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Denial of HBOT for ORN
Moderator(s): Robert W. Sanders
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1/11/2012 at 3:01:52 PM GMT
Posts: 1
Denial of HBOT for ORN

I will never ever never put any patient in the chamber for any diagnosis as long as he/she smokes.

They all have to be smoke free.

This is why insurance companies look at us as a bunch of morons that need to be controlled & regulated.

5/16/2012 at 2:57:50 PM GMT
Posts: 2
I haven't had a denial for that reason but I believe that it will be more common in the future.  The problem with that logic is that if/when his mandible completely falls apart, are they then going to deny him reconstructive surgery and/or enteral feedings and let him die?  Not very likely.  He will get his congressman involved and the VA will be forced to not only allow the HBOT but the reconstructive surgery and feedings as well thereby costing the taxpayer even more.  I don't like to treat patients that smoke but until there is extensive tort reform, I believe that you are on shaky medicolegal grounds if you refuse treatment to an otherwise appropriate patient and they go on to limb loss or death.    Smokers are still allowed on the jury in malpractice cases.

11/17/2012 at 2:33:56 PM GMT
Posts: 1
MORONS??....perhaps, but we must remain patient advocates. if that makes me a moron, so be it, but i can write my congressman as well!!!!

1/9/2013 at 3:04:29 PM GMT
Posts: 2

What would sense would it make though to put a smoking patient in the chamber for any diagnosis? They immediately end the treatment cause as soon as they light up that cigarette.

I understand why they would be denied and as I go through my education with the patient I stress the importance of NOT smoking at least throughout HBO and explain why.

1/10/2013 at 3:00:29 PM GMT
Posts: 1

John A. Bishop wrote: We were treating a patient with osteoradionecrosis and a significant amount of soft tissue necrosis too. We billed United Health using ICD9 codes: 990, and 526.89. They denied payment. The reason given was: Certificate of Coverage Section 2: …. Experimental or Investigational or Unproven Services …" We have resubmitted but they keep loosing our paper work. We are staying on this because this patient is a textbook ORN case

They eventually paid but it was a hassle. Is this a coming trend.  Haven't billed UHC since. jab 

Last edited Thursday, January 10, 2013
2/15/2013 at 5:35:49 PM GMT
Posts: 9

We have not refused hyperbaric therapy to a patient who smokes. We encourage them to quit, offer different techniques and cessation programs if they are interested and inform them of the risks if they continue to smoke (focused on the diminished effectiveness of hyperbaric therapy and/or wound healing). 

I agree with the poster who suggested a denial based on smoking is shaky ethical and legal ground. Similarly. we do not refuse advanced wound care treatments to patients who have uncontrollable diabetes with high glucose levels; instead we attempt to get their sugar under control while still treating their wounds and providing education. The same way we handle patients who smoke. While I understand that smoking diminishes the therapeutic effect of hyperbaric therapy - is there sufficient evidence to state they get absolutely no therapeutic effect?

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