A common question we receive is about insurance coverage for hyperbaric oxygen therapy, or HBOT for short. This blog post goes into detail on insurance coverage for HBOT, what conditions may be covered, out of pocket expenses and more.
What is Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy (HBOT) is a medical treatment that delivers pure oxygen while the body is experiencing increased atmospheric pressure. It is used to treat a variety of conditions, including radiation tissue damage, sudden hearing loss, carbon monoxide poisoning, diabetic wounds and more.
HBOT is a safe and effective treatment, but it can be expensive. The cost of HBOT varies depending on the number of treatments required, the location of the treatment center, and the insurance coverage.
Insurance Coverage for HBOT
In the United States, The Food and Drug Administration (FDA) currently recognizes HBOT for a limited list of 14 conditions, often referred to as "on-label" conditions. Most insurance plans cover some or all of the cost of HBOT when it is given to the patient for one of these FDA-approved conditions. The specific conditions that are covered may vary from plan to plan.
Some of the most common conditions that are covered by insurance for HBOT include:
- Radiation tissue damage
- Diabetic lower extremity wounds (diabetic foot ulcers)
- Failed skin grafts and flaps
- Crush injury & other acute traumatic ischemias
- Necrotizing soft tissue infection
- Carbon monoxide poisoning and smoke inhalation
- Central retinal artery occlusion
- Non-healing wounds
- Gas gangrene
- Decompression sickness
- Idiopathic sudden sensorineural hearing loss (ISSHL)
Insurance companies may also cover HBOT for other conditions, depending on the evidence of its effectiveness.
When HBOT is Not Covered by Insurance
The Food and Drug Administration (FDA) currently recognizes HBOT for 14 conditions, which are generally covered by insurance, as mentioned above.
HBOT also has benefits for other conditions that are not yet approved by the FDA. Many of these conditions have undergone significant research and HBOT is commonly utilized for them around the globe. Treatment for conditions not yet approved by the FDA is generally not covered by insurance and is not available at hospital-based hyperbaric centers.
As an independent clinic, HMS is able to accommodate the needs and circumstances of any patient whom our physicians believe would benefit from HBOT. In circumstances in which insurance coverage is not available, several payment options and financial assistance programs have been made available.
How to Get Insurance Coverage for HBOT
To find out if your insurance covers HBOT, you can call us (516-588-1831) and a patient care coordinator of ours can provide you with more information about your insurance's coverage for whatever condition or health issue you are facing.
Speak with a Patient Care Coordinator
We offer free phone call, info-sessions, to determine whether or not you'd be a good candidate for HBOT and to discuss cost and insurance coverage, as well as answer any other questions you have
The Cost of Out-of-Pocket Expenses
Even if your insurance covers HBOT, you may still have to pay some out-of-pocket expenses. These expenses can include the copay for each treatment, the deductible, and the coinsurance.
The amount of out-of-pocket expenses will vary depending on your insurance plan. You should contact your insurance company to find out what your specific costs will be. Our staff are also well equipped to support you with dealing with insurance coverage and financial assistance and questions.
Other Options for Financing HBOT
At HMS, in circumstances in which insurance coverage is not available, several payment options and financial assistance programs are available. Our team is here to support you in getting the answers you need and coming up with a solution that can work for you.
Here are some additional things to keep in mind about HBOT and insurance:
- The number of HBOT treatments required will vary depending on the condition being treated.
- There are some conditions that are not considered to be covered by insurance for HBOT.
- If you are not sure if your insurance covers HBOT, you should contact your insurance company or you can call our office and they can provide information to you about cost and coverage.
Insurances Accepted at HMS
Accepted Insurance at our Woodbury, New York and Manhattan, New York locations:
- Aetna
- Cigna
- Empire Blue Cross and Blue Shield
- The Empire Plan
- Emblem (including GHI, Vytra, HIP)
- Magnacare
- Medicare
- No Fault
- Oxford/United Healthcare
- Tricare
- Workers Compensation
Accepted Insurance at our Randolph, MA location:
- AllWays Health Partners
- Aetna
- BCBS of Massachusetts
- CIGNA
- Fallon Health
- Harvard Pilgrim Healthcare
- MassHealth
- Medicare
- Tufts Health Plan
- United Healthcare
- VA
Accepted Insurance at our Fort Lauderdale, FL and Miami, FL locations:
- Aetna
- Ambetter/Sunshine
- CarePlus
- Cigna
- Clearspring
- Devoted Health
- Doctors HealthCare Plans
- HealthSun Health Plans
- Humana
- Medicare
- Molina
- Oscar
- Preferred Care Partners
- Simply
- Solis Health Plans
- United Healthcare
- Veterans Affairs (VA) Community Care Network
Conclusion
HBOT is a safe and effective treatment for a variety of conditions. There are several illnesses and injuries for which the FDA has approved the use of HBOT. These are known as on-label conditions, and are often covered by the patient’s insurance.
HBOT, however, has a much wider range of application. Supported by research and treatment outcomes, HBOT is used around the world to help in the treatment of many conditions, illnesses, and injuries that are currently considered off-label in the United States. These are conditions for which HBOT has not yet been approved by the FDA to treat, and are generally not covered by the patient’s insurance.
Importantly, being considered off-label doesn't mean ineffective or unsafe. Many types of pharmaceutical drugs are commonly prescribed off-label by physicians every day in the United States.
Written by Rosemary Byrne, MSN, ANP-BC, ACHRN
Rosemary has been the Clinical Director at HMS New England since 2009 and is certified as an Advanced Certified Hyperbaric Registered Nurse. Prior to her work in hyperbaric medicine, Rosemary worked in women's health, starting her career as a registered nurse on Massachusetts General Hospital's gynecology/oncology surgical unit....
