Pfenninger Aesthetics Center, P.C.

The Medical Procedures Center, P.C.

“We treat people, not just problems.”


John L. Pfenninger, M.D.

4800 N. Saginaw Road

Midland, MI 48640

(989) 631-4545


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The purpose of this communication is to discuss with you the cost and payment mechanism should you desire to have sclerotherapy (vein injections) performed.

For your first visit, we will spend approximately 30 minutes discussing your problem and conducting an examination.  In addition, there will be a separate charge for a test (photoplethysmogram—abbreviated "PPG") that will be carried out to determine if there are any problems deeper in your veins, which would prevent us from doing sclerotherapy.  For this first visit, we will usually accept what your insurance company allows as the "reasonable and customary" fee, provided these services are covered by your insurance company.  If you have a co-pay or deductible, this would be your responsibility.  If these services are not covered by your insurance, payment is expected at the time of service.  You will receive a 20% discount if the office consultation and PPG are paid in full at this time and you have no insurance.

If it is decided that you want to proceed with sclerotherapy, you will usually need to purchase compression (special type support) stockings at your first visit.  Most patients will need panty hose (but occasionally we use below the knee, single leg hose, thigh highs, or even ACE wraps) which will need to be worn after the injections.  We will order them for you at a reduced rate through our supplier.  However, they will need to be paid for before they are ordered.  The costs are $________ for panty hose, $________ for knee-highs, $________ for thigh-highs, and $________ for single leg.  You can purchase compression hose elsewhere, but we prefer MediUSA, Sigvaris, or Jobst brands.

Most insurance companies judge the sclerotherapy injections themselves to be "cosmetic" and do not cover cosmetic procedures.  When we first began doing vein injections, we tried to bill the insurance directly.  However, there were so many claims rejected that it became a nightmare.  Subsequently, we have decided not to participate for the injection procedures.  Thus, you will be responsible for the cost of injections on the date of service (cash, credit card, or check).  Although we generally offer a 20% discount for payments on the date of service, this discount does not apply to sclerotherapy injections, since our fees are below the average rate.  The fee is $372.00 for approximately 30-40 injections, which take approximately 30 minutes.  You may submit your bill to your insurance company and they may reimburse you directly in some instances.  Medicaid and Medicare are particularly difficult to deal with regarding vein injections.  It is very difficult to have them approve any payment, and they consider nearly all sclerotherapy injections cosmetic.  Subsequently, even though we do accept Medicare and Medicaid patients, you must understand that this is may not be a covered benefit and you will still be responsible for payment on the date of service.  We will do what we can to help you with documentation for reimbursement.

Please call in advance should you have any questions whatsoever regarding the billing and fees. Please read over all handouts and fill out your forms before the visit.  We look forward to meeting you.


Copyright, 2011. John L.  Pfenninger, M.D.                                                                Sclero Billing/02/11