Find the most highly trained venous specialist who has a real passion for venous patients. Ask about training, credentials, and experience. There are many venous specialists with various and different backgrounds, such as Vascular Surgeons, General Surgeons, Interventional Radiologsts, and others. For example, vascular surgeons go through a rigorous residency and fellowship program that cover the entire vascular system (arteries, veins, lymphatics), and are also experts in non-operative management and risk factor modification. Seeing a vein specialist does not necessarily mean needing a procedure.
As a patient, it is your right to be informed about the specific training and credentials of your healthcare provider.
Accurate history taking is vital for you to receive appropriate and necessary care. This require that the provider asks you to fill and sometime sign an accurate medical questionnaire. It is very important that the medical record accurately reflects what you have told the provider. Misrepresentation of leg complaints in the medical record is never appropriate and may lead to excessive or inadequate medically necessary treatments. Make sure that you explain in great detail when your symptoms started, their location, what triggers them, and how they affect your life.
As a patient, you should only receive necessary care based on an accurate history
Most of the times health insurance companies require conservative measures such as use of compression stockings (if indicated and tolerated), exercise, weight loss and other measures before an invasive treatment is approved for reimbursement. Without entering in the merit of these requirements, any documentation of nonoperative measures such as compression stockings even though none had been used is considered insurance fraud. Inflating a medical history to have services covered by insurance should not be solicited. Providers are not to make any untrue statements in the chart, even when pressured.
As a patient, you have the right to request a copy of your medical records and verify the accuracy of its information.
Running an quick ultrasound without a preliminary interview and a physical exam is called "screening" and it does not meet the criteria for a thorough and complete test. Ultrasound is a non-invasive test performed by a trained technician and is ordered by a physician. A proper test requires a physician`s request to include the indication. Being a venous ultrasound very operator-dependent, it needs to be directed by your symptoms and physical findings, and it needs to be performed by a trained staff. To evaluate for venous insufficiency, an ultrasound needs to be done with the patient in the standing position for the most part, and if this is not possible for you the exam table needs to be tilted enough that your feet are at a much lower level than the heart.
Ask to be tested in standing position for venous insufficiency, and ask to be interviewed and examined before your first ultrasound exam.
Venous ultrasound testing is to be performed or supervised by a certified sonographer and accurately reported and signed by a physician who has the appropriate training, experience, and credentials for making an accurate ultrasound diagnosis. Ultrasounds are performed and interpreted based on defined venous ultrasound criteria, and improper technique or readings may lead to treating the wrong vein, not treating the right vein, or treating the veins improperly. Ultrasonographers are not compensated for finding a problem in your veins but for delivering a compassionate, thorough, unrushed, safe, and reliable exam.
As a patient, it is your right to be made comfortable during the exam and to obtain a copy of your ultrasound exam to keep for your own records.
Venous conditions can be purely cosmetic (i.e., varicose and spider veins without symptoms), or require medical attention due to significant signs (i.e., inflamed skin, swelling) or subjective symptoms (i.e., significant pain). Health insurance companies cover only certain medical procedures when they consider them medically necessary. On the other hand, ablation of a healthy vein or a vein that causes insignificant symptoms is generally not considered appropriate or necessary care. Cosmetic treatments are not reimbursed by insurance, and medical claims related to esthetic problems cannot be submitted. Treatment of varicose veins based only on ultrasound results is considered inappropriate care. Medical decisions are made from a combination of history, physical examination, and diagnostic tests.
As a patient, you should always be aware of what the medical necessity of your treatment is.