Dr. Helen Gelly sent me the statement below from Blue Cross Blue Shield of Alabama (BCBSAL) as it pertains to considerations regarding Hyperbaric Oxygen Therapy:

Menstruation: There is a great risk for decompression illness in the early phase of the menstrual cycle.

Pregnancy: There is a small risk to the fetus that high oxygen levels will stimulate the muscles around the ductus arteriosus to contract, closing it and causing fetal death. Treatments should last no longer than 120 minutes.

Just to be clear:

  1. There is not a “great risk” for decompression illness (DCI) in the early phase of the menstrual cycle (or at any other phase of the menstrual cycle). While data suggest that DCI incidence in women is not equally distributed over a 4-week menstrual cycle, the risk of DCI for women is the same as it is for men, and that risk is very low.
  2. DCI is due to the effects of nitrogen that result from breathing compressed AIR since air is comprised of both oxygen and nitrogen. It is not possible to get DCI during hyperbaric oxygen therapy, because patients are breathing 100% oxygen. That means the erroneous comments about the menstrual cycle and DCI (as they pertain to HBOT) are not only wrong, they are irrelevant.
  3. Countless pregnant women have undergone HBOT (usually for conditions like carbon monoxide poisoning). In fact, for many years, the Russians delivered babies in a hyperbaric chamber when there was fetal distress. There are no recorded cases of premature closure of the ductus or fetal death due to HBOT.

The definitive work on diving and the menstrual cycle was done by Marguerite St. Leger Dowse and colleagues at the Diving Diseases Research Centre (DDRC) in England. Marguerite and I published a small textbook called “Women and Pressure, Diving and Flying”, in hopes of creating a “one-stop shop” for information on various topics relevant to women. The book is available from Best Publishing in hard copy or as an e-book, and all proceeds benefit the DDRC which is a non-profit organization (“charity” in Britain).

I have no answer for the bigger question of how to correct incredibly inaccurate statements like this in private payer policies, but BCBSAL should be incredibly embarrassed.

Send me your favorite payer policy blunders (meaning, obviously inaccurate information) and I will post them.


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