There are 14, set by the Undersea and Hyperbaric Medical Society and recognized by the FDA: air or gas embolism, carbon monoxide poisoning, clostridial myositis and myonecrosis (gas gangrene), crush injury and compartment syndrome, decompression sickness, enhancement of healing in selected problem wounds including diabetic foot ulcers, severe anemia, intracranial abscess, necrotizing soft tissue infections, osteomyelitis (refractory), delayed radiation injury, compromised skin grafts and flaps, acute thermal burn injury, and idiopathic sudden sensorineural hearing loss. The bot lists these explicitly and notes which the clinic handles.

Honestly. The system prompt requires the bot to state the off-label status openly, summarize the current evidence at a high level (emerging, mixed, promising but not conclusive), and offer a consult. It does not make therapeutic claims and does not promise outcomes. This is partly a regulatory issue, FDA marketing rules around off-label promotion are strict, and partly a trust issue, patients who paid $5,000 for 30 sessions of off-label HBOT based on inflated claims are not return customers.

For FDA-approved indications, yes, typically. Medicare covers the 14 approved indications with documentation requirements (for diabetic foot ulcers, Wagner Grade 3 or higher with 30 days of failed standard care). Commercial insurers generally follow Medicare. The bot explains the typical prior authorization process and what the clinic handles versus what the patient or referring physician provides. Off-label uses are essentially always self-pay.

Depends entirely on indication. Carbon monoxide poisoning may be 1 to 3 sessions over a day, decompression sickness might be 1 to 5 dives, diabetic foot ulcer protocols run 30 to 40 sessions over 6 to 8 weeks, off-label TBI studies have used 40-session protocols, off-label long COVID has used 20 to 40 sessions. The bot quotes the typical protocol for each indication from the clinic's menu so patients understand the time commitment.

Yes, briefly. Major contraindications include untreated pneumothorax, certain chemotherapy regimens (bleomycin, doxorubicin within a window), uncontrolled seizure disorders, and severe COPD with carbon dioxide retention. The bot mentions these as contraindications-to-discuss-at-consult rather than self-screening rules, since proper evaluation needs the physician. Common side effects include ear and sinus barotrauma, occasional myopia changes, and rare oxygen toxicity events at higher pressures.

Recommendation is the medical director's role at consult. The bot can explain the difference, hospital-grade hard chambers run 2.0 to 2.5 ATA monoplace or multiplace, mild HBOT soft chambers run 1.3 ATA, and that the FDA-approved indications generally require hospital-grade pressures. Off-label use of mild HBOT has different evidence and different safety profiles. The clinic's own setup, hard or soft, is what the bot represents directly.

Yes. HBOT is one of the categories with significant travel-for-treatment patient flow, partly because off-label clinics are unevenly distributed. The bot can explain travel logistics, typical out-of-town protocol lengths, lodging coordination if the clinic offers it, and whether the consult can run via telehealth before in-person sessions begin. Multi-week protocols mean travel and lodging cost is material.

Scope the chat to indication education, pricing, and consult booking. Detailed medical history stays out of chat and into the consult. For US clinics handling PHI, run OpenAI under HIPAA-eligible configuration with a BAA, encrypt the WordPress database, restrict log access, and document the chat in your privacy notice. HBOT clinics in hospital settings inherit institutional HIPAA policies, freestanding clinics need to set their own framework.