In instances where a patient is experiencing leg swelling, pain or inflammation related to bulging varicose veins, or skin changes predisposing ulcers or superficial clots, insurance companies may determine a medical condition in need of care. Generally, a three-to-six-month conservative trial of therapy, including elevation, anti-inflammatory medications and compression stocking therapy, will be required to satisfy Medicare and most commercial insurance carriers’ inclusion criteria. Some carriers will also require certain training requirements of the type Vein Specialists satisfies, and most require a detailed letter of medical necessity predetermination. It is thus of paramount importance to keep detailed records of any treatment and history of vein issues.Injection sclerotherapy is rarely covered by insurance unless there has been a history of recurrent hemorrhage or pain directly related to the varicosities in question or in cases of refractory venous ulcers despite previous closure procedures.