If you are trying to find out whether your insurance covers hyperbaric oxygen therapy, you are in the right place. Many people look into HBOT to treat specific medical conditions or ongoing health issues, and the good news is that Medicare and most private insurance carriers do offer coverage when certain medical criteria are met.
For example, if hyperbaric oxygen therapy is intended to treat a serious medical issue affecting your health, like one of the ones below, your insurance claim will more likely be approved for hyperbaric oxygen therapy. On the other hand, if the treatment is for cosmetic problems or wellness, it’s unlikely to be approved. Contact us today to learn more about insurance coverage or to schedule you appointment for hyperbaric oxygen therapy: (619) 470-4325
Learn More About Insurance Coverage for Hyperbaric Oxygen Therapy
Here are some examples of non-emergency conditions that would likely qualify for insurance coverage when seeking hyperbaric oxygen therapy:
- Diabetic wounds
- Chronic bone infections that have not healed after a course of antibiotics
- Skin Grafts and Flaps
- Radiation Tissue Injuries (After Cancer Treatments)
- Soft Tissue Infection
- Central Retinal Artery Occlusion (Non-Medicare): URGENT (patient should be treated within 24-48 hours)
- Sudden Hearing Loss (Non-Medicare)
- Crush Injuries
In order to ensure payment for treatment, some insurance companies require prior authorization. You should ask your referring doctor to obtain authorization for a hyperbaric consultation. If the hyperbaric doctor agrees that the treatment will you’re your condition, then the clinic will seek authorization for the actual treatments.
If approved, your out-of-pocket expenses will ultimately depend on your current insurance plan. Look at your current insurance plan’s copay, coinsurance, and co-deductible to get a better idea of how much you will pay for the service. You can also ask your insurance carrier to explain the pricing in more detail so you understand it.
Insurance Coverage Is Not Guaranteed for Hyperbaric Oxygen Therapy
Keep in mind that there are no actual guarantees of insurance coverage for hyperbaric oxygen therapy. An insurance carrier will usually approve an insurance claim for hyperbaric oxygen therapy if it meets the criteria set forth by Medicare. In some cases, Medicare considers hyperbaric oxygen therapy to be an adjunctive therapy.
Adjunctive therapy is an additional treatment administered to a patient after they have tried undergoing primary or standard treatment methods, such as prescription medications and more traditional treatments. If a patient’s condition does not improve after receiving standard wound care treatment, their insurance carrier is more likely to approve their claim for hyperbaric oxygen therapy.
The ability to receive insured hyperbaric oxygen therapy will require you to continuously undergo standard therapy treatments to satisfy your carrier’s adjunctive therapy requirements. Coverage for the therapy will likely continue as long as you continue to receive these additional standard treatments. The number of treatments needed to heal varies by patient and condition but is usually 20-60 treatments.
What is Not Covered?
We often get calls asking about other conditions and the utilization of hyperbaric oxygen therapy. Generally speaking, the conditions below are usually not covered by insurance companies, but if there is a good chance at improvement, some insurance companies may authorize treatment. As research continues, the positive effects of hyperbaric oxygen therapy, additional conditions may be covered by Medicare and other insurance companies.
- Autism
- Sports Injuries
- Lyme Disease
- Crohn’s Disease (some insurance companies have begun to cover inflammatory bowel diseases, including Crohn’s Disease)
- Chronic circulation problems of the lower legs
- Post Concussion
- Addiction
- Post Stroke
- Post-Traumatic Stress Disorder
These are known as off-label conditions, which are treated with hyperbaric oxygen treatments which has been helpful in some cases. Off-label conditions may be treated on a cash pay basis but would be evaluated by the physician as to whether a benefit may be obtained. This is done on a case-by-case basis.
Do you have any questions regarding insurance coverage for hyperbaric oxygen therapy?
Contact HealMedO2 for help navigating insurance coverage and approval. If you do not currently have insurance, our team can also assist you in finding a plan that best fits your hyperbaric oxygen therapy needs. Call us today at (619) 470-4325.
