Blue Shield & hyperbaric oxygen therapy
Blue Shield commercial plans generally cover hyperbaric oxygen therapy for the same clinically recognized indications as Medicare — with prior authorization, and with details that vary meaningfully from plan to plan.
How commercial coverage works
Blue Shield, like most commercial insurers, publishes a medical policy for hyperbaric oxygen therapy that closely tracks Medicare's recognized-indication list. If your condition is on that list and the clinical criteria are documented, coverage is usually approved.
Nearly all plans require prior authorization. That means the approval has to be secured before your first session, supported by your physician's notes, wound documentation, and evidence that standard treatment has been tried where the policy requires it.
Where plans differ
Your specific plan determines your deductible, your coinsurance, whether we are in network, and how many sessions are authorized at a time before reauthorization is needed. Two people with Blue Shield cards can have genuinely different out-of-pocket costs. This is why we verify rather than estimate.
What we do before you commit
We contact Blue Shield directly, confirm your benefits for your specific condition, obtain the prior authorization, and give you the expected cost in writing. All of that happens before your first session is scheduled, at no cost to you and with no obligation to proceed.
Other payers we work with
Aetna
Covers recognized indications per its Clinical Policy Bulletin; requires documentation mirroring NCD 20.29. Off-label uses considered experimental.
Cigna
Aligns with Medicare's covered indications; prior authorization and periodic reauthorization for extended wound courses.
Medicaid / Medi-Cal
Follows Medicare's recognized-indication list; specifics and prior-auth vary by state. In California, Medi-Cal generally aligns with NCD 20.29.
Medicare
Covers the 14 UHMS-recognized indications under NCD 20.29 (plus diabetic lower-extremity wounds meeting Wagner III+ / 30-day criteria). Part B pays 80% after deductible. Documentation of failed standard care is the usual denial point.
UnitedHealthcare
Covers recognized indications with prior authorization; medical-necessity review common for wound-care courses beyond initial approval.