Home oxygen therapy provides supplemental gas to individuals whose medical conditions prevent them from maintaining healthy blood oxygen levels. Although the public often refers to this as “emergency oxygen,” it is a medically prescribed treatment used for stable, long-term conditions or acute exacerbations. Securing home oxygen is a regulated process requiring coordination between the patient, physician, medical equipment supplier, and insurance provider to ensure the therapy is safe and correctly administered.
Obtaining Medical Authorization
Medical oxygen is regulated by the Food and Drug Administration (FDA) as a prescription drug, meaning a doctor’s order is required for legal acquisition. The first step involves a consultation to determine if hypoxemia (low blood oxygen) is present and requires treatment. The physician will then order specific tests to confirm the necessity for supplemental oxygen therapy.
Qualification for home oxygen is based on the results of a pulse oximetry reading or an arterial blood gas (ABG) test. Insurance providers, including Medicare, require a resting oxygen saturation level (SpO2) at or below 88% or a partial pressure of oxygen (PaO2) at or below 55 mm Hg while breathing room air. Testing is performed while the patient is in a stable, chronic state, not during an acute illness.
The physician must provide extensive documentation, often called a Certificate of Medical Necessity, to the supplier and the payer. This prescription must specify the diagnosis, the required oxygen flow rate in liters per minute (LPM), and the schedule of use (continuous, nocturnal, or with exercise). A prescription for “as needed” oxygen is not acceptable for coverage, as it does not define the appropriate dosage.
Understanding Home Oxygen Delivery Systems
Once a prescription is secured, patients choose between two main types of home oxygen sources: oxygen concentrators and compressed gas cylinders. The choice depends on the prescribed flow rate, frequency of use, and the patient’s lifestyle.
Oxygen concentrators are electrical devices that filter and concentrate oxygen from the surrounding room air. These devices are suitable for continuous, long-term use because they offer an unlimited supply of oxygen as long as they have a power source. Stationary models are larger and designed for home use, while portable oxygen concentrators (POCs) are smaller, battery-powered units that provide mobility.
In contrast, oxygen cylinders, or tanks, store pure oxygen as a compressed gas or cryogenic liquid. These tanks do not require electricity to operate, making them excellent backups for power outages or for travel where a power source is unavailable. However, they contain a finite supply of oxygen and must be physically refilled or exchanged by a supplier once the gas is depleted.
Working with Equipment Providers and Insurance
After medical authorization is complete, the patient coordinates with a Durable Medical Equipment (DME) company to acquire the necessary devices. DME providers are specialized suppliers who deliver, set up, and maintain the prescribed oxygen equipment. They are also responsible for training the patient and caregivers on the safe operation and routine maintenance of the system.
The financial aspect of home oxygen is managed through the patient’s insurance plan, which requires pre-authorization before delivery can occur. Coverage depends on meeting strict medical necessity criteria, such as the qualifying blood oxygen levels and the required documentation from the physician. Patients rent the equipment, rather than purchasing it outright, with insurance covering a monthly rental fee for a specified period.
DME companies work directly with the insurance payer to ensure the prescription meets all coverage guidelines, including those for Medicare, Medicaid, or private insurance. The patient should verify if the provider is in-network and understand any potential co-payments, deductibles, or non-covered costs associated with supplies like tubing and cannulas. The DME provider also manages the logistics of tank refills or exchanges, which is an ongoing service requirement for cylinder users.
Essential Safety and Emergency Protocols
Using supplemental oxygen at home introduces specific fire hazards because oxygen is an accelerant that causes fires to burn hotter and faster. It is important to maintain a distance of at least 5 to 10 feet between the oxygen equipment and all heat sources, including stoves, heaters, and smoking materials. Posting “No Smoking” signs prominently around the home serves as a constant reminder to residents and visitors.
Never use oil-based products, such as petroleum jelly, lotions, or certain lip balms, on the face or near oxygen equipment, as these can ignite easily in an oxygen-rich environment. Water-based lubricants are the only safe option for moisturizing the lips and skin. Furthermore, oxygen cylinders must be stored upright and secured to a cart or stand to prevent them from tipping over, which could damage the regulator or cause a dangerous leak.
An emergency protocol should include knowing the difference between a routine equipment issue and a medical crisis. For minor equipment problems, such as a kinked tube or a low concentrator alarm, the DME provider should be called immediately for technical support. If a patient experiences sudden, severe shortness of breath or a significant drop in saturation, the immediate action is to call emergency services (such as 911). Patients should also follow their doctor’s specific emergency instructions for temporary flow rate adjustments or switching to a backup tank.