Positive Change for Once
by Cheryl Nash and AJ Riviezzo
United Health Care, effective October 25th, 2010, has again revised their medical policy guidelines for ablations. The submission of color photographic prints is no longer required. Also, the submission of US prints is no longer required. It appears their system could not handle the massive amount of data they were receiving thus forcing a change.
The best news coming out of the new policies is that compression stockings are no longer required as a part of conservative treatment. A completed questionnaire addressing the degree and severity of pain still must be submitted for authorization. This questionnaire can be found at: https://www.unitedhealthcareonline.com
The bad news is that diameter sizes have not changed… it is still 5.5mm for GSV, 5mm for SSV. Only one measurement is required. If bleeding or ulceration is present vein sizes of a lower diameter will be accepted.
Perforator size for treatment has dropped to 3.5mm. Additionally, the notes must document the presence of venous stasis ulceration for laser or RF ablation of the perforator.
There are some other requirements so please read the policy for some of the various nuances.
Intersting that only 1 measurment of the GSV and the SSV is required. They will be measured at the sinuses to give the greatest measurment. Also, how about the patients who are 5 foot 1 with veins 4mm that are incompetent? This is still a great improvement from their last update. I still think the timing of the reflux is worth noting. If there is no critera for the seconds of reflux, 'mild' and 'moderate' can mean anything. I think numbers are more concrete.