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Insurance company requiring negative pressure wound therapy before HBOT
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1/14/2013 at 3:41:07 PM GMT
Posts: 15
Insurance company requiring negative pressure wound therapy before HBOT
I was recently informed by MVP Healthcare in New York that we are not able to treat our patients wounds with HBOT without first failing a course of negative pressure wound therapy. Has anyone ever heard of this issue? Here is the statement by MVP : "For the treatment of non-healing wounds, in addition to the wound criteria listed below, documentation must indicate that for members who meet criteria for negative pressure wound therapy, the member has tried and failed negative pressure wound therapy prior to requesting hyperbaric oxygen therapy (HBO)." I have a hard time accepting this statement because it is basically establishing standard of care regardless of the situation. Any thoughts on arguing against MVP's point. I understand that their goal is to save money but a product like the WoundVac does not improve oxygen levels at the site of the wound. Thanks

1/31/2013 at 1:25:02 PM GMT
Posts: 17
MVP Healthcare is sure trying to make it difficult.  What does your CMS guidelines read? If they say other, MVP cannot change it (IMO).  Hope this helps

2/5/2013 at 4:33:32 PM GMT
Posts: 15
MVP Healthcare

Thanks for the response, I did not know they had to follow Medicare guidelines if they were a privately owned insurance company.  I will look into this further.  MVP states that if the patient is eligible for a  WoundVac, it must be used before HBOT can be started.  They are establishing Standard Wound Care for all of their physicians whether the physician wants to use this modality or not.  Plus the WoundVac does not take the place of effective oxygen levels at the wound site.

Thanks Again.


2/15/2013 at 5:20:02 PM GMT
Posts: 9
I know I am posting this late and you have probably already dealt with this particular patient. If it helps for future patients - whenever we have had, what we have felt, are unjustified denials from insurance companies we usually request a physician to physician review and resubmit with a letter of medical necessity. This has worked well for us so far.

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