Many insurance companies have developed their own reimbursement regulations for venous procedures, which may not always be in the best interest of a patient. Some of these regulations do not reflect common practice guidelines, or common sense. Doctors and sonographers need to be familiar with protocol to develop a treatment strategy optimal for each particular patient.
For example, United Healthcare requires vein size to be not less than 5.5 mm for Great Saphenous Vein (GSV) below Sapheno Femoral Junction (SFJ), and the size of Small Saphenous Vein (SSV) to not be less than 5mm below Sapheno Popleteal Junction (SPJ), in order for the patient to be approved for endovenous ablation.
Based on our experience with a number of patients scanned in past years, the majority who need the treatment will not meet these criteria. Some insurance companies may not approve endovenous treatment if the patient does not have incompetence of a terminal valve at SFJ. However, most patients with primary venous incompetence will have a competent terminal valve.
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