HBOT Insurance Questions

Hyperbaric Oxygen Therapy is a specialized medical treatment that most insurance companies require a prior authorization to cover treatment. There are only 15 conditions that most insurance companies including Medicare will cover. Some of the commonly treated insurance conditions are; Compromised Skin Grafts, Diabetic Wounds, Radiation Tissue Damage, Bone infections, to name a few. If you have one of these conditions, there are also strict criteria that need to be met prior to coverage.

Commercial Insurances like BlueCross BlueShield (BCBS), United Healthcare, Cigna, Humana, ETC can be more lenient on the off-label conditions if they deem treatment as medically necessary. Examples of off-label conditions are; Avascular Necrosis, Localized swelling, Sudden Hearing loss, Autism, Pre/Post-Surgical, TBI, to name a few.

Once we confirm coverage from your insurance company there are a few factors to keep in mind such as:

What is a copay:

A copay is a predetermined rate set by your healthcare insurance provider at the time of care. Every insurance company is different and will vary depending on each individual plan.

What is a deductible:

The deductible is the amount of money the patient must pay out-of-pocket prior to your insurance company starts paying a percentage of your visits.

What is a Coinsurance:

A coinsurance is the percentage that patients are responsible for paying after the deductible is met. The rest will be covered by your insurance plan. After the set amount of your coinsurance is met most insurance companies will cover 100%.

Did you know that most insurance companies have In-Network and Out-of-network benefits?

In-network:

Most insurance companies don’t have any Hyperbaric Oxygen Therapy treatment available in the network. When patients go to any In-Network facilities the deductible and coinsurance are typically lower.

Out-of-Network:

When patients go to Out-of-Network facilities the deductible and coinsurance changes and are typically higher than their In-network benefits. Every insurance plan is different, and it varies depending on each individual plan and provider.

Are you wondering whether your insurance plan will cover your condition or not? The worst they can say is No. Contact us today to be set up a free consult and we will be more than happy to look into your coverage.

To see the full list of Medicare approved conditions including required criteria please visit:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=12&ver=3