ABSTRACT
Paula Pinto Rodriguez
Research fellow
Yale School of Medicine
New Haven, Connecticut, United States
Vein ablation is a common and effective treatment for patients with chronic venous insufficiency (CVI). The abuse of vein ablations in the absence of evidence-based guidelines has driven insurance companies to develop aleatory policies that create barriers to appropriate care. This study compares the insurance coverage by single state carriers (SSC) to multistate carriers (MSC), highlighting the variations and inconsistencies of the various policies.
Methods:
The American Venous Forum policy navigator was reviewed for all available insurance policies in the United States. The policies were divided into SSC and MSC. The characteristics of the policies, including anatomic criteria for specific veins, duration of conservative treatment, disease severity and symptoms, as well as types of procedures covered, were compared between the two groups.
Results:
A total of 122 policies were reviewed and divided into SSC (n = 85, 69.7%) and MSC (n = 37, 30.3%). There was significant variation in the size requirement for great saphenous vein ablation. While 48% of the policies did not specify a size criterion, the remaining policies indicated a size ranging between 3-5.5mm. However, there was no significant difference between SSC and MSC in great saphenous vein diameter. MSC were more likely to define axial reflux time > 500ms compared to SSC (81.1% vs. 58.8%, P=0.04). Interestingly, there was a significant difference between SSC and MSC in the criteria for perforator ablation in terms of vein diameter and reflux time. MSC were more likely to provide coverage for mechanochemical ablation (MOCA) compared to SSC (24.3% vs. 8.2%, P=0.03). (Table 1) SSC were more likely to require ≥12 weeks of compression stockings than MSC (76.5% vs. 48.7%, p = 0.01). There were no significant differences in the clinical indications for ablation procedures between the two groups, but MSC were more likely to mention major hemorrhage as a criterion compared to SSC. (Table 2)
Conclusions:
This study highlights the variations in policies for venous ablation and the striking inconsistencies in anatomic and clinical criteria in the absence of evidence-based guidelines. MSC policies were more likely to cover MOCA and required a shorter duration of conservative therapy prior to intervention than SSC. Evidence-based guidance is needed to develop a consistent and uniform national policy for venous ablation coverage.