FAQs: Spider Veins
What are spider veins?
Spider veins are tiny, dilated blood vessels which appear to project outward from a vein like the legs of a spider. They are actually smaller versions of varicose veins lying close to the surface of the skin. Spider veins can be symptomatic, causing itching, burning, aching, bleeding or clotting. Typically they are merely a cosmetic nuisance and serve no useful function for the body.
How do spider veins develop?
The precise cause of these unwanted vessels is still the subject of investigation. However, we believe they develop as a result of a complex interplay of genetic, hormonal and environmental factors. There is often a strong family history responsible for their formation. You might find, for example, a mother, daughter and sister suffering the same problem. Hormonal factors including puberty, pregnancy, menopause, and the use of birth control pills increase your chances of developing spider veins. Other factors, including prolonged standing, obesity and trauma to the leg can aggravate the problem.
How do you treat spider veins?
Vein Clinic PA is a specialty clinic treating most types of leg veins. We have many tools available and one of our Board Certified Providers will determine which procedure would be ideal for your individual needs. Frequently we use a combination of tools since surface veins come in different shapes and sizes and have variable sources. Typically we like to identify the source by using ultrasound, or a special light which allows us to see deeper into the skin. By nailing down the source, we can get you better, long-term relief in fewer sessions.
Injection Sclerotherapy remains the gold standard treatment and the most common method for getting rid of spider veins on the legs. Sclero literally means "scar." Sclerotherapy works by irritating the lining of the unwanted blood vessels to such an extent that they collapse upon themselves and eventually scar over and disappear from view entirely. The success of the sclerotherapy relies upon the experience and skill of the provider. Choosing the right sclerosant, target, volume, concentration and “exposure time” make the difference between success and failure.
We first scan the affected areas using ultrasound looking for any “feeder” veins beneath the skin surface. If present, we use Ultrasound Guided Sclerotherapy to close an entire cluster of spider veins at its source beneath the skin that is otherwise not visible from the surface. Any remaining visible spider veins are then treated using injection sclerotherapy where medication (sclerosant) is injected directly into the affected surface veins. We use Ohmic Thermolysis or Surface Laser for veins that are either too small for sclerotherapy or located in areas where sclerotherapy is not recommended. Ohmic thermolysis and Laser use the spectrum of light that targets spider veins from the outside and closes them by heating the hemoglobin within the affected veins.
Larger surface veins can also be removed by microphlebectomy which is a minimally invasive procedure. Using very fine instruments, the unwanted bulging surface veins are removed through miniscule openings without the need of sutures and topically without causing any scanning.
What should I expect after a Spider Treatment Session?
You may experience mild itching, which can last for one or two days after the procedure. Also, you may experience raised, red areas at the treated site. These should disappear within a few days. Bruising may also occur around the injection site and can last several days or weeks.
If you had sclerotherapy, you may experience the following:
- Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade.
- Brown lines or spots may appear at the vein site. In most cases, they disappear within three to six months, but they may also last longer and in rare cases, indefinitely.
- Neovascularization or matting – the development of new, tiny blood vessels – may occur at the site of sclerotherapy treatment. These tiny veins can appear days or weeks after the procedure but typically fade within three to twelve months without further treatment.
How long does bruising last after Sclerotherapy injections?
Post-sclerotherapy bruising is frequently a result of trapped blood in treated veins and can occur due to inadequate compression, walking, or failure to identify and treat “feeder” veins which flow into the spider veins. Bruising typically resolves in 2-3 weeks. Sometimes aspiration of trapped blood may reduce bruising swiftly. You may also notice discoloration or hyperpigmentation that may last for several months depending on several factors including skin characteristics, use of antibiotics such as minocycline and intake of iron supplements.
How long does it take to see spider veins improve after Sclerotherapy?
It depends somewhat on how fast an individual patient heals, but generally speaking, the thinnest spider veins may disappear fastest with gradual improvement seen over 2-3 weeks. The thicker or dense cluster of spider veins may take several weeks to fade. Many patients may also need additional follow-up treatments to get the best results, as each treatment is expected to result in 50-60 percent improvement, on the average. We recommend waiting for 4-6 weeks before considering treatments to the same area. After 4-6 weeks, any veins that are still present are unlikely to go away unless they are re-treated.
Can I have consult and spider vein treatment on same day?
This is not typical. Consultation is free, although a Board Certified Provider will spend at least a few minutes with you answering your questions. We believe this necessary so you are well informed and educated before you embark on a treatment course. We reserve at least one-half hour for a consultation and one hour for spider treatment.
All this being said, many of our patients travel great distances, from other states or even abroad. You can reserve the consultation and spider session together by paying in advance for the spider treatment. If a Provider determines spider treatment is not necessary, we will refund you the charge for spider vein treatment. If you have already paid for the treatment, we can schedule your consult and spider on the same day, but if you miss your appointment and fail to give us a 24 hour notice, you will be charged $50 per the missed appointment and cancellation policy.
How many treatments will I need?
One of our Board Certified Providers will see you and make the determination. Typically more than one session is required and will depend on your individual condition and also your expectations.
Will spider veins come back after treatment(s)?
The areas we treat will almost certainly improve and are unlikely to come back. Our approach is to go after the source first which gives you the best long term benefit. That being said, spider veins cannot be cured. Spider veins, much like varicose veins, are caused by genetically weak veins which worsen due to risk factors such as standing or sitting for long periods of time, hormones, lifting weights, age etc. There are tens of thousands of veins, some visible and others not quite visible, but may surface down the road.
How long is the appointment?
Spider Vein Treatment sessions are either 60 minutes or 90 minutes in duration. Each session is inclusive of all steps involved in preparation (consent, answering questions, numbing, obtaining pictures, limited ultrasound scan if deemed necessary, application of dressing or stockings). We try our best to devote at least 30 minutes (one-hour session) or 60 minutes (one and one-half hour session) to actual treatment. However, the total appointment may not exceed the duration of your session you reserved (60/90 minutes). Please arrive early and ask questions during your consultation and prior to scheduled treatment as much as possible so we can maximize use of available time for actual treatment. Multiple sessions are frequently required and a 90-minute session is typically recommended for your first treatment. Your provider will discuss your individual treatment plan with you in advance of your sessions.
Do I need compression hose?
For spider treatments, 15-20 mmHg stockings can be obtained from any pharmacy or medical supply store (DME/Durable Medical Equipment). No prescription is required. You can purchase a pair from us onsite if your size is available. After your treatment, we wrap the treated areas. When you get home, just before going to bed you should remove the wrap but continue wearing the compression stockings.
How long do I wear compression hose?
We recommend that you wear compression stockings round the clock for first 24 hrs and during the day only for another 6 days. The first 24 hrs are crucial.
Why do I have to wear compression hose?
This will optimize the results of Injection Sclerotherapy which is the gold standard for treating spider veins. It is like injecting superglue in a small pipe. Compression allows you the best chance of success. We also use tools like the Ohmic Thermolysis or surface laser that do not require the use of compression stockings since nothing is injected into the veins. Your Provider will go over details with you.
Can you treat both my legs on same day?
When you reserve a spider session with us, you are paying us for our time. When you arrive here, we will mark the areas in both legs that are most bothersome to you and attempt to take care of as many areas as we possibly can in the available time. We are typically able to get a great deal accomplished during the available treatment time. However, if there are too many areas, you will likely need to come back for additional sessions.
Is it painful?
Typically patients tolerate the treatments quite well. We use needles that are as thin as a human hair and we numb the area with a numbing cream prior to treatments. We also have freezing spray, ice, and other options to help alleviate pain, if you experience any. Although nitrous oxide (laughing gas), prescription pain medications, or anti-anxiety medications (such as valium) are an option, patients rarely need them.
What is the cost of one session?
Please see our Transparent Pricing Booklet for current pricing or call us at 1-800-955-8346.
Download: vcpa-transparent-pricing-booklet.pdf10.08 MB
FAQs: Varicose Veins
What can I expect from my free consultation?
Your initial consultation includes an assessment of your venous system, a review of your signs and symptoms and an explanation of varicose veins and their effect on your circulatory system. Our vein experts will be able to tell you if your circumstances warrant further examination, which would begin with an ultrasound mapping of your venous system. This mapping is not a part of your initial consultation. For your convenience, one of our billing specialists will contact you within two business days of your consultation and go over your insurance benefits. Our billing team will assist you every step of the way so that you can focus on what is more important, your legs and your health.
What is a vein mapping and why do you do it?
Vein mapping is a non-invasive ultrasound examination of the veins in your legs. It shows the size and shape of your veins, blood flowing through your legs and how the valves in your veins are functioning. This information is used to identify the exact cause of your problem and determine the proper course of treatment. Almost all insurance policies cover this mapping procedure.
How do you know if I am a candidate for treatment?
You are a candidate for treatment if you have varicose veins or venous insufficiency. We determine this by assessing the health of the veins in your legs. We start by asking how your legs feel and whether you are experiencing symptoms, and then look for signs that may indicate underlying problems. If you think you may be a candidate please call to schedule a free consultation.
Do I need a referral from my doctor?
You will not need a referral, in most cases. You may call us if you have questions regarding your insurance policy.
What are varicose veins, and how do I know if I have them?
Varicose veins are diseased veins that no longer allow proper blood flow. Some appear as bluish or green, bulging, curvy or ropey veins just under the skin. Some may be too far below the surface to be visible.
Can I prevent varicose veins?
Unfortunately, the predominant risk factors such as genetic predisposition, occupations (that require standing or sitting for long period of time), pregnancies, hormones and age, are not in anyone's control. However, there are many measures you can take to help delay the onset or slow the progression of varicose veins. Regular exercise, weight management, proper diet and a healthy lifestyle are important for good vein health. Avoiding risk factors such as standing or sitting for long periods, and using preventative measures, such as wearing support hose and elevating your legs can also be helpful.
Can I be cured of varicose veins?
Varicose veins can be successfully treated, but the disorder cannot be permanently cured. The risk factors that contribute to varicose veins are still present after treatment, which may mean that patients will need to return for follow-up treatments at some time after their initial treatment.
Do varicose veins cause Restless Leg Syndrome?
Restless Leg Syndrome (RLS) is a combination of symptoms that includes a constant urge to move legs, itching, tingling, burning or a sensation of crawling on the skin. Although causes may be many, these symptoms are also caused by varicose veins and associated venous insufficiency. These symptoms, regardless of the cause, can interfere with sleep. Medications such as pramipexole (Mirapex) and ropinirole (Requip) may not provide relief if the underlying cause is venous disorder while exposing patients to side effects, including nausea, lightheadedness, fatigue and an increased risk to heart disease. Treatments corrects the underlying vein problem and almost all of our patients notice a rapid improvement.
What are my treatment options?
Treatment therapies vary depending on individual conditions and may include:
- Endovenous Laser Ablation (EVLA) - Laser energy is used to permanently seal the vein.
- Endomechanical Ablation (EMA) – Combined mechanical and chemical energy seal the problematic vein from its source.
- Ultrasound-guided Sclerotherapy (USGS) - Ultrasound guidance is used to "see" the veins while we deliver medicine to the precise location.
- Transcatheter Closure (TCC) – Medicine seals entire length of a vein at one time.
- Microphlebectomy - Short sections of vein are removed through tiny incisions.
How does the laser treatment work?
The area of the vein to be treated is numbed and a laser fiber is threaded through the vein to the source of the problem. Laser energy is applied causing the vein to collapse and seal, permanently. This sealed vein breaks down and is reabsorbed by your body over a period of several weeks or months. Blood that used to flow through that vein now flows through other, healthier veins and proper circulation is restored.
Does the laser procedure or needles hurt?
We understand that nobody likes needles. There is some discomfort with most medical procedures and we take great care to minimize this discomfort. We use a four step numbing process that first desensitizes the skin, and then numbs the area along the vein. You will feel no pain during the actual laser portion of the treatment. We now use a breakthrough needle free numbing system to reduce pain and anxiety even more.
What can I expect after a laser treatment session?
You can expect some tenderness and bruising along the vein line that will last for a few days or a week. Applying cold packs to the affected areas, taking frequent short walks, massaging your legs, and elevating your feet when possible, all help minimize discomfort and speed recovery.
What happens to the blood after you seal the diseased vein?
We treat veins in the superficial venous system. These are the veins that are between the leg muscles and the skin, and make up about 10% of your leg veins. The other 90% of leg veins are deep in the leg muscle and make up your deep venous system. After a vein is treated the blood flows through other, healthier veins, to your deep venous system back to your heart.
What if I need these veins for surgery in the future?
We only treat the diseased veins. These veins are not candidates for surgery, and do not provide good circulation in your legs. Removing them allows blood to flow through other healthier veins and restores proper circulation.
Will I need a whole day off of work for my laser treatment?
No. Laser treatments can be performed in less than one hour. You may return to work immediately, if you choose. We offer evening and Saturday appointments on select days and clinics throughout the week.
I have a busy schedule. Will I have a lengthy recovery time?
Laser treatments are minimally invasive and have little effect on surrounding tissues, therefore the recovery time is much shorter, and with less discomfort, than older methods such as vein stripping. Resuming most normal activities immediately is recommended because it promotes rapid healing. Ask your vein specialist when you can return to more strenuous activities, such as running and exercising.
Will I have to wear compression stockings?
Yes. Wearing compression stockings is an integral part of a vein treatment therapy. Properly-fitted gradient compression stockings provide support in the areas that need it the most, promote rapid healing and also make your legs feel better. The length of time to wear them depends on the individual therapy and specific treatment method, and can vary between several days and weeks. Many insurance companies require a trial period of stocking use before approving vein treatment therapy.
Can I just treat the unsightly, visible veins?
This is not recommended, and most insurance companies require treatment therapy that includes treating the source veins. Treating only the unsightly varicose veins does not address the underlying causes and will not improve circulation. Removing the symptom without addressing the source will allow the progression of the vein disease and could lead to more serious conditions such as leg ulcers, bleeding veins, permanent discoloration of the skin or even blood clots.
What happens if I treat only my spider veins?
Spider veins are a type of varicose vein. Excess blood pooling in veins puts pressure on the vessels all the way out to the skin. Excess pressure on the surface veins weakens these vein walls, producing varicosities that appear as tiny blue, red or green "webs". Treating only the spider veins will not improve your circulation, and you will likely continue to develop new spider veins. Treating spider veins is considered cosmetic because it does not address the underlying circulatory conditions.
Is it possible to treat both legs on same day with endovenous laser ablation (EVLA)?
Laser treatments (EVLA) to more than one major vein in a day increases the risk of complications such as Deep Vein Thrombosis, lidocaine toxicity and infection. Ideally EVLA treatments are spaced 2 -3 weeks apart to minimize pain, bruising and complications such as blood clots. However patients who travel from far may not be able to make follow-up visits easily and others may be on tighter time frame. Subsequent treatments may be performed sooner on a case-by-case basis after assessing the risks and benefits. Your Phlebologist will evaluate your individual needs and recommend a treatment plan that is specific for you.
FAQs: Insurance and Billing
What is Patient Account Services (PAS)?
Patient Account Services is Vein Clinic PA's customer contact center to answer your billing inquiries and resolve personal balances due to Vein Clinic PA. Finance Counselors are available to assist you with the financial aspects of your care at Vein Clinic PA. You may contact one of our team members at:
Address: 2801 Wayzata Blvd, Minneapolis, MN 55405.
Where can I find Vein Clinic PA’s policies?
What other paperwork will I need to complete at my first visit?
In addition to the policies and information contained in the Patient Education Binder, your registration materials also include a Patient Demographics Form, Patient History Form and the Acknowledgement of Policies that will allow Vein Clinic PA to release information to your insurance company. Accurate and complete forms help ensure that your claims will be paid promptly by an insurance company.
Will I receive bills from Vein Clinic PA?
Yes. You will receive one monthly statement for all services provided at Vein Clinic PA until your balance is paid in full by you or your insurance company.
Can I request a copy of all charges that have been incurred at Vein Clinic PA?
Yes. Patient Account Services can provide you an Itemized Statement of Charges upon request.
Will I be required to give you my Social Security Number?
Yes. Having the SSN opens the possibility to further research insurance information if there are issues with the claim or if the insurance states upon receipt of the claim that there is another payer.
What is the difference between in-network and out-of-network? Does the answer to this question change if my insurance is processed through a third party administrator?
The Insurance world is complex and constantly changing. Vein Clinic PA participates in some insurance networks and not in others. For those we participate in, we are considered in- network. For those we do not participate with, we are considered out-of-network. Those we do or don’t participate with changes frequently. Some patients may have more than one insurance company involved in your coverage. And often, there are third party administrators (TPA) that processes claims on behalf of your insurer. Your benefit coverage level for care provided by Vein Clinic PA is determined solely by your insurance, not Vein Clinic PA. Please contact our Patient Account Services for assistance in navigating what your insurance company may cover. See an example of in-network and out-of-network in Appendix B.
Can I get an estimate for the cost of my treatment?
If you need an estimate of charges for services please contact Patient Account Services at 952- 641-4498. We will provide you with the best estimate your insurance makes available to us. It is important for you to obtain this information directly from your insurance company because your insurance company ultimately determines how much they will pay Vein Clinic PA on your behalf.
How do I know if the fees Vein Clinic PA charges are reasonable?
Vein Clinic PA believes in transparent and fair pricing. We realize that quality care is not cheap but we believe that it doesn’t have to be expensive either. We have consistently priced our services below those listed at www.fairhealthconsumer.org. Please see Appendix C for details about this website and how consumers can learn about the costs for health services from an unbiased source.
Why am I responsible for payment when my insurance “covers” my care?'
Our Providers at Vein Clinic PA are Board Certified. We follow guidelines on best practices when treating our patients that are based on national and international criteria established by studies, journals and professional associations. Your provider will recommend a treatment plan that will help you achieve the leg health you deserve. We will work hard to make sure that policies created by your insurance company are met while also ensuring you receive the best possible care. Not all insurance companies will authorize all treatments recommended by your Provider. If your insurance company requires it, Vein Clinic PA will request pre-determination from your insurer confirming they deem the recommended services to be medically necessary. Even with an approved pre-determination, there is no guarantee your insurance will cover all aspects of your treatment. That decision is made solely by your insurance company after your treatment is rendered. Any unpaid balances may become your responsibility.
If a service is considered cosmetic in nature, your Provider at Vein Clinic PA will indicate that to you. Cosmetic services cannot be billed to Insurance and you will be responsible for the payment of cosmetic services. If you need further assistance, please contact Patient Account Services at 952-641-4498.
What does the term “Usual and Customary Allowance” refer to?
Insurance coverage varies among individual insurers and policies. Many insurance companies limit payments using a fee schedule which they deem "usual, customary and reasonable" (UCR) allowances. Vein Clinic PA's charges may differ from insurance companies' fee schedules. If Vein Clinic PA does not participate in your insurance company’s network, you are responsible for payment of all amounts your insurance company does not pay.
Does Vein Clinic PA accept Medical Assistance (Medicaid)?
Vein Clinic PA participates with the state Medicaid programs of Iowa, Minnesota and Wisconsin. This participation allows Vein Clinic PA to serve patients with this type of insurance plan. Medical Assistance programs often require vein services to be pre-authorized. Medical Assistance programs generally provide coverage through a managed care health plan (i.e. UCare, Health Partners, etc.). If your coverage is through a managed care plan, you'll need an approved referral from your primary care physician to have your care at Vein Clinic PA covered by Medical Assistance. It is important for you to verify with your state's Medical Assistance office or your managed care health plan to verify your health plan’s requirements, authorizations or referrals needed prior to obtaining treatment.
How can I receive care if I do not have insurance or if Vein Clinic PA does not participate in my insurance company’s network)?
Vein Clinic PA will provide you an estimate and offer you affordable care via a time-of-service discount. Please call Patient Account Services at 952-641-4498.
Do you accept Medicare?
Yes. Medicare Part B (medical insurance) helps to pay for clinic services, doctor fees and outpatient hospital services. Vein Clinic PA is contracted with Medicare and will file Part B (physician services) claims for you. You'll receive a Medicare Summary Notice from Medicare when it processes your claim. Medicare Part B payments may be sent directly to you, and you'll be responsible for reimbursing Vein Clinic PA for any payments you receive. If you have supplemental insurance, Vein Clinic PA will file a claim on your behalf if Medicare does not send your claim to your supplemental insurance. Processing of Medicare claims usually takes four to eight weeks after the claim has been filed. Claims to supplemental insurance are filed after Medicare has made payment. Vein Clinic PA is not in network with all supplemental insurances. You'll be responsible for any remaining balance after Medicare and supplemental insurance payments.
What forms of payment do you accept?
You are responsible for payment not covered by your insurance company. You may discuss financial arrangements with a team member in Patient Account Services. For your convenience, Vein Clinic PA accepts:
- Cash including bank debit cards, money order or wire transfer
- Personal, traveler's or cashier's checks
- Visa, MasterCard, Discover, American Express, CareCredit
- Flex Savings Accounts, Health Savings Accounts (credit cards or checks)
- Patients may pay online at www.veinclinicpa.com
Do I need prior-authorization from my insurance company for my treatment?
Your insurance company may require you obtain their approval before proceeding with treatment. It is important that you make yourself aware of your insurance company requirements and any coverage limitations before your visit. Your Vein Clinic PA Provider will decide which tests and procedures you may need. If your insurance company requires pre- determination of any of the recommended treatment, Vein Clinic PA will request this from your insurance company. Pre-determination is essentially your insurance company’s assessment of whether they think your recommended treatments meet their definition of medical necessity. Prior Authorization (pre-determination) is not a guarantee of payment. You are responsible for payment of services not authorized and covered by your insurance company.
Does Vein Clinic PA offer financial assistance?
Vein Clinic PA conducts itself responsibly, both ethically and fiscally. Unlike hospitals and other non-profit care centers, we do not receive concessions or tax breaks from state or federal agencies. Nevertheless we are a medical practice and find ourselves caring for patients whom came to us with hope and expectations but perhaps without the financial means to receive the care they need. If we find that we have the power (and means) to assist these patients, we have and we will do everything possible to offer care.
Certain state laws, federal laws and our contracts with insurance companies place restrictions on how and to what extent we can offer reduced or free care. Accordingly, we are able to offer assistance to patients unable to meet their financial obligations on a case-by-case basis. Based on a patient’s ability to pay, we may be able to offer individualized payment plans, medical services at reduced rates or at no cost.
If you are experiencing a financial hardship, please contact Patient Account Services at 952-641- 4498 or arrange to meet with one of our Financial Counselors to discuss options such as a payment plan. Our staff may ask you to complete a Financial Hardship Application, which will help us fairly evaluate your eligibility for financial assistance. Until your Financial Hardship Application has been reviewed and approved by our Financial Counselors, you will continue to be financially responsible for your medical care. Completing a Financial Hardship Application may not absolve you of your full financial responsibility with Vein Clinic PA.
Financial Hardship Policy and Applications can be obtained from, and returned to Patient Account Services by email, fax, mail, or in person
What is ambulatory care?
Ambulatory care is care given in the doctor's office or surgical center without an overnight stay.
What is authorization (prior-authorization or pre-determination)?
Authorization is the approval of care, by an insurer or health plan. Your insurer or health plan may require prior- authorization (pre-determination) before you receive treatments.
What is balance billing?
Balance billing is the practice of a provider billing you for all charges not paid by your insurance plan, even if those charges are above the plan's usual, customary and reasonable (UCR) charges or are considered medically unnecessary.
What is claims review?
Claims review is the review your insurer or health plan performs before paying your doctor or reimbursing you. This review allows the insurer to validate the medical appropriateness of the services given and review the charges related to your care.
What is coordination of benefits (COB)?
Coordination of benefits is an agreement between your insurers to prevent double payment for your care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility.
What is coinsurance?
Coinsurance is a provision that limits an insurer's coverage to a certain percentage. This provision is common among indemnity insurance plans and preferred provider plans. If your insurance includes coinsurance, you'll be responsible for charges beyond those covered by your insurance. See an example of how coinsurance works in Appendix A.
What a copayment?
Copayment is the portion of a claim or medical expense that you must pay out-of-pocket. Copayment usually is a fixed amount. See an example of how a copayment works in Appendix A.
What is a CPT code?
Medical professionals use this set of five-digit codes for billing. The acronym CPT stands for: Current Procedural Terminology.
What is a deductible?
A deductible is the portion of your health care expenses that you must pay before your insurance applies. See an example of how deductibles work in Appendix A.
What is an explanation of benefits (EOB)?
An explanation of benefits is a statement mailed to an insured person noting how a claim was paid or why it wasn't covered. Medicare recipients receive a Medicare Summary Notice (MSN) rather than an EOB.
What is a fee schedule?
A fee schedule is a list of the maximum fee that a health plan will pay for each service based on CPT billing codes. Some plans refer to it as fee maximums or as a fee allowance schedule.
What is a Health Maintenance Organization (HMO)?
An HMO can be defined in several ways:
- An organization that provides health care to members in return for a preset amount of money.
- A health plan that places at least some of the care providers at risk of medical expenses.
- A health plan that uses primary care doctors to determine whether members receive care from specialists (although some HMOs don't).
What are the International Classification of Disease (ICD) Codes?
ICD codes are an international disease classification system used in diagnosis and treatment.
What is managed health care?
Managed health care refers to a system of health care delivery that tries to manage the costs and quality of health care and access to care. It often involves use of contracted provider networks, limitations on benefits for care given by non-contract providers (unless authorized to do so) and use of care authorization systems. Managed care includes managed indemnity plans, preferred provider organizations, point-of-service plans, open-panel HMOs and closed-panel HMOs.
What are Maximum Out-of-pocket Costs?
Your maximum out-of-pocket cost sets a limit to your annual financial liability. Once you have paid out of pocket (typically through deductibles, copayments or coinsurance) to the "maximum" amount, the insurance company pays the full charges for any additional covered medical services rendered that year. Your monthly premium will not count towards your maximum out-of-pocket costs. See an example of how an out-of-pocket max works in Appendix A.
What is Medicaid?
Medicaid is a program financed jointly by the federal government and the states that provides health care coverage for low-income people.
What is Medicare?
Medicare is the federal program insuring people age 65 and older and people who have disabilities of all ages. Medicare Part B covers outpatient services which is what Vein Clinic PA provides to its patients.
What is Medigap?
Medigap is private insurance that supplements Medicare reimbursement for medical services. Medicare often reimburses care at lower rates than those charged by doctors. Medigap is meant to cover the gap between Medicare reimbursement and provider charges so that the Medicare recipient doesn't have to pay the difference.
What is a Preferred Provider Organization (PPO)?
Preferred Provider Organizations contract with independent providers for services. The doctors in a PPO are paid on a fee-for-service schedule that is discounted below the provider’s standard fees. The panel of providers is limited. PPO members sometimes can use a doctor outside the PPO network, but usually the patient then pays a bigger portion of the fee.
What is a premium?
A premium is the amount you (and your employer) pay to the health insurance company each month to maintain your coverage.
What is a Provider?
A provider is any supplier of health care services such as a doctor, nurse practitioner, physician assistant, pharmacist, physical therapist and others.
What is a self-insured plan?
In self-insured (self-funded) plans, the employer (rather than an insurance company or managed care plan) assumes the risk of medical costs. Self-funded plans are exempt from state laws and regulations such as insurance premium taxes and mandatory benefits. Self-funded plans often contract with insurance companies or third party administrators to administer the benefits.
What is a third party administrator (TPA)?
A third party administrator handles the administrative duties and sometimes utilization review for self-funded plans.
What is meant by usual, customary or reasonable (UCR) charge?
Usual, customary or reasonable charges reflect the prevailing fees for service in an area. Many insurers and managed care plans reimburse providers based on UCR charges. This term may be synonymous with a fee allowance schedule.
Does Vein Clinic PA accept Medicare?
We accept all forms of Medicare and will bill Medicare directly on your behalf. Medicare requires us to ask you about your insurance status, including other insurance you may have, each time you visit us. We may also ask you to sign a form acknowledging your responsibility for charges Medicare will not cover.
If you have secondary or supplemental insurance, we will also file a claim with this company on your behalf. Secondary and supplemental insurance coverage varies by plan and carrier. There is no guarantee of full coverage and you may be responsible for a portion of the bill.
Does Medicare “cover” all services deemed medically necessary?
Generally, Medicare will pay 80% of Medicare-approved amounts. Typically, this leaves 20% that must be covered by supplemental insurance or paid by you. In addition, an annual deductible must be satisfied each calendar year, and some Medicare plans have additional co-pays or deductibles that must be paid by the patient.
What are the Medicare Deductible and Coinsurance Charges?
The Medicare “Deductible'' is the amount that must be paid by a Medicare beneficiary before Medicare will pay for any items or services for that individual. Currently, the Medicare Part B* deductible is $147 per year. The Medicare “Coinsurance'' is the portion of the cost of an item or service which the Medicare beneficiary must pay. Currently, the Medicare Part B*coinsurance is generally 20% of the reasonable charge for the item or service. Typically, if the Medicare reasonable charge for a Part B item or service is $100, the Medicare beneficiary (who has met his/her deductible) must pay $20 of the physician's bill, and Medicare will pay $80.
Can Vein Clinic PA waive a balance owed by the patient?
Federal Law prohibits us from routinely waiving patient balances. Routine waiver of deductibles and coinsurance is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3) excessive utilization of items and services paid for by Medicare. A Physician’s Office that is routinely waiving Medicare coinsurance or deductibles is misstating its actual charge. In certain cases, a Physician’s Office that routinely waives Medicare coinsurance or deductibles also could be held liable under the Medicare and Medicaid anti-kickback statute. The statute makes it illegal to offer, pay, solicit or receive anything of value as an inducement to generate business payable by Medicare or Medicaid.
What if I cannot afford to pay for my portion of charges?
One important exception to the prohibition against waiving coinsurance and deductibles is that providers may forgive the coinsurance in consideration of a particular patient's financial hardship. This hardship exception, however, must not be used routinely; it should be used on a case-by-case basis. Please see our Financial Hardship policy for details. Except in circumstances where financial hardship will apply, a good faith effort to collect deductibles and coinsurance must be made. Otherwise, claims submitted to Medicare may violate the statutes and other provisions of the law.
* Medicare Part B covers services offered at Physician Offices
What is a Medicare Summary Notice?
Medicare will send you a Medicare Summary Notice (MSN) every three months listing the services and supplies billed on your behalf, what Medicare paid, and what you may owe us. This is not a bill. You will receive a bill from us if you have a remaining balance after Medicare's payments and any secondary insurance have been applied.
What is a Medicare Advantage Plan?
Medicare Advantage Plans work a lot like private insurance. In fact, they're offered by private companies but approved by Medicare. These plans may cover services offered at Physician Offices (Medicare Part B). If you have a Medicare Advantage Plan, and we are in-network with your insurer, we will bill your plan on your behalf instead of Medicare.
Explain “Medicare approved amount” and “write-off”.
Medicare sets rates for medical services and procedures that all contracted physician offices must follow. This rate may also be called the "Medicare approved amount”. If the Medicare approved amount is less than the amount we charge for a service or procedure, the difference is “written off” – meaning you aren't expected to pay it.
How long do you wait to send unpaid bills to collections?
- Sending an account to collections is something Vein Clinic PA sees as a last resort. We understand that patients may not have the means to pay their bills in full, and our experienced team members at Patient Account Services are happy to work with you to set up a payment plan that fits your budget.
- You will receive three billing statements sent about 30 days apart and, if necessary, a final notice. That means patients receive as many as four billing statements from us before we consider sending an account to collections. If you are unable to pay your account in full, we encourage you to contact our Patient Account Services as soon as possible 952-641-4498.
- If you have a copay or coinsurance that applies to a service or procedure, Medicare or your Medicare Advantage Plan provider will reduce its payment by that amount. Here's an example:
|Detailed Ultrasound Scan (mapping)|
|Medicare approved amount:||$240|
|Medicare pays 80% of approved amount:||-$192|
|Your supplemental insurance pays 20% of approved amount:||-$48**|
|We write off the difference between our charge and Medicare's approved amount:||-$410|
|Balance with supplemental insurance:
Balance without supplement insurance:
** If your supplemental insurance does not cover this amount, you will be billed this portion of charge
Example 1: Copayment, Deductible, Coinsurance, Out of Pocket Max
The example assumes this patient is seeking healthcare services within their network (in- network example). It shows the cost sharing from the patient’s point of view. This patient’s insurance plan features:
80/20 coinsurance rate** (up to $5,000)
$5000 Out-of-Pocket Maximum
* excluding some doctor visits, which may be covered by $20 copayment
** insurance company pays 80%, and you pay 20%.
The previous example is a simple illustration created in order to give you a better understanding of health insurance. Your policy can have different deductible, coinsurance, or copayment. Please contact your Insurers for details and information specific to your coverage.
Example 2: In-Network versus Out-of-Network
The example assumes this patient is comparing their benefits for in-network verses out-of- network healthcare services. It shows the cost sharing from the patient’s point of view. This patient’s insurance plan features:
80/20 coinsurance rate** (up to $1,000)
$1,000 Out-of-Pocket Maximum
* excluding some doctor visits, which may be covered by $20 copayment
** In-network: insurance company pays 80%, and you pay 20%
70/30 Coinsurance rate*** (up to $2,000)
$2000 Out-of-Pocket Maximum
* excluding some doctor visits, which may be covered by $20 copayment
*** Out-of-network: insurance company pays 70%, and you pay 30%
Once your out-of-pocket maximum has been met, that is the maximum you will pay during current plan year. Many policies allow the deducible and out-of-pocket max to apply to both networks.
Who is FAIR Health?
In 2009, an investigation by then-New York State Attorney General Andrew Cuomo uncovered conflicts of interest in one system that health insurers used to calculate reimbursement for patients who received care from providers outside their plan’s network. As a result of this investigation, FAIR Health – an independent, not-for-profit corporation – was created to establish and maintain a new database that could be used to help insurers determine their reimbursement rates for out-of-network charges, and provide patients with a clear, unbiased explanation of the reimbursement process.
As part of the collective settlement the Attorney General’s office reached with the insurers, FAIR Health received millions of de-identified healthcare claims that many had used to help them determine their rates. This data continues to be analyzed and processed with the goal of increasing its completeness, accuracy, and neutrality, as it will form the basis of our licensed products. The data is also the basis of educational products and tools for consumers made available on this website. - See more at: http://fairhealthconsumer.org/whoweare.php
featuring Medical Cost Lookup for Consumers