Coverage usually follows the diagnosis.
Whether insurance covers hyperbaric oxygen therapy depends on your plan and the reason for treatment. Insurers usually cover HBOT only for a defined list of medical conditions, when a physician documents the diagnosis and the treatment meets the plan's criteria.
Goals like general wellness, recovery or healthy aging are not on those lists. That is why most HBOT at wellness centers is paid for directly. If you live in Rockledge or elsewhere in Brevard County and have a plan through an employer, Medicare or a marketplace, the plan's own coverage policy is the document that decides.
What Medicare lists.
According to Medicare's coverage page, Part B may cover HBOT in a chamber for eligible people with specific conditions. At a high level, the list includes:
- Acute carbon monoxide poisoning, decompression illness and gas embolism
- Gas gangrene, progressive necrotizing infections and cyanide poisoning
- Crush injuries, acute traumatic peripheral ischemia and some limb reattachments
- Diabetic wounds of the lower legs and feet that meet specific criteria and have not healed with standard care
- Certain other conditions, including some cases of chronic bone infection and bone damage from radiation
Medicare notes that you usually pay 20% of the Medicare-approved amount, and the Part B deductible may apply. Private plans often use similar lists, but each plan sets its own rules.
Prior authorization and paperwork.
For covered HBOT, many plans require prior authorization. That means your physician submits the diagnosis and treatment plan, and the insurer approves it before sessions begin. Plans may also limit the number of sessions, require treatment at an approved facility, and ask for progress notes before approving more. If a request is denied, your physician's office can often help with the appeal, and your insurer must explain the reason.
Covered HBOT is often delivered through hospital or wound-care programs that bill insurance directly. Suntree is a wellness center, and the team can explain how a physician referral fits into a visit.
Why wellness HBOT is usually self-pay.
Uses such as athletic recovery, cognition, inflammation or healthy aging are off-label. Researchers are studying them, but they are not on Medicare's list and are generally not covered.
That is why Suntree publishes its prices: $200 for a standard 60-minute session, or a $199 monthly membership with a three-month commitment and $99 member sessions. Our HBOT cost guide works through example monthly totals, and the pricing page compares every option.
What to ask your insurer.
Call the number on your insurance card and ask:
- Does my plan cover hyperbaric oxygen therapy, and for which diagnoses?
- Is prior authorization required, and who submits it?
- Does it matter where the HBOT is provided, such as a hospital or an outpatient center?
- What would my deductible, copay or coinsurance be?
- Can you send the answer in writing?
How Suntree handles payment questions.
Suntree does not promise insurance coverage. Coverage depends on your plan and your diagnosis. Call 321-334-2000 to discuss payment before you book, or use the online request form and the team will follow up.
If you think you may have carbon monoxide poisoning, decompression sickness or a gas embolism, that is a hospital emergency. Call 911. Suntree is not an emergency facility.