Desert Surgery Faqs

• What insurances does Dr. Trotta take?
• How long does it take for a new patient to get an appointment to see Dr. Trotta?
• How many and what kind of appointments will I have if I have surgery?
• When does Dr. Trotta perform surgeries?
• Where are surgeries performed?
• Will my insurance cover my surgery?
• Why am I receiving a bill from Dr. Trotta as well as from the hospital?
• How can I contact Dr. Trotta after hours?
• Does Dr. Trotta do laparoscopic hernia repairs?
• Can gallstones be removed without removing the entire gallbladder?

What insurances does Dr. Trotta take?

We accept most private insurances, including Premera Blue Cross, United Healthcare, and Group Health.
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How long does it take for a new patient to get an appointment to see Dr. Trotta?

We can usually schedule a new patient appointment within a week of your call.
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How many and what kind of appointments will I have if I have surgery?

A typical patient will come in for an initial consult, at which time Dr. Trotta will determine whether you have a problem that can be fixed surgically. A surgery date will be scheduled at that time and either paperwork will be filled out then, or a pre-operative appointment will be scheduled. At the pre-op appointment you can ask the doctor any questions you have and sign the paperwork. After filling out paperwork, you must go and pre-register at your surgery location. The surgical facility will call you the night before your surgery to let you know what time to be there the morning of surgery.

You will return to our office 10-14 days after surgery for a post-operative appointment. At this time Dr. Trotta may release you from care, or he may set up another post-op appointment for a few weeks later. The number of post-op visits varies for each patient and depends on the type of surgery and individual healing processes. You may also call the office at any time if you have questions or would like to see Dr. Trotta again after surgery to follow-up.

Not all patients will follow this type of appointment schedule. Every person and every problem is different and may require different care. This schedule is typical, but does not apply to everyone.
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When does Dr. Trotta perform surgeries?

Dr. Trotta does surgeries every Tuesday and Thursday in the mornings.
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Where are surgeries performed?

Surgeries performed on Tuesdays are at Kadlec Medical Center; surgeries performed on Thursdays are at the Tri-City Regional Surgery Center, located just next door to our building.
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Will my insurance cover my surgery?

Each individual insurance plan varies. You should contact your insurance company to find out what your plan covers.
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Why am I receiving a bill from Dr. Trotta as well as from the hospital?

Our office and the hospital bill each patient separately. Our bill covers your office visits and Dr. Trotta’s services in performing the surgery. The hospital bill covers the other expenses associated with your surgery. We only handle the bills from our office.
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How can I contact Dr. Trotta after hours?

If you have a medical question or problem that needs to be addressed after office hours, call our office and follow the prompts to have the answering service page Dr. Trotta, who will give you a call. If the question is not urgent, feel free to leave a voicemail at the office and someone will call you during the next business day.
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Does Dr. Trotta do laparoscopic hernia repairs?

No. Dr. Trotta does surgically repair hernias, but not laparoscopically.
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Can gallstones be removed without removing the entire gallbladder?

No. Gallbladder removal (laparoscopic cholecystectomy) is the only way to surgically remove gallstones.
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• What causes varicose veins?
• Can varicose veins be cured?
• How can I tell if I have a spider vein problem or a varicose vein problem?
• How can varicose veins be treated?
• How will the blood in my veins get back to my heart after all of the abnormal veins are destroyed?
• Do both legs have to be treated with the Closure procedure?
• What is a skin ulcer or venous stasis ulcer?
• What kind of sedation is used for the Closure procedure?
• How long do I have to stay off of my feet after the Closure procedure?
• Is every patient with varicose veins approved for the Closure procedure?
• Where will the Closure procedure be performed?
• Will my leg look better after treatment?
• Will insurance cover the treatment?

What causes varicose veins?

One-way valves inside healthy veins are designed to keep blood flowing up the leg, against the force of gravity. But in patients with venous insufficiency, the diameter of the vein has become increased and the valves can no longer close properly, causing blood to flow backwards in the vein. This backwards-flowing blood pools in the leg and is called reflux. The increased pressure of the excess blood in the vein causes it to become swollen and bulgy and the lack of proper circulation can cause the leg to be tired, achy, and heavy. One of the most common veins to cause reflux is the greater saphenous vein, which is located in the thigh. The reflux of blood from this vein causes the varicose veins in the lower leg. There are many causes of varicose veins. Obesity, pregnancy, female hormones, genetics, age, and jobs that require standing for long periods of time are a few of the common causes of varicose veins. Since women often have multiple risk factors, they are more likely to have varicose veins, although many men suffer from varicose veins as well. Varicose veins are a very common and treatable condition.
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Can varicose veins be cured?

Varicose veins can be treated at a very high success rate, but treatment alone does not eliminate the risk factors that cause them and cannot reverse a person’s predisposition to develop varicose veins. You are encouraged to wear the compression stockings for the entire recommended time period and many patients return for follow up treatments.
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How can I tell if I have a spider vein problem or a varicose vein problem?

Spider veins are clusters of small purple or blue veins that cannot be felt and do not protrude. Varicose veins are larger, bulgy, and can be manually pushed in, but pop back out.
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How can varicose veins be treated?

There are two main types of treatments that we use in our office. First is radiofrequency ablation of the saphenous vein, also known as the VNUS® Closure procedure. This treatment is used to eliminate venous reflux. The procedure actually closes the damaged vein so that blood is rerouted through the leg and provides improved circulation in the leg and alleviation of symptoms. See the Closure information page and the following frequently asked questions for more details. The second type of treatment is called sclerotherapy. Sclerotherapy is a session of injections in the leg that are intended to provide cosmetic improvement of varicose veins. It takes 20-30 minutes per session and multiple sessions may be required to achieve desired results. It is a simple procedure and you will walk out of the office able to go about normal activities. See the sclerotherapy information page for more details. Patients who have had the Closure procedure may also choose to have sclerotherapy at a later time to provide maximum results.
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How will the blood in my veins get back to my heart after all of the abnormal veins are destroyed?

Since having venous insufficiency means that blood is not flowing up the leg properly, closing the affected vein will increase blood flow up to the heart and improve the circulation throughout the leg and reduce the tired, heavy feeling in the leg. Having the abnormal vein closed does not have any negative affect on blood flow to the heart, as it actually helps blood flow up out of the leg more easily.
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Do both legs have to be treated with the Closure procedure?

Venous insufficiency can occur in one or both legs. If only one leg has venous insufficiency, only that leg needs to be treated. If both legs have venous insufficiency, then each leg will be treated at a separate time. This is to ensure proper healing in one leg before starting treatment on the other. Since the procedure does include pre- and post-op visits to the office, if one leg is treated soon after the other then we will work with you to combine appointments and reduce the number of visits.
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What is a skin ulcer or venous stasis ulcer?

A skin ulcer that is caused by a venous reflux disorder is called a venous stasis ulcer. The ulcer occurs in the ankle area and is characterized by darkening skin in the area and a leathery appearance over time. Eventually the skin breaks down and bleeding often occurs if treatment is not sought.
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What kind of sedation is used for the Closure procedure?

We do not use general anesthesia for the procedure. We offer a small dose of Valium to you as a sedative before the procedure and a local anesthetic during the procedure. Many patients feel relaxed and tired during the procedure; some fall asleep, but most are just relaxed and calm. Patients say that they feel very little or no pain during the procedure. Because of the sedatives given, however, someone must be present to drive you home for safety purposes.

How long do I have to stay off of my feet after the Closure procedure?

The Closure procedure is generally performed in our office on Fridays, which gives you the chance to rest over the weekend and keep legs elevated. Most patients are ready to return to work on Monday. Your individual circumstances, such as exercise routines and jobs that require standing, will be discussed with Dr. Trotta during your pre-operative appointment. The use of compression stockings after the procedure is very highly recommended to maintain pressure on the closed vein and to ensure that the procedure is successful. The compression stockings are typically to be worn for 4 weeks after the procedure.
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Is every patient with varicose veins approved for the Closure procedure?

The Closure procedure treats varicose veins that are caused by vein reflux, and not all patients have reflux. To check for reflux, all patients with varicose vein problems will undergo a duplex ultrasound examination. This examination is done by a technician in our office on Monday and Tuesday evenings. It is very similar to an ultrasound done during pregnancy, except this one is on the leg. It checks the flow of blood in the vein and helps the doctor determine whether there is vein reflux or not. If there is reflux, then you are probably a candidate for the Closure procedure (although other restrictions may apply to individual cases). If there is no reflux, then you may be a candidate for sclerotherapy (see sclerotherapy information page).
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Where will the Closure procedure be performed?

Every step of the process takes place right in our office. The technician who performs the ultrasound comes into the office on Monday and Tuesday evenings. Both sclerotherapy treatments and the Closure procedure are performed in the small OR suite in the office. This is a sterile environment where you can feel comfortable and receive personal attention from our staff. Clean, comfortable robes are provided for Closure patient use in the office.
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Will my leg look better after treatment?

The Closure procedure is not a cosmetic procedure. It is intended to alleviate symptoms, including leg heaviness, aching, tiredness, burning, and other symptoms, by eliminating saphenous vein reflux. Though sometimes there are cosmetic improvements after the Closure procedure, it is not intended to be cosmetic, nor does Dr. Trotta promise any cosmetic results.

Sclerotherapy is a cosmetic procedure. It can be done after the Closure procedure or on its own to improve the appearance of veins. It may take multiple visits to achieve desired results.
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Will insurance cover the treatment?

For Closure procedure:
When Dr. Trotta says that you are a candidate for the Closure procedure, the first step in the process is for your information to go to the billing department so that we can obtain a pre-authorization from your insurance company. Most major insurance providers cover at least a portion of the Closure procedure, but every company has a different pre-approval process and a different reimbursement policy. Most companies require a “paper trail,” which is documentation showing that you have venous insufficiency and that conservative management has been tried and failed. This is why you must wear compression stockings for 3-6 months prior to the procedure and have Dr. Trotta document that the stockings did not alleviate symptoms.

The cost of the procedure is $5260, which includes the cost of the catheter used to close the vein, other surgical supplies and equipment, the medication, and the use of the doctor, nurse, and radiovascular technician for the day. Insurance may pay some or all of this cost, but this varies by individual plans and/or individual deducible policies and fulfillment.

When we receive the pre-authorization from the insurance company, we will notify you that we are ready to schedule the procedure, and of the balance that will need to be paid at the time of the pre-operative appointment. This amount is the estimated balance that will be left to you as the cost of the Closure procedure day. It may or may not include a leftover balance from prior visits and it does not include the cost for follow up visits. Since the pre-authorization from the insurance company is not a guarantee of payment, our office cannot ensure that the balance we collect from you will be the complete payment until we have the check from the insurance company. You should be sure to understand that though we try to provide as accurate an estimation as possible based on information from the insurance company, the actual payment from the insurance company may end up being more or less than we estimated. If that is the case, we will remedy the situation by either issuing a refund check to you for the amount overpaid, or collect an additional payment from you to cover the remaining balance.

Of course, if you have any questions regarding insurance or payment information, you are welcome to call our office at 946-4802 and we will discuss your individual situation.

For sclerotherapy:
Sclerotherapy is considered a cosmetic procedure by insurance companies and therefore we collect a payment of $300 for the treatment at the time of service from all patients, regardless of insurance company. Sometimes an insurance company will end up paying for the treatment and if that is the case, we will refund your money. An insurance company is also more likely to pay for sclerotherapy after you have had the Closure procedure, but this is not a guarantee, and therefore we must still collect payment at the time of service.
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