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Sleep Apnea and Medical Insurance: What You Need to Know

February 11, 2021

Filed under: Uncategorized — 21stsleep @ 10:47 pm
an individual handing their insurance card over while a doctor fills out paperwork

As a dental professional who wants to offer sleep apnea therapy to your patients, you may not realize that dental insurance does not cover the cost of treatment. As unfortunate and frustrating as this can be, it is the reality, which means you must look for an alternative solution to keep your clients from going elsewhere to receive appropriate care. What you may not realize is that medical insurance may cover the cost of sleep apnea therapy, but you and your team will need to know how to navigate this new method of payment. Read on to discover what you need to know to take better care of your patients physically and financially.

How Medical Insurance Views Sleep Apnea Therapy

Although dental insurance companies do not reimburse for oral appliance therapy, it is not uncommon for medical insurance to provide much-needed financial relief to patients. Dentists who provide oral devices can typically expect reimbursement for this type of service; however, there are some stipulations you need to be aware of to ensure all parties are financially taken care of, such as:

  • Sleep studies are typically covered by medical insurance because they can confirm a patient’s “medical necessity.” Although, it should be noted that most insurers will lean toward offering coverage for at-home tests more than those performed in a laboratory.
  • Customized oral appliances are most commonly covered by medical insurance, not devices sold online. Why? Because there is no clinical proof that the individual requires the device when ordering through the internet.
  • All paperwork and claims must be filled out thoroughly and correctly, as misinformation or incorrect data can cause a claim to be denied. To avoid potential errors, many dental professionals opt to work with a third-party medical billing company that can streamline this process.
  • Keeping track of your patient’s treatment information is crucial to ensure insurance will accept the claim and offer reimbursement. It’s also necessary to use the correct codes when filling out paperwork, as this can mean the difference between approval or denial of a claim.

What About Medicare?

When a patient comes to you with their medical insurance, you can feel confident that as long as everything is filled out correctly and it is deemed “medically necessary” for them to receive oral appliance therapy, no claim will be denied. But what about Medicare? There is good news on that front as well. As long as you enroll as a Medicare DME Supplier, you can help your patients and ensure reimbursement for treatment.

As long as the patient sees a physician prior to receiving sleep apnea therapy, it is possible that Medicare may approve necessary treatment. However, it is important that you work closely with the medical physician. As a dentist, you can detect certain signs of sleep apnea that others may be unable to. Unfortunately, many patients are misdiagnosed by doctors who mistake symptoms for depression, not sleep apnea.

By collaborating with referred physicians, you can ensure your clients get the necessary care they need without going into debt to receive it.

About 21st Century Sleep Seminars
Dr. Kent Smith is a top professional in sleep medicine who has experience in treating, writing, and speaking about sleep disorders. His wealth of knowledge has helped other dentists integrate sleep apnea treatment into their own practices. At 21st Century Sleep Seminars, we can provide you with the information, tips, advice, and network of professionals you need to effectively treat these sleep disorders your patients are facing. To learn more, visit our website or call (972) 255-3712.

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