title: Inequalities of health insurance guidelines for the treatment of symptomatic varicose veins.
abstract: OBJECTIVE
  The emerging model of US health-care delivery is aimed at reducing costs, standardizing care, and improving outcomes. Although it is necessary for health-care providers and insurance carriers to work together to achieve those goals, insurers have the added duty of assuring physicians and patients that they comprehend the medical evidence and, based on that understanding, construct policies. Are US insurers meeting that responsibility or are they simply creating policies to serve their own needs?
  
  
  METHODS
  The medical policies of several US health insurers were analysed. The goal was to see whether it could readily be determined if these carriers used evidence-based medicine consistently to create uniform policies for the treatment of patients with symptomatic varicose veins. The literature was also reviewed to determine whether increased insurance documentation requirements have affected cost reduction, standardization of care and/or improvement of outcomes related to chronic vein disease management.
  
  
  RESULTS
  There is a dramatic lack of uniformity among the insurance policies reviewed. Insurers appear to not choose important papers to create policy but use carefully chosen articles to reinforce what they want their policies to say. In so doing, conflicting policy criteria are being created. Complicating this inconsistency, rules for medical necessity are modified frequently, raising frustration levels among vein providers and their patients. What is clear is that costs are not being lowered, care is not being standardized and little is being done to prevent potential complications resulting from chronic vein disease.
  
  
  CONCLUSIONS
  Patients and physicians are increasingly ill-served by, and frustrated with, the clear lack of consistency in the medical policy criteria being created by US insurance carriers in covering the treatment of patients with symptomatic varicose veins. The contradictory coverage requirements, seemingly based on no understanding of evidence-based medicine guidelines, and total variability in reimbursement for various types of treatment options is particularly worrisome. Collaboration between venous treatment providers and insurance carriers, to create evidence-based standards of care, would be timely and beneficial in creating guidelines for optimal patient care.
authors.affiliation: Unity Healthcare, LLC, Lafayette, IN, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Schul
authors.forename: T
authors.initials: T
authors.lastname: King
authors.forename: L S
authors.initials: LS
authors.lastname: Kabnick
mesh_terms: D002908:Chronic Disease; D003657:Decision Making; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D014648:Varicose Veins / Q000628:therapy*; D014652:Vascular Diseases / Q000191:economics / Q000628:therapy
keywords: chronic venous disease; chronic venous insufficiency; compression stockings; endovenous thermal ablation; patient reported outcomes