"'Varicose Vein' Indemnity Insurance Payout Dispute... Medical Community Also Divided Over Hospitalization Criteria"

Insurers Tighten Reviews After Supreme Court Ruling
Concerns Grow Over Spread of Disputes About the Need for Hospitalization
"The Society Must Disclose the Medical Basis for Its New Recommendations"

Controversy over whether indemnity health insurance covers varicose vein surgery is spreading into a debate within the medical community over criteria for hospital admission. While it is itself a concern that insurers intend to determine whether inpatient treatment is medically necessary, doctors in private practice are also questioning the medical basis and consultation process behind criteria developed by a medical society to address indemnity insurance disputes.

According to the medical community on October 19, insurers have recently begun strictly scrutinizing whether patients were actually hospitalized and whether hospitalization was medically necessary when reviewing indemnity insurance claims for varicose vein surgeries and procedures. They have also started informing policyholders that their claims may not be paid.

Varicose veins are a condition in which problems with the valves in the leg veins cause blood to flow backward, enlarging or bulging the blood vessels. In addition to visible changes, the condition can cause leg pain and heaviness, as well as swelling. In severe cases, it can lead to skin changes or venous ulcers. It is common among people who work standing for long periods, those who sit for most of the day, and workers in occupations involving extended travel, such as airline or train crew members. The condition tends to worsen over time.

Treatment depends on the patient's condition and ranges from conservative approaches, such as wearing compression stockings, to procedures that close the veins using lasers or radiofrequency, and surgery to remove affected veins. Other methods include inserting a special catheter into a vein or using medical-grade bioadhesives to close it. Since the cost of non-covered procedures and surgeries can range from hundreds of thousands to several million won, some hospitals have faced allegations of overtreatment for encouraging patients to be admitted rather than treated as outpatients so they can receive indemnity insurance benefits.

Concerns over insurance disputes and review criteria for determining whether hospitalization is justified have grown further, particularly after the Supreme Court ruled in June, in a case involving varicose vein surgery, that "the fact that a patient stayed at a hospital does not, by itself, constitute hospitalization under the terms of an insurance policy; the need for hospitalization must be determined by comprehensively considering the patient's condition and the actual treatment provided." This means that even if a patient was hospitalized for a genuine medical need, the insurer may, in a subsequent review, refuse to recognize the need for hospitalization. The patient may then be denied the expected inpatient insurance benefit, with the treatment instead classified as outpatient care and only part of the medical expenses reimbursed.

Cho Changwook, a physician specializing in cardiovascular and thoracic surgery who performs varicose vein operations, said, "The court ruling concerned a specific case at a hospital where medical records were lacking." He added, "Private insurers have used the ruling to distort the issue, portraying varicose vein treatment as a hotbed of overtreatment and fraudulent claims, and have broadened their criteria for reviewing insurance claims, leaving innocent patients to suffer."

The medical community argues that the need for hospitalization can vary even for patients undergoing the same procedure, depending on factors such as age, health, the scope of the procedure, and post-operative bleeding or pain. It says that applying uniform criteria could lead patients who actually need observation or treatment to choose outpatient care or delay treatment altogether.

Kim Seungjin, president of the Korean Association of Thoracic and Cardiovascular Surgeons, points out problems with the Korean Society of Phlebology's "Recommendations on Appropriate Hospitalization Criteria for Varicose Vein Surgery" while speaking with reporters at a hospital in Seoul's Gangnam District on the 16th.

Kim Seungjin, president of the Korean Association of Thoracic and Cardiovascular Surgeons, said, "The risks for each patient must be taken into account during recovery after surgery." He explained, "The residual effects of sedatives may cause dizziness or difficulty walking, and patients may need to be monitored while local anesthetics are absorbed. The fact that surgery takes less time does not mean that every patient no longer needs post-operative observation."

Kim criticized the "Recommendations on Appropriate Hospitalization Criteria for Varicose Vein Surgery," issued by the Korean Society of Phlebology together with the Korean Surgical Society, the Korean Society of Thoracic and Cardiovascular Surgery, the Korean Society of Hospital Medicine, and other organizations, saying they conflict with existing clinical practice guidelines. The new recommendations say inpatient treatment is unnecessary when a patient has only chronic conditions such as diabetes, hypertension, or hyperlipidemia. They say hospitalization is necessary only when the surgery involves a major incision, such as vein stripping or phlebectomy, or when side effects from anesthesia or complications during surgery make discharge impossible.

Kim said, "In its 2021 clinical practice guidelines, the Korean Society of Phlebology said patients needed an average of three to six hours or more for recovery and observation after varicose vein surgery. Yet in its 2026 recommendations, it changed the criteria for determining the need for hospitalization without medical evidence." He added, "This could lead to the need for hospitalization being judged based on the visible extent of a vein's bulging or on standardized classifications, rather than on the patient's actual condition." Kim also criticized the society, saying, "It rushed to draw up the recommendations to address indemnity insurance disputes without coordinating with the association whose members perform most of these surgeries." According to the National Health Insurance Service, of the 14,873 varicose vein surgeries performed in South Korea last year, 76.7% (11,490) were performed at hospitals and clinics other than tertiary and general hospitals.

The association is calling for revisions to the recommendations, saying, "Diabetes and hypertension should be considered when identifying high-risk patients, and the need for hospitalization should be assessed individually for patients with symptoms." It also proposed that cases in which complications during surgery lead to a change to inpatient care be assessed primarily on the basis of the operating surgeon's records, with a separate review process established. Kim said, "We are trying to consult with the Korean Society of Phlebology, with the Korean Medical Association and other organizations taking the lead," adding, "If no agreement is reached, we will also convey our views to the National Assembly."

This content was produced with the assistance of AI translation services.