Information About Insurance Coverage for Oral Appliances
INSURANCE COVERAGE FOR ORAL APPLIANCES
Dental plans generally do not provide coverage for oral appliance therapy. Without exception, oral appliance therapy should be billed to medical insurance carriers and most medical insurance companies will cover oral appliance therapy if they are confident they are paying for a treatment that the patient requires. To accomplish this there must be a sleep study to determine if a patient is suffering from Sleep Disturbed Breathing (SDB).
Dr. Braga works closely with Sleep Medicine Physician Specialists and Medical Sleep Labs to verify and document that you suffering from Sleep Apnea, to what degree and document the medical necessity for the treatment. At the completion of this procedure the Diplomate Sleep Physician provides Dr. Braga with the necessary prescription for the oral appliance.
STANDARDS OF CARE
Medical insurance companies are required to adhere to the American Academy of Sleep MedicinePrractice Parameters. The Practice Parameters state that oral appliance are indicated for use in patients with mild to moderate obstructive sleep apnea who:
– Prefer oral appliances to CPAP
– Do not respond to CPAP
– Are not appropriate candidates for CPAP – Fail treatment attempts with CPAP or behavioral measures such as weight loss or sleep position changes
– In some cases need a combination CPAP/Oral Appliance Therapy
Oral appliances are custom made for each patient and because of this, they must be paid in full at the time of delivery. Our insurance specialists will work with your insurance company to very accurately determine your coverage. We will submit all necessary paperwork from our office to ensure that your benefits are maximized.
Cahill Dental Care is a Medicare Approved DME provider of custom made oral appliance for sleep apnea. The Medicare payment is sent directly to the patient who then uses the reimbursement to help pay for their oral appliance.
Financing is available for oral appliance therapy through a third party credit program.
ANSWERS TO COMMON QUESTIONS
– Is a Dentist the only medical professional licensed to provide oral appliances to treat Obstructive Sleep Apnea?
Yes. Other medical professionals are not licensed to perform this service. Internet devices to treat snoring can mask a serious sleep disturbance problem, cause TMJ (Joint) problems and negatively alter you occlusion (Bite).
–How will I know what my treatment will cost and how much my insurance company will pay?
Patients normally begin treatment with a consultation conducted by Dr. Braga. If you provide us with your insurance information prior to your appointment our office can contact your insurance company before your arrival. You will then have an very accurate picture of what your insurance will cover and what your out-of-pocket expenses will be.
–Will my dental insurance pay for sleep apnea treatment?
Insurance coverage for sleep apnea is covered by your medical plan. Dental insurances do not cover any of your treatment for Sleep Apnea.
–Do insurance comapnies normally cover oral appliance therapy for sleep apnea?
Yes. Virtually all medical insurance companies cover oral appliance therapy for treatment of Obstructive Sleep Apnea. However if your diagnosis is Primary Snoring and not Obstructive Sleep Apnea no insurance, medial or dental, will pay for your treatment.
If I don’t have sleep apnea but I snore will an insurance company cover my treatment costs?
Unfortunately, snoring is viewed as a benign condition by the medical community and therefoe insurance companies do not cover treatment for snoring only. However, if snoring is one of the symptoms of your Obstructive Sleep Apnea your insurance will cover treatment and in a large number of cases treating Sleep Apnea will greatly reduce your snoring and in some cases eliminate it.
–Do most insurance companies have providers (Dentists) in their medical network for oral appliance therapy?
No most insurance companies do not have specific medical in-network dentists providing treatment. Only dentists are licensed to provide oral appliance but be sure to ask questions about credentials. Questions such as, ‘How long have you provided this service?, How many patients have you treated?, What specific training do you have in the treatment of sleep apnea? are important to the ensuring that you are getting appropriate care.
–Can I still be treated by Dr. Braga and get coverage for my treatment even if she is not a provider in my insurance network?
Yes. If there is an in-network provider you can still see us and receive your out-of-network benefits.
–Is Dr. Braga an In-Network Provider for any insurance companies?
Yes. This office is an in-network provider for BlueCrossBlueShield, HealthPartners, Medica and PreferredOne. Cahill Dental Care is also an authorized Medicare DMEPOS — an Medicare approved supplier of custom made dental devices to treat Sleep Apnea.