Vein Surgery

Vein evaluations are available at either the Nebraska Medical Center or at the Village Pointe Aesthetic Surgery center. Please call 402-559-8200 to schedule 

What to expect from your vein evaluation 

  1. All patients being evaluated for varicose veins will be seen by our nurse practitioner or physician assistant for an initial consultation.  She will do a thorough assessment of your circulation and will closely examine your veins to determine what the best treatment option may be for you.  Risk factors for varicose veins will be identified and suggestions will be given for ways to control and eliminate these risks. 
  2. All patients will be scheduled in the vascular lab at University Hospital or Village Pointe Aesthetic Surgery for a venous ultrasound.  This ultrasound will look for faulty valves within the veins, as well as the presence of an undetected blood clot, or other problems that could be causing the varicose veins. 
  3. All patients will be given a prescription for graduated compression stockings.  The strength of compression and style (below-knee, above-knee, pantyhose) will be determined based on your vein pattern and personal preference.  This is a necessary step required by all insurance companies.  Many patients find that the compression stockings are all that they need to control the symptoms they have been experiencing.
  4. A follow-up appointment will be made with one of our vascular surgeons to evaluate the effectiveness of the stockings, and to review results of your venous ultrasound.  At that time, the surgeon will make the final decision about what type of procedure is best suited to treat your vein problems and we will petition your insurance company for pre-authorization to perform the procedure.
  5. When we have obtained pre-authorization, which could take anywhere from 1 week to 4 months or longer(depending on the insurance company) we will notify you so that you can be scheduled for surgery, and pre-operative arrangements can be made.

Vein Services that are available

  1. Endovenous laser therapy or venous ablation (EVLT)— a laser fiber is inserted in a larger vein in the thigh and as the laser is pulled back, the vein closes on itself.  This is an outpatient procedure, allowing you to return to work within 5-7 days.  Since this is a new procedure, many insurance companies do not recognize this as a standard treatment, and will not authorize payment.
  2. Vein ligation or stripping—removal of small parts, or long segments of varicose vein.  This procedure is generally outpatient, but some patients will be required to stay overnight in the hospital.  Recovery is usually 2-4 weeks, and significant bruising and swelling is common. In most cases, patients are able to return to work in 7-10 days.  Many insurance companies will pay for this type of procedure, provided adequate medical information is supplied, and individual company criteria is met.
  3. Stab phlebectomy—tiny incisions are made to interrupt the smaller varicose veins.  The incisions are so small they are typically not even stitched, but allowed to close on their own, eventually leaving a very minimal scar.
  4. Injection sclerotherapy—a solution is injected into the smaller veins, causing them to shrink away.  This is an office procedure, and patients can return to work the same day.  Only small veins are appropriate for this procedure.  Often this procedure is done after the stripping or EVLT to remove the remaining varicose veins.  Insurance companies oftentimes will not pay for this procedure, as it is deemed “cosmetic”.  Out of pocket cost for this can range from $330-$410 per visit.  Payment is expected at the time of the appointment.

The pre-authorization process

Nearly every insurance company requires that patients have a period of medical management prior to approving any surgical procedure.  Medical management includes compression stockings, and leg elevation.  Other specific requirements are based on each insurance plan.  We encourage you to contact your insurance company before we see you and find out exactly what your company requires.  While some insurance companies view varicose veins as a legitimate medical problem, others see this as a strictly cosmetic procedure, and do not routinely cover any vein procedures.  Policies change yearly, so it is difficult to predict what your company might decide regarding your particular claim.

During the pre-authorization period, we will send all of our office notes, your venous ultrasound report, and a standard letter, requesting pre-approval with the appropriate information included.  It generally takes 7-10 business days after the surgeon sees you before this documentation is sent, since we must allow time for transcription of the information.  If possible, please find out ahead of time where your information needs to be sent.

We will attempt to obtain pre-authorization for your vein procedure one time only.  If your insurance company denies this procedure, it is up to you to contact them and petition them to reconsider.  Our secretaries will be happy to send you copies of all of our documentation to assist you in this process. 

We will also be happy to discuss out-of-pocket payment options with you, with charges based on your procedure.  If this is an option you would be willing to consider, our office financial advisor will be happy to meet with you.