Physician Referrals: Are They Necessary?

One Out of Every Two

According to the Society of Interventional Radiology, more than 30 million Americans suffer from venous insufficiency – decreased blood flow from the legs to the heart. By age 50, one out of every two adults experiences varicose veins, with damaged or weakened valves allowing blood to pool or reflux instead of flowing back to the heart for oxygen and other nutrients. Unfortunately, the majority suffer in silence, waiting for a physician referral that may come only after life-threatening complications appear.

Varicose Veins Underdiagnosed and Undertreated

Venous disease and its associated varicose veins are increasingly gaining attention as undertreated, underdiagnosed and even often misdiagnosed problems: 

• The American Heart Association states, “Chronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem.”
• A scientific paper published on Vascular Disease Management from the Northern Heart and Vascular Institute in Redding, California, states, “Despite significant advancement in its treatment options, venous insufficiency remains the most prevalent yet underdiagnosed vascular disorder today.”

Need for Specialized Varicose Vein Treatment

When asked to explain the causes of undertreatment, medical professionals repeatedly cite the lack of:

• Trained vein specialists focused solely on venous issues
• Understanding that varicose veins are a serious treatable medical condition
• Knowledge about new, safe minimally invasive vein treatments

Physician Referral Process

Typically, when patients present symptoms beyond their general practitioner’s area of expertise, their physician will refer them to a specialist. While often serving patients well, the referral system does have drawbacks, particularly for patients suffering symptoms from varicose veins:

• Many doctors and patients don’t realize that most insurance companies – including Medicare – cover medically necessary procedures to treat varicose veins.
• Medical problems resulting from varicose veins may be attributed to other health conditions, such as diabetes or high blood pressure.
• Doctors may treat venous insufficiency symptoms – like prescribing diuretics for swelling or medications for restless leg syndrome – leaving the underlying varicose veins causing the issue untreated.
• Some doctors delay specialized treatment and try to address the problem because they don’t want to appear unknowledgeable or incompetent.
• Many patients are afraid to ask for a referral for fear of offending their physician.
• Many times, specialists require a physician referral and schedule appointments weeks or even months down the road, further delaying assessment and treatment.
• Insurance requirements may be confusing. Some insurance policies require physician referrals and precertification for patient appointments with specialists. Others may not require referrals but have preferred networks and providers that patients must use.
• The long wait times involved at every step of the referral process can be discouraging as quality of life continues to suffer.

Understanding Varicose Veins 

Medical – Not Cosmetic. Varicose veins are a recognized, serious medical condition with potential risk for complications that can impact every aspect of quality of life. Many times, spider or varicose veins are visibly evident, but too often, patients fail to recognize accompanying symptoms in the lower body, such as:

• Aching, pain, cramping or throbbing
• Heaviness and tiredness
• Itching or burning
• Tingling or numbness
• Restless legs
• Swelling
• Skin discoloration

Complications. Too often, symptoms progress to critical conditions before patients come to MIIGS. In fact, about half of the patients treated by MIIGS are at risk for amputation when they first visit the center. When blood pools in the lower limbs, patients can experience complications, such as:

• Cellulitis that rapidly spreads
• Thrombophlebitis, or vein swelling
• Venous ulcers
• Delayed wound healing
• Systemic infections
• Limb loss

General Criteria for Treatment and Coverage. Most insurance companies have four fairly standard criteria for establishing whether they will cover venous treatments. Three of these criteria patients can usually assess for themselves. The last requires a specialist. 

The criteria are as follows:

1. Is a patient experiencing the painful symptoms described associated with varicose veins and their complications?
2. Are varicose veins visible on standing digital photos?
3. Have conservative therapies – such as wearing medical-grade compression hose, elevating the legs or limiting standing activities – failed?
4. Does an ultrasound assessment show venous reflux and pressure?

MIIGS and Minimally Invasive Vein Treatments

Recognizing the need for vein specialists offering safe, immediate treatments for varicose veins, four Louisiana doctors partnered to form MIIGS in Alexandria – the region’s only interventional radiology clinic. Our physicians are Board of American Radiology-certified vein specialists dedicated to identifying and treating the underlying causes of often life-threatening complications through minimally invasive treatments. MIIGS also houses a full staff of certified nurses and trained administrators experienced at guiding patients through the process of consultation, treatment and recovery.

No Physician Referral Necessary

While many vein specialists require a physician referral, MIIGS does not. Slightly less than half of the patients we treat are physician referrals, with the other 50 to 60 percent self-referred. Patients should check with their insurance company to confirm whether a physician referral is necessary for the insurance company to cover the costs of consultations and treatments at MIIGS. Our doctors offer same- or next-day appointments and can plan a course of safe, convenient treatment to follow the initial consultation.

Fears and Delays

Many patients delay seeing a vein specialist. They may be frustrated with painful symptoms and ineffective treatments yet fearful of painful surgical procedures with extended recovery times. Meanwhile, many of those same patients have had to alter their lifestyles as well as family and social relationships for months or even years because movement is too painful or they must wait for ulcerations to heal. Interventional radiology offers a better way.

Interventional Radiology at MIIGS

Interventional radiology uses guided imaging equipment to target and treat a variety of conditions through advanced techniques that are minimally invasive. MIIGS interventional radiologists use X-rays, ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) to treat conditions that traditionally required open surgery under general anesthesia. Instead, interventional radiology procedures are typically easier for patients, with:

• Little to no pain and usually no need for general anesthesia
• Quick recovery times, often with immediate resolution of circulatory problems
• Only small, pinpointed incisions to allow catheter access to collapse the vein
• Convenient access, with outpatient procedures performed at the MIIGS clinic

Two of the most commonly used minimally invasive treatments are radiofrequency and laser ablation. They are medically effective 90 percent of the time, and patients report improvement in symptoms 95 percent of the time.

One Consultation Can Change a Life

MIIGS welcomes all patients experiencing symptoms of peripheral vein disease, varicose veins, venous insufficiency or venous disease. Many of our patients suffer from additional risk factors, such as elevated blood cholesterol, diabetes, hypertension, inactivity and excess weight – all factors that can turn heavy, achy, cramping pain or nonhealing critical wounds into emergency situations. At MIIGS:

• We don’t require physician referrals
• We can schedule same- or next-day appointments
• Most insurance covers medically necessary vein treatments
• We specialize in safe, convenient, minimally invasive treatments with little to no downtime

If you know someone too afraid to see a doctor or someone who has had to limit their lifestyle to accommodate painful symptoms or complications, tell them about MIIGS. Patients can call us at (318) 528-7560 or visit our website to submit an online form, obtain more information or even schedule a consultation. Knowledge is power, and one consultation can change a life. Read one of our patient recovery stories, and it just may change your mind about what your future holds.