Does insurance cover hyperbaric oxygen therapy treatments?
Will hyperbaric oxygen therapy for my medical condition be covered by insurance?
A question we’re often asked is “Does insurance cover hyperbaric oxygen therapy?”
The short answer is yes, hyperbaric oxygen therapy (HBOT) can be covered by Medicare and commercial insurances depending on the medical condition.
Most insurances will require prior authorization to cover HBOT treatments. How much you pay out-of-pocket depends on your insurance plan. Some insurance plans require patients to pay a copay, while others require patients to pay towards a deductible or coinsurance.
Learn more about the difference between a copay, deductible and coinsurance here.
What conditions are commonly approved by insurance?
At this time, Medicare and most commercial insurance companies will cover HBOT for:
- Air or Gas Embolism
- Carbon Monoxide Poisoning
- Chronic Osteomyelitis
- Compartment Syndrome/Crush Injury/Other Traumatic Ischemias*
- Compromised Skin Grafts and Flaps
- Decompression Sickness (Bends)
- Diabetic and Selected Wounds
- Exceptional Blood Loss (Anemia)
- Gas Gangrene
- Intracranial Abscess
- Necrotizing Soft Tissue Infection*
- Osteoradionecrosis and Radiation Tissue Damage*
- Thermal Burns
- Idiopathic Sudden Sensorineural Hearing Loss (covered by select commercial insurance companies)
*covered as adjunctive therapy
It is important to note that some of the medical conditions listed above have limitations. Some insurance plans will only approve the use of HBOT as adjunctive therapy when there has been no measurable signs of healing for at least 30 days of treatment with standard wound therapy. HBOT is expected to be used in addition to standard wound care and the patient’s wounds must be evaluated at least every 30 days to continue HBOT.
Are there additional conditions that are covered by insurance?
There are numerous studies and scientific evidence showing HBOT as an effective treatment for a range of medical conditions. Though insurance companies reserve the right to approve or deny HBOT coverage for any medical condition despite these supportive findings, there are a number of off-label conditions that are sometimes covered by commercial insurance companies.
Off-label conditions that may or may not be covered by insurance are:
- Lyme Disease
- Multiple Sclerosis
- Near Drowning
- Post Traumatic Stress Disorder (PTSD)
- Recovery from Plastic Surgery
- Sports Injuries
- Traumatic Brain Injury
- Anoxic Brain Injury
- Avascular Necrosis
- Cerebral Palsy
- Crohn’s Disease
- Circulation conditions
- Complex Regional Pain Syndrome
A number of commercial insurance companies—including BlueCross BlueShield (BCBS), United Healthcare, Cigna, Humana, and more—will approve HBOT for off-label conditions if they deem treatment as medically necessary.
Does insurance cover hyperbaric oxygen therapy if my condition isn’t listed?
There’s still a chance that you may receive insurance coverage for a medical condition that isn’t on the commonly approved list. Most commercial insurance companies will request medical records for determination of medical necessity.
At Hyperbaric Healing Treatment Center, we are determined to help our patients find treatment and coverage for their medical condition. We will work with you to put together medical records, letters of support/explanation and whatever documentation is needed to help you find coverage. For patients not approved for HBOT by their insurance, we also provide discounted out-of-pocket packages.
Contact us today to learn how HBOT can help you.
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