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202008-130650

2020

Empire Healthchoice Assurance Inc.

Indemnity

Ears/ Nose/ Throat

Oxygen/ Oxygen Treatments

Medical necessity

Overturned

Case Summary

Diagnosis: Ears/Nose/throat/hearing problem/loss.
Treatment: Oxygen/oxygen treatments.

The insurer denied hyperbaric oxygen therapy. The denial is overturned in whole.

The patient is a female with a history of sudden sensorineural hearing loss in the left ear. The patient was noted to have an audiogram, which confirmed the hearing loss, and she underwent a subsequent steroid injection.

Yes, the requested service hyperbaric oxygen therapy (HBO), is medically necessary for the patient. The patient received two steroid injections in the middle ear space without improvement in the hearing. There is evidence within the literature and recommendation from the American Academy of Otolaryngology/Head and Neck Surgery that HBO therapy can benefit a patient's hearing if administered within 3 months of the initial insult.

There is some evidence that HBO therapy can have an effect on reversing idiopathic Sensorineural hearing loss (SNHL). While patients can have an increased opportunity for treatment sudden hearing if the HBO is administered within 2 weeks, current guidelines published by the American Academy of Otolaryngology state that patients can have a hearing benefit if administered within 3 months. Hearing loss is a life impacting change for patients, and all reasonable treatment should be utilized to improve a patient's outcome, in the case of this patient, who sustained sudden hearing loss in the left ear.

Therefore, the hyperbaric oxygen therapy is medically necessary for this patient.

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