Insurances and Payments
Does insurance cover Dental Sleep Appliances?
In most cases dental sleep therapy is covered by your medical insurance (not dental insurance) if you have had a sleep study and been diagnosed with OSA.
Our staff are trained and experienced to help you obtain your maximum medical benefits your particular plan allows. Our staff will work closely with you to check benefits, check medical necessity requirements with your insurance, and get any pre-authorizations that may be needed. They will also assist in getting a prescription and letter of medical necessity from your primary care provider or sleep doctor.
What will my insurance pay for the device?
This will vary from plan to plan. We would not be able to give you an exact quote until we have seen you in the office and are able to verify with the insurance that you meet their medical necessity policy for the oral appliance. We do provide estimates to patients before they come in for the impression visit. The dental device is considered a DME, Durable Medical Equipment. In most cases, all costs will be applied to your deductible and/or co-insurance just like a CPAP and CPAP supplies would be.
Are you “in-network” with my insurance?
We are currently only in-network with Blue Cross Blue Shield.
Most medical carriers do not contract with dentists and therefore we are considered “out-of-network.” In some cases a "Gap Exception" can be requested which means that your insurance company may agree to cover our services at the “in-network” level.
Do you accept Medicare?
Yes we do file Medicare claims and if you meet their medical necessity requirements they will cover a portion of the cost. We are considered a "non-participating" Medicare provider. This means non-participating providers haven't signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services.
How long will the insurance verification process take?
This will vary from patient to patient but it can several weeks up to a month or more. In most cases, we will have to request records from your sleep doctor and sometimes your dentist. We will also have to have a letter of medical necessity form signed by your sleep doctor. Once we have this information back we will be able to begin the insurance verification process and start any pre-authorizations that may be needed. Depending on your insurance the pre-authorization may be approved in a few days or weeks. Once we know what the insurance coverage will be we will contact you with that information and be able to schedule your impression visit.
What payment options do you accept?
We accept CareCredit, credit cards, checks, and cash.
What is the code used to bill the treatment?
The DME code is E0486.
If you have additional questions please call us. We are always happy to assist you.