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The Effect of Commercial Insurance Policies on Outcomes of Venous Ablations
Cassius Iyad Ochoa Chaar, MD, Afsha Aurshina, MBBS, Yawei Zhang, Fang Wang, Jonathan Cardella, MD, Kristine Orion, MD, Bauer Sumpio, MD, Timur Sarac, MD.
Yale University School of Medicine, New Haven, CT, USA.

The Effect of Commercial Insurance Policies on Outcomes of Venous Ablations
The use of venous ablation (VA) for treatment of chronic venous insufficiency (CVI) has exponentially increased. In order to limit cost and overuse, insurance companies have adopted various aleatory policies. The goal of this study is to compare policies of 5 major local insurance carriers and determine whether treatment within criteria of a certain policy is associated with improved patient outcomes.
A retrospective single center review of patients treated with VA was performed. Clinical success was defined by patients reporting improvement/resolution of symptoms in the leg treated and technical success by vein closure on ultrasound. Long-term follow up was collected by telephone survey inquiring about intensity of symptoms on a numeric rating scale 0-10 (NRS) prior and after treatment of each leg. The policies of AETNA, CIGNA, BCBS, UH and CTCARE were reviewed. The clinical and technical success rates were compared when veins were treated within criteria of each policy. A subgroup analysis looking at patients who had clinical success was performed to determine potential rate of denial of coverage for each policy.
There were 253 patients with 341 legs treated. The mean age was 58.5 15.2 (68% women). The most common symptom was pain (89.7%) with 47.8% of patients having C3 disease. The clinical success, technical success, and complications were 84.2%, 95.1%, and 3.8%, respectively. On survey, there was improvement of NRS in 84.3% of legs after procedure and 76.7% after mean follow-up of 26.8 months. There was no significant difference in clinical success, technical success or complication rate when patients were treated within the 5 insurance policies. Subgroup analysis of procedures with clinical success (n=287) showed significant difference between the 5 policies in potential denial of coverage ranging from 5.6% for CTCARE to 64.1% for UH (p<.0001). (Table)
The current insurance policies are equivalent in terms of selecting patients who benefit from VA. Policies with more stringent criteria typically restrict treatment to larger veins and deny a significant number of patients with CVI, procedures they can benefit from.

Patient Outcomes based on the criteria of different insurance policies
Veins treated within insurance policy n (%)237 (69.5%)236 (69.2%)275 (80.7%)121 (35.5%)320 (93.8%)<.0001
Outcomes based on chart review
Clinical Success84.8%85.2%84.7%85.1%84.7%1
Technical Success94.5%93.6%95.3%91.7%95%.65
Outcomes based on follow up survey
Improvement in NRS after procedure81.2%84.4%84.2%84.1%83.7%.91
Improvement in NRS long-term75%76.6%76.3%78.5%76.1%.98
Insurance Coverage for Successful Procedures (N=287)
Potential denial of coverage for successful procedures30%30%18.8%64.1%5.6%<.0001

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