It is unclear where the line is drawn between the need and the desire for surgery. As this article points out the debate has been going on for a long long time:

“Physicians have been debating the treatment of varicose veins for well over two thousand years – the legendary Hippocrates himself wrote about them in the fifth century BC – but today both medical necessity and health insurance are major factors in determining the course of treatment for the condition.
When varicose or spider veins are treated for the exclusive purpose of improving the patient’s appearance, it is considered cosmetic surgery and will not be covered by the patient’s health insurance or Medicare. Virtually all procedures addressing spider veins will fall into this category.
If, however, the varicose veins are causing symptoms like pain, swelling, fatigue or other symptoms that affect the patient’s ability to work or function normally, or if the underlying venous reflux disease is producing complications like skin ulcers or blood clots, a physician can determine that treatment is required to restore or preserve the patient’s health and well-being, and is therefore considered a medical necessity. Under those circumstances, most health insurance and Medicare plans will cover the procedure.

All VNUS Closure® procedures are performed as medical necessities – as diagnosed by a trained vein specialist – and are covered to the extent of the patient’s health coverage policy. The Closure procedure is not designed to address spider veins and is rarely performed for primarily cosmetic reasons. However, the successful treatment of venous reflux with the Closure procedure frequently produces significant cosmetic improvements.

http://www.vnus.com/vascular-disease/difference-between-varicose-veins-and-spider-veins.aspx

Source: The Vnus Closure Procedure

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