- Personal Health Information & Self-Help
Painful Varicose Veins?
You might have Venous Reflux Disease?
Venous reflux disease is a condition that affects the superficial venous system of the legs. Our bodies are made up of multiple veins that include: superficial veins - the one's closest to the skin surface, the deep veins - the one's further from the skin surface and perforators - tiny veins that connect the superficial veins to the deep one's (sort of like a bridge). Healthy leg veins have these valves that open and close each time blood travels through them, keeping the blood traveling upward only. When the valves become damaged, the result is the blood traveling upward doesn't stay up...it pools downward causing bulging, varicose veins. Basically, these veins become diseased, permanently.
Try this - hold your two index fingers together at the tip. This is what would resemble your leg vein valves. They open (go ahead, separate them) to let blood travel upward and then they tightly close again to keep the blood traveling up. Notice, that when your fingers are pressed together nothing would go through. Now, separate them again and keep them that way. This is what venous reflux disease is. The valves in the veins separate and do not return to their normal state. In other words, they do not touch again. Blood that goes up will simply pool downward because there is no longer anything keeping it from doing so. This will eventually lead to bulgy, large and painful varicose veins of the legs. And since our legs are below the level of the heart, this condition will only worsen over time.
Some of your symptoms will include:
- bulging leg veins
- pain that increases with activity
- swelling of the legs
- severe tiredness of the legs
- changes in the way your skin looks
- open wounds that develop, when left untreated
When left untreated, venous reflux disease can become a serious matter. For example, let's say that you've had bulging varicose veins all your life and you've ignored your symptoms. Now, you're older and have other conditions such as hypertension, obesity or diabetes. You notice some wounds beginning to develop on your legs. They simply came out of nowhere. This is called venous stasis ulceration. These wounds can eventually become infected and not heal on their own due to your co-morbidities (other health issues).
Venous reflux disease is a condition that is treatable and paid for by your insurance company. I will tell you what to do to prepare for your treatment before you even visit the doctor. I'm going to give you some tips on how you can spend less out of pocket for your treatment so that you can feel better faster. Read on! And, as soon as you're ready make an appointment with a doctor that specializes in varicose veins. Don't ignore your symtoms.
Is endovenous ablation right for you?
Years ago when patients suffered from painful varicose veins they were not given many options for treatment. Doctors often would recommend that patients simply have them stripped away. But, simple it wasn't. The procedure was painful for weeks after it was performed. Vein stripping was a barbaric method of removing varicose veins. Very large incisions were made to remove the vein and the patient was left badly scarred. Today, there are several options to treating varicose veins, including vein stripping (now, referred to as microphlebectomy). But, you should first have vascular testing before jumping into the operating room.
I've interviewed hundreds and hundreds of men and women who suffered with painful varicose veins and it was almost always the case...everyone was in a rush to get something done about it. Don't rush this treatment. Remember, your legs need to carry you for the rest of your life. You must be tested for the cause of your symptoms. Ultrasound is a sure way to determine if you have reflux disease. It's a non-invasive scan of your legs to test whether or not the blood is flowing in the right direction. If it's determined that you have reflux disease then your first option should be endovenous ablation.
Of course, microphlebectomy is also an option, but unless you treat the underlying condition that's causing your symptoms, your insurance company may not pay for any option other than endovenous ablation of the diseased vein first. Microphlebectomy can be performed as a follow up procedure if you still have symptoms after endovenous ablation. Then, your chances of having your insurance company pay for it is much greater.
Preparing for your surgery
First and foremost, some insurance companies have certain requirments that must be met by the member (you) in order for them to cover the costs for varicose vein surgery. I'm going to tell you what those requirements are in order to prepare you for almost immediate approval. Keep in mind that even if you have Medicare (which does not require prior approval for any procedures), your insurance company may still deny paying for your surgery when they receive the claim for the charges from your surgeon.
You need PROOF that your varicose veins are preventing you from performing activities of daily living. Those activities can be something as simple as being able to walk pain free. For example, If you have a job that requires you to stand or walk for many hours and then by the time you get home your legs feel like you have 30lb weights attached to them, then your varicose veins are preventing you from doing normal activities. Even having a job can become painful, but who can afford to stay home these days. We have to work right? So, read closely at what I'm about to share with you. If you're prepared for your surgeon's visit then you will be scheduled for surgery quicker and this means getting rid of your symptoms quicker too.
Getting Tested can be Easy
Now, if you want to save a few dollars while you're trying to figure out the cause of your symptoms then for the love of peace...stick with your primary care physician (PCP) before seeing a specialist. The copay for your PCP is much less than that of a specialist. And, a specialist will generally bill your insurance at a higher level than a general practitioner. So, stick with your PCP for a while and you'll pay less out of pocket.
Let's look at an example. If you were to see a specialist right away and on that first visit he/she examines you and then says " I need to run some tests" well, now you've done it. You will need to return for a second pre-operative consultation because you weren't prepared. Now, you'll have a second copay and waste another afternoon sitting in the crowded waiting room. You could have seen your PCP, asked him/her to order the ultrasound and then have those results with you in hand when you visited the specialist. Certainly, your specialist wouldn't re-order the testing. Now, you won't have a second visit to make and your specialist will immediately determine a course of treatment for your condition.
Don't forget, your PCP is a licensed medical professional. He/she can examine you and order the testing you need before you rush out to see a specialist. To rule out reflux disease, your PCP would simply order a vascular doppler study or ultrasound to rule out reflux disease. And, guess what? While performing this study the technician will also look for DVT which is basically a blood clot. So, you get two results for one test. Ching! Ching! You can also call a vein specialists office and just ask the staff questions. That wouldn't cost you anything, right? Ask questions ahead of time, before your specialist visit. Go prepared and you'll get healthier faster!
Tips for Insurance Approval
Ok, so as I mentioned before, you must meet certain criteria in order for your insurance company to pay for your varicose vein surgery. I want to help you be better prepared. Do not skip any of these as they almost always have to be on your list of "did it" or you may end up paying more out of pocket for your surgery. The first thing your insurance company is going to ask is - How long have you had your symptoms? Believe it or not, some of the patients I've interviewed can't even tell me how long they've had their varicose veins. Think hard people and make sure you know this. Another important question you'll need to answer with details is - what have you done to help yourself relieve your symptoms? Crazy huh? Who's not going to try to relieve pain they're having? Problem is that some of us forget to document what we've taken for the pain or even how long we've taken it. Again, you need to know the answers.
You get one shot at an interview with the person who is responsible for speaking with your insurance company on your behalf in an effort to get your surgery paid for. Don't screw it up! And, they'll be other questions too. Do you elevate your legs? Well, do you? Leg elevation is so important to relieving the swelling you may notice after a hard day's work. Go ahead, do your legs a favor and prop them up on the couch every night. I promise it will feel great!! Some patients legs swell so bad, they need to use icebags on a regular basis. While others may say that the pain is so severe only Advil with a side heat packs spells relief. These are important details you will need to tell your interviewer. Every detail is extremely important so don't miss sharing any of them.
Now, the meat and potatoes of being prepared...do you wear compression stockings to control your symptoms? This is 100%, across the board, no holds barred, absolutely a necessity when you prepare for varicose vein surgery. If you've never worn compression stockings then you will take the risk of having to pay for your surgery on your own. Believe me, some insurance companies will tell your interviewer that the procedure is approved and some will even tell him/her that no prior notification or authorization is required, but when they receive all of the claims for your surgery...that's when they start playing hardball. Now, all of the details start to become important. Compression stockings can be purchased in any pharmacy. Sure, they won't be medical grade, eventually you can get a prescription from your doctor for those, but the question from your insurance company will be "have you worn compression stockings?". So, spend a couple of dollars and pick yourself up a pair. Wear them for at least 3 to 6 months before making an appointment with your doctor. And, finally you should take pictures of your varicose veins. Some surgeon's offices may take pictures of your legs for your insurance company, but take a few yourself after a hard day's work (you know, when they really flare up) and keep them on file. You never know if you'll find yourself fighting your insurance company for payment. Trust me, it can happen.
What happens in the O.R.?
Endovenous Ablation is a simple, 30 minute procedure. You will be given a light sedative so you won't feel a thing. Your surgeon will make 2 small incisions, one at the level of the groin and one at the level of the knee. A very tiny catheter is inserted into the diseased superficial vein called the greater sapphenous vein and is slowly withdrawn. As it's withdrawn, the catheter omits radiofrequency energy causing the vein to shrink.
The ablated vein is eventually absorbed by your own body. Don't worry though, blood flow is not interrupted. It's simply re-routed to deeper, healthy veins. And, the incisions are so small that sometimes you don't even require sutures. A bandage is placed over the incision sites and will heal in a matter of days. Some patients are relieved of their symptoms immediately following their procedure while others feel better in less than a week.