Policyholder Services

I recently completed training in hyperbaric medicine and will serve as supervising hyperbaric physician at a hospital-based clinic. Will OMIC cover my HBOT activities?

Hyperbaric medicine (also known as HBOT or hyperbaric oxygen therapy) is the use of 100% oxygen under greater than atmospheric pressure as an adjunctive treatment for various medical conditions. Originally used to treat decompression sickness, hyperbaric oxygen therapy is now FDA approved for more than a dozen indications, including embolism, carbon monoxide poisoning, gas gangrene, and problem wound healing. While most approved uses are for non-ophthalmic conditions, the FDA granted approval in 2011 for HBOT in the treatment of central retinal artery occlusion (CRAO). Hyperbaric oxygen therapy is also used off-label for numerous non-ophthalmic and ophthalmic conditions.

When a patient has a medical condition that may benefit from hyperbaric oxygen therapy, the treating physician will generally refer the patient to a hyperbaric consultant. The hyperbaric consultant will perform a complete history and physical examination to determine the patient’s eligibility for treatment with this modality. If the patient is an appropriate candidate, the hyperbaric consultant will establish a plan of care and write an order for treatment. While the treatment itself may be administered by a certified hyperbaric technologist, state law dictates who must directly supervise the treatment to ensure the safety of the procedure and respond to any adverse events. In many states, this supervisor may be a medical doctor, doctor of osteopathy, or an extended health care provider such as a nurse practitioner, clinical nurse specialist, or physician’s assistant.

OMIC’s policy covers its insured physicians for direct patient treatment within the ordinary and customary scope of practice of an ophthalmologist. Therefore, coverage would extend to claims arising from the referral of (or failure to refer) patients for hyperbaric oxygen therapy for ophthalmic conditions. Since performance of hyperbaric medicine currently falls outside the ordinary and customary scope of practice of an ophthalmologist, coverage would not extend to services rendered as a hyperbaric consultant or supervising hyperbaric physician. While, from a clinical perspective, it may be appropriate for a competent, qualified ophthalmologist to serve in these capacities, doing so raises concerns from an insurance perspective. The nature of such cases is different than that of ophthalmology claims, and OMIC does not have the same level of knowledge and experience relating to hyperbaric medicine as we do in the underwriting and claim handling of ophthalmic care and treatment. For these reasons, OMIC does not insure such activities.

Physicians who serve as hyperbaric consultants or supervising hyperbaric physicians at a hospital or hospital-based clinic may be able to secure coverage through the facility for services they provide on the facility’s behalf.