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The Variations and Inconsistencies in Venous Ablation Coverage Policies between Single State and Multistate Carriers in the United States. Journal of vascular surgery. Venous and lymphatic disorders Pinto, P., Fukaya, E., Rodriguez, L. E., Obi, A., Ting, W., Aziz, F., Nguyen, K., Murphy, E. H., Ochoa Chaar, C. I. 2023

Abstract

Vein ablation is a common and effective treatment for patients with chronic venous insufficiency. The overuse of vein ablations despite the existence of evidence-based guidelines has driven insurance companies to develop restrictive policies for coverage 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.The American Venous Forum policy navigator was reviewed for the various policies available in the United States. The policies were divided into SSC and MSC. The characteristics of the policies, including anatomic and hemodynamic criteria for specific veins, duration of conservative treatment, disease severity, symptoms, and types of procedures covered, were compared between the two groups. SAS 9.4 was used for statistical analysis.A total of 122 policies were analyzed and divided between SSC (n = 85, 69.7%) and MSC (n = 37, 30.3%). There was a 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 minimal size ranging between 3-5.5mm. However, there was no significant difference between SSC and MSC. Similar findings were encountered with the small and anterior accessory saphenous veins. MSC were more likely to define saphenous 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 size and reflux time. MSC were significantly more likely to provide coverage for mechanochemical ablation than SSC (24.3% vs. 8.2%, P=0.03). SSC were more likely to require =12 weeks of compression stockings therapy than MSC (76.5% vs. 48.7%, p = 0.01). There were no significant differences in the clinical indications between the two groups, but MSC were more likely to mention major hemorrhage compared to SSC.This study highlights the variations in policies for venous ablation and striking inconsistencies in size criteria particularly. MSC were more likely to cover mechanochemical ablation and require a shorter duration of conservative therapy prior to intervention compared to SSC. Evidence-based guidance is needed to develop more coherent policies for venous ablation coverage.

View details for DOI 10.1016/j.jvsv.2023.07.012

View details for PubMedID 37703944