Insurance
This is a brief
guide to help you to understand insurance coverage for oral sleep
appliances. This information will be
useful to you in understanding the insurance process and making your experience
flow as smoothly as possible. Because
this process can sometimes be complicated, we do our utmost to inform you and
answer your questions. We are also dedicated to informing you about financial processes
prior to providing any services. The
information below provides information that will help you understand the
process prior to your visit.
Overview of Insurance:
You were referred to our office because of our unique expertise in treating sleep disorders. Our relationship with you and our ability to treat you are our highest concern.
We are in a unique position as our doctors have D.M.D. (dental) credentials and provide services customarily covered under your major medical benefits. Claims for evaluation and treatment with oral appliance therapy for obstructive sleep apnea are routinely filed under a major medical insurance policy, not a dental plan. We are contracted with many insurance carriers and contracts with others are pending. However, we are not contracted with or considered preferred providers with all medical insurance companies. We look forward to the day that all medical insurance companies will contract with us so that all patients will have medical coverage for oral appliance therapy.
To ensure that you know the benefits and limitations of your policy in regard to oral appliance therapy, we suggest that you review your medical insurance policy or “benefits booklet” or call your insurance provider so that you may be aware of important details of your specific medical contract.
When speaking with your carrier, you will need to know the appropriate billing code: this is E0486, which is a ”HCPCS” code. Please check with your insurance carrier for specific coverage benefits and reference billing code: E0486.
If we are not contracted with your carrier, we will provide you with forms and necessary information to submit your claim to your carrier. We are happy to help with any questions you may have in submitting insurance forms. Your insurance carrier will be instructed to send insurance reimbursements directly to you. You will be asked to pay for your services in our office.
Criteria for coverage:
To meet medical necessity requirements for insurance coverage you must first be diagnosed with obstructive sleep apnea by your physician.
Many insurance carriers consider oral appliances a first line therapy while others specify that you must first have a trial of Continuous Positive Airway Pressure (CPAP). When this is the case, they will require that you have either failed Continuous Positive Airway Pressure (CPAP) or are unable to tolerate an attempt.
If you have any questions on any of this information, feel free to call our office.
Prior To Your Visit:
Referral
We will obtain a referral from your doctor’s office.
Panoramic x-ray
If you have had a recent panoramic (within the last six months) we will ask your dentist to send us a copy of your x-ray. We have the capability to take the x-ray here if you don’t already have one.
Insurance Information
Call your insurance and check your benefits:
Ask if a prior authorization will need to be obtained before coming in. Most insurance companies do not need prior authorization before your first appointment (with the exception of Medicare advantage plans and HMO plans). If prior authorizations are needed for the appliance, requests can be submitted after the first appointment.
Ask about the amount of deductible you have left to pay. Be aware that some carriers have a separate deductible for Durable Medical Equipment (DME).
Find out which procedures and office visits would be covered and if they are covered at the in-network rate*.
*If we are out of network with your carrier, it is important to explain that you have been referred to Dr. Kuehne or Dr. Spencer by your physician and that there are no contracted dentists in the geographical area that can provide this service. Ask them for an in-network rate (known as a gap exception or out-of-network waiver).
Payment Options:
Our payment options are as follows:
Cash or Check
Credit Card: Visa, MasterCard or Discover
Care Credit**
**We do realize that for many people payment for needed treatment is difficult. We offer an extended payment plan or interest free payment plan through CareCredit. If you know that you would like to use such an option, please talk to our office staff and they can give you further information. You can apply at: www.carecredit.com or call 1 (800) 300-3046 ext.4519
Overview of Insurance:
You were referred to our office because of our unique expertise in treating sleep disorders. Our relationship with you and our ability to treat you are our highest concern.
We are in a unique position as our doctors have D.M.D. (dental) credentials and provide services customarily covered under your major medical benefits. Claims for evaluation and treatment with oral appliance therapy for obstructive sleep apnea are routinely filed under a major medical insurance policy, not a dental plan. We are contracted with many insurance carriers and contracts with others are pending. However, we are not contracted with or considered preferred providers with all medical insurance companies. We look forward to the day that all medical insurance companies will contract with us so that all patients will have medical coverage for oral appliance therapy.
To ensure that you know the benefits and limitations of your policy in regard to oral appliance therapy, we suggest that you review your medical insurance policy or “benefits booklet” or call your insurance provider so that you may be aware of important details of your specific medical contract.
When speaking with your carrier, you will need to know the appropriate billing code: this is E0486, which is a ”HCPCS” code. Please check with your insurance carrier for specific coverage benefits and reference billing code: E0486.
If we are not contracted with your carrier, we will provide you with forms and necessary information to submit your claim to your carrier. We are happy to help with any questions you may have in submitting insurance forms. Your insurance carrier will be instructed to send insurance reimbursements directly to you. You will be asked to pay for your services in our office.
Criteria for coverage:
To meet medical necessity requirements for insurance coverage you must first be diagnosed with obstructive sleep apnea by your physician.
Many insurance carriers consider oral appliances a first line therapy while others specify that you must first have a trial of Continuous Positive Airway Pressure (CPAP). When this is the case, they will require that you have either failed Continuous Positive Airway Pressure (CPAP) or are unable to tolerate an attempt.
If you have any questions on any of this information, feel free to call our office.
Prior To Your Visit:
Referral
We will obtain a referral from your doctor’s office.
Panoramic x-ray
If you have had a recent panoramic (within the last six months) we will ask your dentist to send us a copy of your x-ray. We have the capability to take the x-ray here if you don’t already have one.
Insurance Information
Call your insurance and check your benefits:
Ask if a prior authorization will need to be obtained before coming in. Most insurance companies do not need prior authorization before your first appointment (with the exception of Medicare advantage plans and HMO plans). If prior authorizations are needed for the appliance, requests can be submitted after the first appointment.
Ask about the amount of deductible you have left to pay. Be aware that some carriers have a separate deductible for Durable Medical Equipment (DME).
Find out which procedures and office visits would be covered and if they are covered at the in-network rate*.
*If we are out of network with your carrier, it is important to explain that you have been referred to Dr. Kuehne or Dr. Spencer by your physician and that there are no contracted dentists in the geographical area that can provide this service. Ask them for an in-network rate (known as a gap exception or out-of-network waiver).
Payment Options:
Our payment options are as follows:
Cash or Check
Credit Card: Visa, MasterCard or Discover
Care Credit**
**We do realize that for many people payment for needed treatment is difficult. We offer an extended payment plan or interest free payment plan through CareCredit. If you know that you would like to use such an option, please talk to our office staff and they can give you further information. You can apply at: www.carecredit.com or call 1 (800) 300-3046 ext.4519
