AVF efforts to work with insurers to update their venous coverage policies to reflect current nomenclature and to reflect clinical practice guidelines which have been developed by the AVF/SVS continue to gain ground! The latest can be seen in the Anthem Blue Cross CA policy on:
Subject: Treatment of Varicose Veins (Lower Extremities)
Document #: SURG.00037 Publish Date: 12/29/2021
Status: Revised Last Review Date: 11/11/2021
With no particular fanfare they begin their description of medical necessity as including:
- Truncal vein incompetence (that is, reflux with retrograde flow of 0.5 second duration or greater in the GSV, AAGSV, or SSV) based on vein anatomy is confirmed by Doppler or duplex ultrasound evaluation and report; and
- Prior policies had required “junctional incompetence.”
This simple change will save the frequent denials in patients with a competent SFJ but symptomatic reflux down the remainder of the GSV.
We would like to thank the Medical Directors of Anthem Blue Cross CA for addressing our concern about their prior policy and for their willingness to update this policy which benefits their patients and their providers.
The AVF Health Policy Committee continues to work to identify flawed coverage policies (commercial and governmental) and work toward bringing them in line with best practices.
Mark Iafrati, MD
Chairman, AVF Health Policy Committee
Please join us as we raise our collective voice for the sake of our patients!
It’s our honor to fight on your behalf.
Antonios Gasparis – President, AVF
Mark Iafrati – Chair, AVF Health Policy Committee
Please support these efforts with a donation to the American Venous Forum.