Negotiations with Health Insurers Can Lead to Positive Changes in Policies Towards Venous Disease.

Abstract

Many health insurance plan (HIP) policies toward the treatment of chronic venous insufficiency (CVI) are outdated, formulated by administrators with the advice of physicians unfamiliar with CVI, and are not evidence-based. Denial of appropriate care by the HIP is frustrating to both the patient and provider, leading to delays in care and much time and effort in the appeals process. This led to meeting with the HIPs outlining the problems with their CVI policies. Through education of the HIP medical staff and reviewers, the specialists were then asked to review the policies and recommend changes. As a result of the collegial communications with the HIPs, a number of changes were made in their documents regarding treatment of CVI. These include (1) proper nomenclature for the venous systems, (2) the elimination of the need for chronic analgesic medication, (3) treatment for nonaxial varicose veins, (4) decrease in the required length of conservative (ie, elastic compression stockings) treatment prior to surgery from 12 weeks to 6 weeks, among other changes as well. While HIPs seek to reduce expenses and maximize operating margins, they are also tasked with facilitating appropriate access to necessary medical care for their members. Cooperation among physicians can lead to a dialogue between payers and providers, and can lead to positive changes in HIP policies toward the treatment of venous disease.