Insurance Reimbursement for Wound Care Clinics
Wound care is a critical component of medical treatment, but it is often subject to differing policies on insurance reimbursement depending on the setting in which the wound care if provided. This disparity can result in significant out-of-pocket expenses for patients, inexpert self-treatment of wounds, and more serious medical problems down the road. Improper treatment of relatively minor wounds due to lack of insurance reimbursement can result in infections and other major illnesses that cost even more money to treat.
Insurance reimbursement for wound care clinics is one aspect of insurance coverage you should confirm, especially if you have kids, or have accident-prone family members. Insurance is an increasingly expensive and frustrating expense. The frustration comes in part from not getting adequately reimbursed for care you seek, or not getting reimbursed at all. In addition to learning more about your insurance coverage, be sure to learn proper wound care.
Insurance reimbursement is often not provided for follow-up treatment of wounds in a doctor's office. Things such as dressing changes and checkups on the progress of wound healing may not be fully covered. As a result, many patients do not seek a doctor's assistance in the ongoing treatment of a wound. They change their dressings themselves, perhaps in a non-sterile setting. The dressings they apply themselves may be inappropriate for their wounds. Lay persons may not recognize the developing signs of infection, which require immediate treatment with antibiotics. They need a doctor’s attention, but insurance reimbursement is not available for it.
Insurance reimbursement for wound care clinics is a standard insurance industry practice. Wound care clinics are dedicated to the treatment and prevention of wounds; these services are billable under most insurers’ policies. Dressings, for example, are considered part of the treatment and are billable to insurance, saving the patient the out-of-pocket expense.
Some patients are more vulnerable to wounds than others. Obesity can lead to diabetes, and diabetics wound easily and take longer to heal. Insurance reimbursement for wound care clinics enables patients to get help managing their non-wound conditions so that they get fewer and less severe wounds. When wounds do develop, they receive prompt treatment that can avert more serious and expensive infections or even amputations.
Wound care has traditionally been the province of home medical care companies, which supply dressings and topical prescription medications to those who treat their wounds at home. These supplies are generally not subject to insurance reimbursement, but people buy them out-of-pocket out of necessity. Wound care was a $5 billion market in 2002, and its size is continuing to grow. The home medical care industry is seeing more of its revenues diverted to wound care clinics as insurance reimbursement for wound care clinics catches on.
Insurance reimbursement for wound care clinics is vitally important because the cost of wound care clinics is high. Factors contributing to wound care clinic costs include the increasing sophistication of wound care, which includes not only bandages and gauze but, increasingly, high-tech dressings and "artificial skin" biologically-derived products. The specialized expertise of wound care specialists also figures into the cost equation, as does the relative scarcity of certified wound care clinics.
Insurance reimbursement for wound care clinics provides additional revenues for wound care providers, enabling expansion of such vital treatment programs. It benefits patients who otherwise might lose limbs or die as a result of improper wound care. Prevention and early treatment of wounds in the chronically vulnerable population helps reduce long term health care costs.
