East Tennessee Vein Clinic is in network with most insurance plans. Being in network is important to the patient because it means our clinic has agreements with various insurers to use their fee schedule as charges for treatment we render. This means insurance with most plans covers most of the cost of treatment other than deductible and co-payments a patient may have. Secondary insurances often cover much of the difference. We file with both primary and secondary insurances for the patient.
Medical Necessity: To be eligible for insurance coverage of treatment most insurances require documentation of medical necessity. Most patients who have varicose veins that cause symptoms of leg pain such as aching, cramping or swelling, etc. inadequately relieved with conservative therapy will qualify for insurance coverage of treatment. Medical necessity is evaluated at the time of your initial consultation and ultrasound “maps” and photographs with written documentation are subsequently sent to the insurance company to confirm medical necessity
A written predetermination of medical necessity is obtained by our office from the insurance company before actually beginning treatment of vein disease. This means that the insurance agrees that the treatment is medically necessary and should be covered by insurance. Medicare does not require a predetermination.
Referrals: We frequently see patients referred by physicians. Referral by another physician however, is not usually necessary to undergo an initial evaluation or treatment.
In Network means our clinic has agreements with various insurers to use their fee schedule as charges for treatment we render. This means insurance with most plans covers most of the cost of treatment other than deductible and co-payments a patient may have. We are currently in network with:
- United Healthcare River Valley
- Blue Advantage
- Humana Gold
- Secure Horizons
- Tri-care for life
- Currently we do not participate with TENNCARE
- We are continuously adding insurance plans
Out of Network means insurance is accepted towards payment but there is no fee schedule agreement with the insurance. This means that the patient will pay more for the cost of treatment since out of network benefits usually pay a percentage of what they allow for charges and the patient is responsible for the rest. Medical practice’s that are both out of network and set very high charges for their treatment can result in thousands of dollars in bills to the patient. At East Tennessee Vein Clinic we endeavor to maintain reasonable charges and to add all insurers to our network that we may be able to assist the greatest number of patients. We want to help.
Cosmetic Veins: Veins that are simply cosmetic in nature and cause no discomfort will not qualify for insurance coverage. Spider veins, though frequently painful, will not qualify for insurance coverage.
Disclaimer: Please note that the description above is meant to be helpful in understanding insurance and that the particulars of your individual insurance plan will apply.