Varicose Vein Surgery 'Venasil' Should Be Covered by Disease Surgery Expenses

[Asia Economy Reporter Oh Hyung-gil] It has been concluded that insurance companies should pay disease surgery fees for Venasil surgery for varicose veins in the legs, which causes blood to flow backward due to venous abnormalities in the legs, resulting in swelling and pain.

According to the insurance industry on the 19th, the Financial Disputes Mediation Committee of the Financial Supervisory Service recently decided that disease surgery fees must be paid in the dispute mediation filed by applicant A against B Insurance Company.

A visited a hospital in May 2020 due to frequent swelling and pain in the leg, was diagnosed with varicose veins in the legs, was hospitalized, and underwent Venasil surgery. The following year, A claimed disease surgery fees from the insurance company for the Venasil surgery costs, but the insurer refused to pay, stating that Venasil surgery does not qualify as surgery under the insurance contract.

The insurer argued that Venasil surgery (saphenous vein occlusion using cyanoacrylate) is not a procedure such as amputation or excision defined as surgery in the special contract terms, and since it corresponds to measures such as puncture, it is difficult to consider it as surgery.

Venasil involves inserting a catheter into the vein and injecting a biocompatible adhesive to close the blood vessel. In 2016, the New Medical Technology Assessment Committee under the Ministry of Health and Welfare evaluated Venasil as a safe technology with a lower incidence of subcutaneous hemorrhage compared to existing procedures, showing similar complications, and as an effective technology that improves symptoms and quality of life after the procedure compared to traditional surgery.

The mediation committee stated, "Although the relevant terms specify 'amputation, excision' in the definition of surgery, it is not limited to these and includes acts of 'other manipulations.' Since the vein is closed and the affected area, which is the direct cause of the disease, is fundamentally removed, it corresponds to 'amputation, excision, and other manipulations.'

Regarding the injection of the biocompatible adhesive, since it physically and directly compresses the vein to occlude it, it is difficult to exclude Venasil from surgery by considering it a chemical or auxiliary act corresponding to measures such as puncture under the terms of this case.

Furthermore, the committee added, "If Venasil, which can replace traditional surgery for varicose veins in the legs, is excluded from surgery simply because it is an advanced surgical method, it would be inconsistent with the reality of the medical field." Accordingly, the committee concluded that the insurer must pay disease surgery fees to A.

A financial authority official explained, "Insurance companies intended to cover risks and costs from traditional surgeries, so it is necessary to compensate for safer and superior minimally invasive treatments that replace existing treatment methods."