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We have all seen spider veins and many of us know someone who has had them treated. Unfortunately, we have also heard of those who have given up on treating their spider veins because they “keep coming back.” Too often this results from either the physician’s lack of knowledge regarding the correct treatment for spider veins or unrealistic expectations by the patient.

Lately, it seems that we are inundated with ads for discount spider vein treatments, often by unqualified opportunists who seek to make a quick buck. The need for retreatment or lack of a definitive cure punish those who are ill informed. Likewise, it rewards the profiteers who are either unscrupulous or untrained to recognize and treat the real cause.

Unfortunately, the medical profession and state licensing boards have no rules as to who can treat venous disease. Therefore, it is not uncommon for inappropriate “specialties,” ranging from emergency medicine to pain management physicians, to sell themselves as “vein specialists.” Not only have these so called “vein specialists” misled patients but they have created a “board” to credential themselves, which is not recognized by the American Board of Medical Specialties, the credentialing body that certifies expertise in a field. This unrecognized credential leads to a false sense of security for the patient and potential for harm. Surprizingly, it is not illegal to call oneself, for example, a cardiologist, even without formal training; nor is it illegal to be “Board Certified” by a private company that sells the title. With that being said, among the authentic board certifications, there is a significant difference between being certified by the American Board of Internal Medicine Subspecialty Board of Cardiovascular Diseases and the American Board of Cardiology.

Patients are often told that their insurance does not cover spider vein treatment, a statement that is completely false for many patients. Insurance companies do cover treatment for venous disease from appropriately trained and credentialed physicians when the criteria are met. Usually, the physician must specialize in interventional cardiology or radiology, vascular surgery or dermatology. Physicians in these areas have the background and supervised apprenticeship (residency and fellowship training) to treat not only the disease but the potential complications of the disease.

As in all things, it is best to perform due diligence. Here are some guidelines:

  • Check a treating physician’s credentials and reputation in the community, prior to subjecting yourself to treatment that can result in far more serious consequences than a blemish or the need for retreatment.
  • Rarely will you find appropriately trained specialists running discount ads. Furthermore, the individual’s reputation within the community of peers is usually well known. The greatest compliment physicians can receive is to have their patients be the prime sources of their referrals. Therefore, inquiring with patients who have been treated by that specialist is always a good idea.
  • Not all cardiologists are equal. Training and experience in interventional cardiology or, at least, invasive cardiology, is essential. Likewise, interventional radiologists are the only radiologists who are qualified, by virtue of their training, to perform invasive procedures.
  • Not all vascular surgeons perform venous procedures. Calling oneself an expert or paying a service to do it for you does not make it so.
  • Is the physician credentialed by your insurance company to do venous procedures? If not, it is likely that the doctor does not have the necessary training to meet insurance standards. Therefore, they should not meet your standards either.
  • Check the Board of Medicine to assure yourself that this particular physician has not had his or her license revoked, suspended or modified in any way, nor has he or she lost or relinquished hospital privileges to avoid disciplinary action.

Once you have decided on a specialist whom you are with, you will want to have some questions answered before deciding to undergo treatment. Reasonable questions to ask are:

  1. Will the specialist be doing the treatment?
  2. Will I see the specialist before, during and after treatment?
  3. How can I get a hold of the specialist if I have a problem?
  4. What are the possible complications of the procedure?
  5. Does the specialist have specific training in invasive procedures?
  6. Is this covered by my insurance and, if not, why not? (Call your insurer to check for yourself if the answer is no.)
  7. How many treatments will I require and are they all covered?
  8. Does the specialist perform other invasive procedures?
  9. Does the specialist have hospital privileges to do this procedure?
  10. Is the performing physician affiliated with any universities or medical schools?
  11. Does the physician teach students or other colleagues this specific procedure?

Regarding medical tourism: Few credentialed physicians are willing to treat the “medical tourist” who went out of country to get a deal on treatment and returned with a far more difficult condition to treat with a lower likelihood of a successful outcome. Caveat imperator! Buyer beware!