Fri, September 17, 2010 11:20:11 AM
Approved HBOT Uses Kessinger Health and Wellness Newsletter
 

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According to a bulletin put out by AETNA insurance company, there are many situations when HBOT is an approved treatment. Of course they have not approved many other situations for treatment to be covered by their insurance, but this is a step in the right direction.

Health insurance is a bit like car insurance. Car insurance only covers catastrophic problems like a car accident. It doesn't pay for tires, oil changes or wiper blades. Health insurance will help pay for acute care such as surgeries and a visit for strep throat, but often chronic problems which can be dealt with naturally are not covered.

Many people think that if their insurance won't cover something, then it's not necessary. Often if one would take steps on their own, outside of insurance, they could prevent the need for emergency care completely. Our focus at Kessinger Diagnostic Centre is to prevent illness and keep surgeries from being necessary, by helping individuals keep track of their health and make sure they are headed in the right direction.

Insurance companies need a name to put on an illness before they will consider it for payment. Because our focus is to prevent illnesses, many of the things we do are not covered by insurance. There is no insurance code for removing plaque from arteries, or preventing diabetes. It is up to each individual person to manage their own "oil changes" and make sure that they do not end up with an acute problem.

Below is the list that Aetna published 4-9-2010

Clinical Policy Bulletin:
Hyperbaric Oxygen Therapy (HBOT)

Number: 0172


Policy

  1. Aetna considers systemic hyperbaric oxygen therapy (HBOT) medically necessary for any of the following conditions:
    1. Acute air or gas embolism
    2. Acute carbon monoxide poisoning
    3. Acute cerebral edema
    4. Acute peripheral arterial insufficiency (i.e., compartment syndrome)
    5. Acute traumatic peripheral ischemia (including crush injuries and suturing of severed limbs) when loss of function, limb, or life is threatened and HBOT is used in combination with standard therapy
    6. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
    7. Compromised skin grafts and flaps
    8. Cyanide poisoning (with co-existing carbon monoxide poisoning)
    9. Decompression illness ("the bends")
    10. Exceptional blood loss anemia only when there is overwhelming blood loss and transfusion is impossible because there is no suitable blood available, or religion does not permit transfusions
    11. Gas gangrene (Clostridial myositis and myonecrosis)
    12. Idiopathic sudden deafness, acoustic trauma or noise-induced hearing loss, when HBOT is initiated within 3 months after onset
    13. Non-healing infected deep ulcerations (reaching tendons or bone) of the lower extremity in diabetic adults unresponsive to at least 1 month of meticulous wound care (including aggressive debridement, maximal antibiotic therapy, tight glycemic control, and appropriate treatment of arterial insufficiency, including revascularization if necessary). HBOT is not considered medically necessary for superficial lesions.
    14. Pneumatosis cystoides intestinalis
    15. Progressive necrotizing soft tissue infections, including mixed aerobic and anaerobic infections (necrotizing fasciitis, Meleney's ulcer)
    16. Prophylactic pre- and post-treatment for members undergoing dental surgery of a radiated jaw
    17. Radiation necrosis (osteoradionecrosis, myoradionecrosis, brain radionecrosis, and other soft tissue radiation necrosis)
    18. Radiation proctitis

  2. Aetna considers the use of systemic HBOT experimental and investigational for the following conditions (not an all inclusive list) because there is insufficient evidence in the medical literature establishing that systemic HBOT is more effective than conventional therapies:
    1. Actinic skin damage
    2. Actinomycosis and other mycoses
    3. Acute coronary syndrome
    4. Acute or chronic cerebrovascular insufficiency/accident (including thrombotic or embolic stroke)
    5. Acute renal arterial insufficiency
    6. Acute thermal and chemical pulmonary damage, i.e., smoke inhalation (e.g., carbon tetrachloride, hydrogen sulfide) with pulmonary insufficiency
    7. Aerobic septicemia and systemic aerobic infection
    8. Anaerobic septicemia and infection other than clostridial
    9. Arthritic diseases
    10. Arthritis
    11. Aseptic necrosis of the femoral head and neck
    12. Autism
    13. Bell's palsy
    14. Bone grafts or fracture healing (e.g., nonunion fractures)
    15. Cancer
    16. Cardiogenic shock
    17. Cerebral palsy
    18. Chronic peripheral vascular insufficiency
    19. Closed head and/or spinal cord injury
    20. Cognitive impairment (e.g., senility, senile dementia)
    21. Crohn's disease
    22. Cystic acne
    23. Facial neuritis
    24. Frostbite
    25. Hepatic artery thrombosis
    26. Hepatic necrosis
    27. HIV infection
    28. Interstitial cystitis
    29. Intra-abdominal abscess, pseudomembranous colitis (antibiotic-induced colitis)
    30. Intracranial abscesses
    31. Ischemia due to lupus vasculitis
    32. Legg-Calve Perthes disease
    33. Lepromatous leprosy
    34. Lyme disease
    35. Melasma
    36. Meningitis
    37. Migraine or cluster headaches
    38. Multiple sclerosis
    39. Myocardial infarction
    40. Myofascial pain syndrome
    41. Necrotizing arachnidism
    42. Non-diabetic cutaneous, decubitus, pressure and venous stasis ulcers
    43. Non-vascular causes of chronic brain syndrome (e.g., Pick's disease, Alzheimer's disease, Korsakoff's disease)
    44. Ophthalmologic diseases (including diabetic retinopathy, retinal detachment, central retinal artery occlusion, central retinal vein occlusion, radiation injury to the optic nerve, glaucoma, keratoendotheliosis)
    45. Organ transplantation and storage
    46. Osteoporosis
    47. Parkinson's disease
    48. Pulmonary emphysema
    49. Pyoderma gangrenosum
    50. Radiation-induced cystitis, myelitis, enteritis
    51. Reflex sympathetic dystrophy (complex regional pain syndrome)
    52. Sickle cell crisis or hematuria
    53. Skin burns (thermal)
    54. Superficial and/or non-infected diabetic ulcers
    55. Surgical wound dehiscence
    56. Tetanus
    57. Tinnitus

  3. Aetna considers systemic HBOT experimental and investigational for members with any of the following contraindications to systemic HBOT, as the safety of systemic HBOT for persons with these contraindications to HBOT has not been established:
    1. Concurrent administration of doxorubicin, cisplatin, or disulfiram
    2. Premature infants (birth prior to 37 weeks gestation)
    3. Untreated pneumothorax

  4. Aetna considers topical HBOT administered to the open wound in small limb-encasing devices experimental and investigational because its efficacy has not been established through controlled clinical trials.

Visit us on the web at www.drkessinger.com
(573) 341-8292 or virginia@drkessinger.com
 
Sincerely,

Kessinger Health and Wellness Diagnostic Centre
Virginia, Amanda, Lucy, Liz, Krystal, Annette, Claudette, Tracy &
Jack Kessinger, DC, ND, DABCI
Jay Kessinger, DC, ND, DABCI, Registered DAN Doctor