RE: Re: Insurance Approval for HBOT

[Guest guest]

We have just sent in our Medicaid application and it was at the suggestion

of the Medicaid enrollment officer that we apply this way. They were very

helpful and even changed the form so that we would be listed as a clinic. I

believe that we will be reimbursed at a higher rate than if we had been

listed as HBOT. I will continue to update as the application is determined.

(Also our doctor suggested that we may then also bill for DME such as the

hood, tubing, etc. and perhaps even the administration to cover staffing

costs.)

>From: " sly243 " <sly243@...>

>Reply-medicaid

>medicaid

>Subject: [ ] Re: Insurance Approval for HBOT

>Date: Tue, 17 Jan 2006 05:14:59 -0000

>

>Interesting idea... prescription would be for oxygen and the

>chamber is just the pressured administration apperatice?

>

>

> >

> > Has any HBOT provider sought to become a medicaid provider

>under " medical

> > supplier " and bill through pharmacy supplier of retail oxygen?

> >

> >

> > >From: " sly243 " <sly243@y...>

> > >Reply-medicaid

> > >medicaid

> > >Subject: [ ] Insurance Approval for HBOT

> > >Date: Sun, 15 Jan 2006 14:57:06 -0000

> > >

> > >We were able to obtain Insurance pre-certification for HBOT from

> > >United Healthcare. HBOT was presented as a small adjunct

>catalyistic

> > >therapy critical to effectuate the overall comprehensive treatment

> > >plan consisting primarily of physical therapy.

> > >

> > >

> > >We were successful in obtaining insurance pre-certification for

> > >ambulance transport to and from the outpatient facility due to our

> > >stretcher transportation requirement.

> > >

> > >The insurance policy provides for 60 physical therapy sessions per

> > >year.

> > >

> > >Physical Therapy

> > >Physical therapy is limited to 60 visits per person per calendar

> > >year. Additional visits may be approved if medically necessary.

> > >

> > >The Plan covers short-term outpatient physical therapy to improve

>the

> > >patient's ability to perform tasks required for independent

> > >functioning when function has been temporarily lost and can be

> > >restored: i.e., strokes, cerebrovascular accidents. A licensed

> > >therapy provider, under the direction of a physician, must

> > >perform the services.

> > >

> > >Rehabilitation services that are not expected to result in

> > >significant physical improvement in your condition within two

> > >months and treatments that cease to be therapeutic and are

> > >administered to maintain a level of functioning or to prevent

> > >a medical problem from occurring or recurring of the start of

> > >treatment are not covered.

> > >

> > >What we did:

> > >

> > >1. Obtained referral from primary care physician to HBO facility

>and

> > >doctor.

> > >

> > >2. Obtained referral from primary care physician for Physical

> > >Therapy.

> > >

> > >3. Developed a comprehensive treatment plan in which physical

>therapy

> > >was primary treatment and HBOT was an adjunct catalyistic therapy.

> > >

> > >Submitted treatment plan to insurance for pre-certification (5

>days

> > >advance notice requirement.)

> > >

> > >Received approval ...

> > >

> > >------------ FOR HBOT PROVIDERS ----------------------------

> > >Please consider bringing in physical therapy services to your

> > >facility. Consider developing comprehensive treatment plans

> > >primarily focused on physical therapy with HBOT as an adjunct

> > >treatment. Develop different treatment plans for various

> > >injuries,ie. stroke, diabetes, children, elderly etc...

> > >

> > >If planned and presented properly you should be able to receive

> > >precertifications for treatments and the ability to provide

>services

> > >to a broader spectrum of patients.

> > >

> > >

> > >------------ FOR MEDICARE AND MEDICAID ---------------------

> > >

> > >Medicare helps pay for medically necessary outpatient physical and

> > >occupational therapy and speech-language pathology services when:

> > >

> > >

> > >Your doctor or therapist sets up the plan of treatment, and

> > >Your doctor periodically reviews the plan to see how long you will

> > >get therapy.

> > >

> > >You can get outpatient services from a participating hospital or

> > >skilled nursing facility, or from a participating home health

>agency,

> > >rehabilitation agency, or public health agency. Also, you can get

> > >services from a Medicare-approved physical or occupational

>therapist,

> > >in private practice while in his or her office or in your home.

> > >Medicare doesn't pay for services given by a speech pathologist in

> > >private practice. There is no limit to the amount of medically

> > >necessary outpatient physical therapy, occupational therapy, or

> > >speech-language pathology services you may receive. You can get

>these

> > >services from any Medicare-approved outpatient provider.

> > >

> > >http://www.medicare.gov/Coverage/Home.asp

> > >

> > >Update: Beginning January 1, 2006, financial limitation of therapy

> > >services (therapy caps) will be implemented. The dollar amount

>for

> > >the 2006 limitation on physical therapy and speech-language

>pathology

> > >services from January 1, 2006, through December 31, 2006, will be

> > >$1,740.00.

> > >

> > >------------------------------------------------------------------

>-

> > >Summary:

> > >

> > >HBOT is not a primary treatment for any condition. HBOT is a

>small

> > >adjunct catalyistic therapy critical to effectuate the overall

> > >comprehensive treatment plan.

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> >

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