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Understanding Insurance Coverage for Vein Treatment

When it comes to seeking medical treatment, insurance coverage often plays a crucial role in determining the financial burden on patients. Many people assume that choosing a physician who participates in their insurance plan is the only way to tap into their insurance benefits. 


However, in the vein treatment field, there’s an interesting aspect to explore – your insurance may cover some of the costs even if your chosen vein treatment doctor isn’t participating with your insurance provider – or they may not cover any of your care, even if your provider is participating.

How Does Out-of-Network Coverage Work?

In the world of healthcare, the terms “in-network,” “out-of-network,” “non-participating,” or “non-par” are commonly used. Participating physicians – or in-network physicians – have established agreements with insurance companies, often resulting in lower costs for patients. On the other hand, non-participating doctors may not have such agreements, leading individuals to believe that their insurance won’t cover the associated expenses.


Surprisingly, when it comes to vein treatment, this isn’t always the case. Insurance providers may cover a portion of the treatment even if the selected doctor is not part of their network. This can be particularly relevant when seeking specialized care from experienced vein treatment specialists who may not be participating with all insurance plans.

Before & After Photo Gallery

*Individual Results May Vary

Real Patients. Real Results. View before & after images of vein and cosmetic procedures in our photo gallery.

Factors Influencing Insurance Coverage for Vein Treatment

Several factors come into play when determining whether insurance will even cover a portion of your vein treatment costs with a non-participating physician, as not all treatment is covered, even with participating physicians.

High Modern Deductibles 

Until several years ago, most deductibles were reasonable, maybe $500-$1000. Today, most people have very high deductibles, we often see a $5,000-$10,000 annual deductible. So whether or not your physician is participating may not even matter, especially if you do not receive regular healthcare throughout the year, since the patient will be paying that deductible amount out of pocket anyway. The choice between in-network and non-participating providers might be less impactful than before, as patients often bear the brunt of their deductible expenses regardless. 

Medical Necessity 

If your vein treatment is deemed medically necessary, insurance providers are more likely to cover a significant portion of the expenses, regardless of the doctor’s network status.

Type of Treatment

Not all vein treatments are covered; for example, no insurance provider covers spider vein treatment, which is considered cosmetic and, therefore, elective.


Some insurance plans require pre-authorization for certain procedures. Checking with your insurance provider and obtaining pre-authorization can increase the likelihood of coverage.

Out-of-Network Benefits

Most insurance plans have out-of-network benefits that cover certain medical services, even if the doctor is not in-network. Review your policy to understand the extent of these benefits.

Exceptional Circumstances

In certain situations, insurance providers may make exceptions and offer coverage for out-of-network care, especially if no suitable in-network providers are available or if the out-of-network doctor possesses unique expertise.


In a case where a physician of your choosing is non-par with your insurance plan, as long as your policy is PPO (rather than HMO), the non-par doctor can still bill them, and they will still typically cover treatment, just at different rates for deductible and co-pay compared to if you were seeing a participating physician. 

Consultations Available Now

To learn more, schedule your consultation with Dr. Schwartz by filling out the form on this page or by calling his practice at 913-451-8346. Premier Vein & Body by Schwartz serves patients throughout the Kansas City metro.

Navigating the Insurance Coverage Process for Outpatient Vein Treatment

To ensure coverage for your vein treatment with an out-of-network doctor, follow these steps:


  • Verify Insurance Coverage: Contact your insurance provider to understand the specifics of your coverage, including any out-of-network benefits and pre-authorization requirements.
  • Communicate with the Doctor’s Office: Inform the vein clinic office manager about your insurance coverage and discuss potential payment options. They will be able to assist you in navigating the insurance process.
  • Keep Detailed Records: Maintain detailed records of all communications with your insurance provider and the doctor’s office. This documentation can be valuable in case of any disputes or clarifications needed.


Navigating vein treatment costs involves understanding the caveats of insurance benefits, requirements for coverage, rising deductibles, and self-pay options. Patients can make informed decisions by considering their insurance type, deductible levels, and the availability of self-pay discounts. As the healthcare landscape evolves, this article aims to empower individuals to prioritize their vein health without compromising financial well-being.

Can I Get Vein Treatment If I Do Not Have Insurance or My Doctor Is Not In-Network With My Plan?

Our team will work with you to find the best payment plan, regardless of insurance coverage. Here are some things to consider if you do not have coverage for your treatment.

Self-Pay Option

For patients without insurance coverage, a self-pay option is available at a discounted rate of $3,150 per treated leg at Premier Vein & Body by Schwartz. This includes all codes performed in a single session, offering an affordable alternative.

Understanding Allowable Amounts

The amount charged to the insurance company is not the primary concern; what matters is the allowable amount set by the insurance provider. With non-participating insurance, billing is based on the self-pay discount, providing a transparent and consistent approach to costs.

Determining Patient Responsibility

If the allowable amount exceeds $3,150, patients are responsible for their standard deductible and co-pay, mirroring the process for both in-network and non-participating scenarios. If the allowable amount is below $3,150, patients cover the difference up to the self-pay discount. For instance, if the allowable amount is $2,800, the patient pays the additional $350.

Maximum Patient Payment

In the worst-case scenario where insurance doesn’t contribute any payment, the most a patient would pay is the self-pay discounted rate of $3,150.


*Individual Results May Vary


Read from real patients about their experiences with Dr. Schwartz and his team at Premier Vein & Body by Schwartz.

Take the Next Step

If you have further questions about varicose vein treatment or your specific insurance plan coverage, please call us at (913) 451-8346 or complete our online contact form, and one of our trusted staff members will reach out to you. Premier Vein & Body is located in Kansas City, MO, just across the state line, and proudly serves Overland Park, Johnson County, and the entire Kansas City metro area.


** This blog provides general information and discussion about medicine, health, and related subjects. The words and other content in this blog and any linked materials are not intended and should not be construed as medical advice. If anyone has a medical concern, they should consult with an appropriately licensed physician.

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