chronic venous disease,” says Dr. Beverly Chan of Oakville Vascular. Indications that you have the condition range from the painful symptoms I experienced to the formation of spider veins to full-on varicose veins. Worse news: There’s not a whole lot you can do to prevent it. “Genetics are the single most important factor in developing varicose veins,” says Dr. Alexander Matz, founder of Canada Vein Clinics. “If you have one parent with varicose veins, your chance of getting them goes to 50 per cent. If both of your parents have them, your chances jump to over 90 per cent.”
Even though varicose veins are an indication of valve dysfunction, it’s a common belief that they’re simply a cosmetic concern or a normal sign of aging. In my own life, it was vanity that finally made me seek out a specialist, despite experiencing discomfort for some time. “When we treat veins, we get rid of them, so many people believe that they are being treated cosmetically,” says Chan. “But so many people come back afterwards and note that the heaviness has gone away, the aching and itchiness are gone — there are so many symptoms that people don’t realize actually have to do with their veins.”
Often, that’s because we get used to a new normal as the condition gets worse and worse, since venous insufficiency is a chronic issue and a progressive disease. “Many people learn how to live with it, and some can tolerate quite a bit of pain and discomfort,” says Matz. “If you have varicose veins and you don’t treat them or take care of them, they’re going to get worse.”
So, what is actually happening in your legs to cause problems? When everything is working properly, your veins move blood back to your heart and lungs. When blood reaches your legs and ankles, it needs to fight gravity to make it back to the heart, which is why veins have valves in them that block the blood from moving backwards and causing venous reflux. Chronic venous disease stops valves from working properly, which allows blood to move in the wrong direction and pool in the legs. The veins become stretched, weakened and even leaky, which leads to spider veins, swelling, discoloration, varicose veins and in extreme cases, leg ulcers — not to mention that pain I described before. According to Matz, recent studies have also shown a connection between venous insufficiency and deep vein thrombosis, which can cause blood clots and pulmonary embolism.
Treating venous insufficiency often comes down to an in-office procedure. The number-one way to treat varicose veins is with endovenous ablation, which involves closing the problematic vein so that blood bypasses it. A small incision is made in your leg, a catheter is inserted into the vein and then through either thermal (radiofrequency or laser) or nonthermal (medical grade glue) ablation the vein is sealed from the inside out. There is also a surgical option called vein stripping in which the vein is removed entirely, but it requires general anesthetic and downtime and has a higher rate of vein regrowth than endovenous ablation, so it’s now used much less frequently.
About six months before my 30th birthday, I opted for thermal ablation to treat my venous insufficiency. The procedure was quick and relatively painless, though I did feel some discomfort before the numbing cream kicked in. I was out of there in a couple hours, and I was able to walk out of the clinic and take a cab home. I was sore and achy for a while, and the inside of my right leg sported some seriously impressive bruising. I also had to wear compression stockings for several weeks afterwards and avoid any weight-bearing exercises, although walking frequently was highly recommended to help with healing.
Complete recovery takes time, but a few months out from the procedure I noticed that my varicose vein had shrunk considerably and was no longer raised. Even better, the pain that had characterized my existence for almost two years was gone. It’s shocking to me that I lived with it for so long when there was a relatively easy fix, not knowing that it isn’t normal and that it can lead to much worse symptoms. “I find that for patients, [treating veins] improves their quality of life quite significantly,” says Chan. I have to say I agree.
The main thing that held me back from treatment was the cost. In Ontario, endovenous ablation is not covered by OHIP, and it’s not cheap. Prices can start at $2,500 per leg — I spent about $3,500 to treat one vein in one leg. If you have private insurance, you may have partial coverage, but it’s a prohibitively expensive procedure for many and most people have to pay for it out of pocket, which is hard to understand given the complications that can arise from forgoing treatment. The good news is it’s a very effective procedure. The chance of the vein reopening is extremely slim, and if you treat it early enough, you can almost completely undo the damage.
I certainly didn’t expect to be treating varicose veins on the shy side of 30, but I know it’s important that I take this condition seriously — and not just because I now feel confident wearing denim cut-offs and short skirts instead of covering up with longer hemlines. More important than my summer wardrobe is the fact that I can move through my day lighter on my feet (literally), no longer feeling heavy, sore and swollen. I almost forget what it was like to live any other way.
Five ways to manage venous insufficiency
Wear compression stockings
“Compression stockings are the number-one preventative measure,” says Matz. Whether you have venous insufficiency or not, it’s a good idea to wear them when you’re going to be sedentary for a long time (think long road or plane trips or days at your desk).
Drink plenty of water
“Staying well hydrated is important,” says Chan, explaining that dehydration can cause blood to become sticky, and sticky blood is more likely to form clots.
Exercise regularly
Walking and working out can reduce the amount of blood pooling in your veins by pumping blood back up to the heart and aiding in circulation. “Moving as much as you can is a preventative measure,” says Matz.
Try a supplement
“There’s a newer supplement in Canada for veins called Venixxa,” says Chan. “It’s a micronized purified flavonoid fraction from immature oranges that takes away symptoms and helps reduce swelling from chronic venous disease.”
Elevate your legs
Propping up your legs when you’re watching television or working may give you some relief from symptoms, since elevating your legs above your heart helps with blood flow.
OHIP Coverage List
As of January 1, 2018, Ontario residents 24 years of age or younger are covered for eligible prescription drugs that are listed with the Ontario Drug Benefit (ODB) or the Exceptional Access Drugs formularies. For more information go to the Ontario government’s OHIP+ web page. UPDATE: as of April 1, 2019, OHIP+ will be the second payer IF the Ontario resident has private health insurance coverage. OHIP+ will still be the primary payer for those residents who do not have private health insurance coverage.
Ontario’s provincial healthcare plan is referred to as OHIP, which stands for the “Ontario Health Insurance Plan”.
OHIP coverage is available 3 months after a person establishes residency in Ontario.
If you have just moved to Ontario from another country or if you are a returning expat then apply for OHIP as soon as you arrive in Ontario.Affordable Health & Dental Plans
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SERVICES OFFERED BY OHIP COVERAGE
The following services are partially or fully covered by OHIP.
- Medically necessary services provided by a qualified doctor.
- Medically necessary services provided in a hospital, including meals, required drugs, procedures and public wards (semi-private and private rooms not covered).
- Eye examinations ONLY IF: you are under the age of 20 or 65 and up (one exam per year), or; you have a medical condition that requires regular eye examinations (one exam per year is covered).
- Registered podiatrist services are partially covered under OHIP (note that surgery is not covered). Coverage is $7 to $16 per visit, with an annual maximum of $135 per person. There is also $30 for x-rays.
- Ambulance services IF:
- You have a valid health card and transportation occurs between medical facilities.
- Ambulance transportation is deemed medically necessary. There is a $45 co-payment if transportation did not originate at a medical facility (e.g. pick-up at your home), UNLESS you are receiving social assistance, in which case the $45 fee is waived.
- Mammograms are covered via the OBSP (Ontario Breast Screening Program) for all women who: are between the ages of 50 to 74 years old (no referral needed), or; are between the ages of 30 to 69 and are considered to be a high risk (referral is required). Mammograms are also covered if you are referred to a publicly funded Ontario hospital or clinic by a physician.
- Midwife services.
- Dental surgery performed in a hospital. For example, fracture repair, tumor removal, reconstructive surgery and medically necessary tooth removal (tooth removal requires prior OHIP approval).
- Some birth control pills / oral contraceptives are covered IF you are younger than 25 years old (covered by OHIP+ program). If you are 25 or older than there MAY be coverage if you are considered “low-income” and qualify for a specialty drug program.
- Surgical abortions if performed in a hospital or clinic. Mifegymiso is also covered if you have a prescription from your doctor.
Please note that you may be billed if you miss an appointment with a physician or if your health card isn’t valid. You must cancel an appointment at least 24 hours in advance to avoid being charged this fee.
NORTHERN HEALTH TRAVEL GRANT
You may be eligible for a Northern Health Travel Grant if you reside in northern Ontario and have to travel a long distance to obtain special medical care. This grant pays 41 cents per kilometer travelled. There is a deductible of 100 km.
If you live in one of the following areas you may be eligible for assistance: Algoma, Manitoulin, Cochrane, Kenora, Sudbury, Nipissing, Parry Sound, Rainy River, Timiskaming, or Thunder Bay.
SERVICES NOT COVERED BY OHIP
- Ambulance transportation services if not deemed medically necessary (maximum cost of $240).
- Routine eye examinations for people between the ages of 20 and 65.
- Glasses and contact lenses.
- Laser eye surgery.
- Eye exams required by third parties or potential employers.
- Physiotherapy is usually not covered, UNLESS you meet one of the following conditions:
- You are less than 20 years of age or are 65 or older AND have been referred by a physician stating that you require physiotherapy.
- You have been discharged as a hospital inpatient after an overnight stay and need physiotherapy to recover from your injury or condition (the reason you were hospitalized).
- You are a client of Ontario Works or the Ontario Disability Support program and are referred by a physician or nurse practitioner.
- Any dental services performed in a dental office.
- Paramedical services such as chiropractors, massage therapists, naturopaths, acupuncturists and osteopaths are usually not covered. If you are under 20 or are 65 or older then there MAY be publicly funded coverage available for physiotherapy services.
- Necessary emergency medical treatment obtained outside of Canada (e.g. while traveling) is only covered on a very limited basis (via the Out-of-Country Travellers Program); it is highly recommended to have travel insurance protection if traveling outside of Canada. Out of province ambulance costs are not covered.
- Prescription drugs if you are 25 or older (as of January 1, 2018), although assistance MAY be available (see below), depending on your personal situation.
- Any cosmetic surgery.
- Semi-private and private rooms in a hospital.
- Birth control pills and other contraceptives UNLESS you are 24 or younger OR you qualify for a specialty drug program (e.g. low-income family).
ONTARIO DRUG BENEFITS
Prescription drugs are usually not covered by the Ontario Health Insurance Plan; however, there is assistance for those who need help in paying prescription costs. The Ontario Drug Benefit (ODB) program provides coverage for the following people who possess a valid Ontario health card and meet one of the following requirements:
- Seniors who are aged 65 and older.
- Residents under the age of 25.
- Ontario residents who are on social assistance i.e. Ontario Disability Support Program and/or Ontario Works.
- Ontario residents who reside in long-term care homes and homes for special care.
- Ontario residents who are receiving professional home care services.
- Residents who have high drug costs compared to their income and are registered with the Trillium Drug Program (see below).
For a complete listing of prescription drugs that are covered by the ODB program (including OHIP+) please click here.
Ontario residents who DO NOT qualify for the ODB program have the option of applying for the Trillium Drug Plan. The TDP provides drug benefits to Ontario residents who have high prescription costs in relation to their net income, and/or have little or no private insurance coverage.
– for full details see the OHIP web site. To see the full Schedule of Benefits go here –
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