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There Is More to Your Referral to a Vein Specialist (Phlebologist) Than Meets the Eye


When the Affordable Care Act (ACA) was introduced Americans were told, “If you like your insurance you can keep your insurance. If you like your doctor, you can keep your doctor.” For millions of Coloradans, nothing could be further from the truth.

Patients need to be aware of changes in the healthcare landscape if they want to choose and keep the Phlebologist of their choice. As discussed in our article “How to choose a vein specialist,” different physicians from extremely varied backgrounds and skill sets perform Phlebology procedures. Not all Phlebologists have the same experience based on their original medical sub-specialty, percentage of time they commit to Phlebology, and their case volume. Here are a few things patients need to consider if they want to have full choice to pick the most qualified Phlebologist.

Insurance Company Physician Network

It is becoming more common under the ACA for Health Insurance companies to promote limited physician panels under the disguise of improved patient care. The truth is, maximum patient choice provides an opportunity to receive the best care. Frequently the most qualified physicians are removed from panels, as they are the most popular in delivering needed services. Excluding the most qualified physicians from panels decreases services provided for patients and limits Insurance Company expenditures.

Make sure the Phlebologist of your choice is included in the Insurance plan you choose

Frequently the least expensive plans are those companies who utilize a “physician employee HMO model” limit choice. Patients may be forced to make an unpopular decision between 1) utilizing a less qualified physician, 2) paying “out of network” cost, or 3) waiting prolonged periods of time to change insurance and thus being allowed to use the Phlebologist of their choice.

Referrals to Phlebologists from Multi-Specialty Plan Medical Groups and Hospital-Employed Physicians

Most patients assume that physician referrals to sub-specialists are based exclusively on the skill and expertise of the physician they are being referred to. Unfortunately, that has changed as well. Physicians in multi-specialty groups or hospital-employed physicians are frequently encouraged by their employer to refer patients to sub-specialty physicians within their same network or institution. Referring patients to other physicians employed in the same network undoubtedly improves the fiscal health of the organization.

Patients need to be aware that, unfortunately, “business decisions” about sub-specialty referrals may come into play as equally as the quality and experience of the sub-specialist. In medical sub-specialties that have existed for long periods of time and for those for which there are numerous physicians practicing the sub-specialty, the issue is less critical. For Phlebology, which is an extremely new field, has few physicians exclusively committed to the field, and the expertise and is varied, choice of physician is extremely important.

Patients need to remember that they have a choice. The overwhelming majority of superficial venous problems involve elective decisions and patients have ample time to make decisions. Patients should have absolute confidence in their Phlebologist before initiating treatment and should consider second opinions if they have any concerns with the Phlebololgist to whom they were referred. Remember, not all “phlebologists” today are Board Certified. Make sure your phlebologist is a Board Certified Phlebologist.

Copyright 2016 Albert Vein Institute