Blue Shield of California Promise Health Plan Accepted
La Jolla Vein & Vascular is excited to announce as of June 1st, 2024, we will accept BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN Medi-Cal insurance.
In San Diego County, Blue Shield Promise Medi-Cal is contracted with the Department of Health Care Services (DHCS) of San Diego County to provide Medi-Cal health benefits to its Medi-Cal recipients. We are pleased to announce our providers now also accept this health plan.
What will Blue Shield of California Promise Health Plan Medi-Cal insurance pay for at La Jolla Vein & Vascular? Members will have access to our award-winning doctors who specialize in the diagnosis and treatment of a wide range of vein conditions including varicose veins, venous leg ulcers, and chronic venous insufficiency. Insurance will typically cover the cost of seeing our doctors, ultrasound examanations, and medically necessary vein treatment.
Will Blue Shield of California Promise Health Plan Medi-Cal insurance pay for varicose vein treatment? Blue Promise will pay for varicose vein treatment that is deemed medically necessary. See the criteria below. Insurance will typically cover the cost of seeing the doctor for an evaluation and the diagnostic ultrasound.
Am I able to have my veins treated if I have Blue Shield of California Promise Health Plan Medi-Cal insurance? Prior authorization and approval by the health plan is required. This means the doctor will submit their notes and findings as to why vein treatment is felt to be medically necessary. Blue Promise will review the medical records and doctor’s supporting notes and may approval vein treatment if certain criteria are met. The criteria for medically necessary vein treatment is below:
1. Varicose veins must cause leg pain or other symptoms.
Medically necessary vein treatment means that the varicose veins must cause symptoms such as: leg pain, heaviness, persistent swelling, night-time cramping or burning. Complications of varicose veins that may indicate treatment include leg ulcer (open wound) from the vein problem, recurrent blood clots or phlebitis, ruptured bleeding vein, or skin discoloration around the ankle.
2. Symptoms affect daily life.
The symptoms must be severe enough to affect a person’s ability to do their daily routines or work. For example, a teacher may have varicose veins that prevent them from standing and doing their job, because they have to take frequent breaks to elevate their legs. A server at a restaurant may no longer be able to work long shifts, due to leg pain after a few hours. Symptoms can interfere with lifestyle by limiting the amount of exercise one hopes to achieve, or inability to cook or do house chores due to leg pain.
3. Conservative Treatment must be tried for 6 -12 weeks.
In most cases, insurance require that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss, anti-inflammatory medication such as ibuprofen or venoactive agents such as horse chestnut or Vasculara, and hot/cold packs. Many insurance types REQUIRE 6 to 12 weeks of wearing medical grade compression stockings prior to being approved for treatment. You should have your consultation as soon as possible and begin implementing conservative management into your lifestyle. You should begin keeping a daily log documenting that you are using conservative treatments. If your primary care physician has already prescribed compression stockings, it is helpful if you have a note, you’re your doctor or the prescription, as this counts toward your conservative management time period.
4. Venous reflux must be demonstrated on ultrasound.
Underlying venous insufficiency must be documented by ultrasound examination. The ultrasound study to determine the treatment and the physician visits are covered benefits with most insurance types.
Treatments that are not covered by insurance because they are considered to be ‘cosmetic services’ include:
- Varicose veins that do not cause any symptoms
- Spider veins
Click here to see if you meet criteria for medically necessary vein treatment. Schedule your consultation with the doctor today at either our La Jolla or Vista
location. Call 858-550-0330.
