Frequently Asked Questions About Sleep Apnea Insurance Coverage
DOES DENTAL INSURANCE OR MEDICAL INSURANCE COVER THE SLEEP APNEA APPLIANCE?
The sleep apnea appliance is considered medical treatment and dental insurance will not cover treatment however most medical policies will consider paying for the appliance at a dental office.
DO YOU PARTICIPATE WITH MY MEDICAL INSURANCE?
As a dental provider, we are contracted with dental policies only. Medical insurances create barriers for dental providers and usually only have medical physicians as participating providers. However, since most medical professionals are not trained in the fabrication and treatment of sleep apnea appliances, medical insurances will usually cover the appliance even though we are not in their network of providers.
HOW DO I GET MY INSURANCE TO COVER TREATMENT IF YOU DO NOT PARTICIPATE?
If your medical insurance policy is not an HMO plan, we are usually able to obtain benefits from your medical carrier if you meet their guidelines for treatment. We may also be able to request a "network insufficiency" which means if your medical policy does not have any contracted providers for the service, they will provide coverage at the same rate as they would for the in-network provider. If you have an HMO policy, which does not allow members to see a physician out of their network, we may request a "gap waiver". If approved, this would allow you to be seen out of the HMO network since there are no providers in the network that perform this service.
HOW MUCH DOES MY MEDICAL INSURANCE COVER?
Medical policies vary depending on the insurance company and plans. They also set forth guidelines as to what a patient's clinical indications should be for the appliance to be considered under the medical policy. This is called "medical necessity". At the initial consult, we will evaluate your signs and symptoms to make sure you are a candidate for the treatment and that you meet your insurance policy's guidelines. At the time of the consultation, we will discuss how your medical insurance policy covers the sleep apnea treatment.
WHAT DO I HAVE TO DO TO GET THE WAIVERS AND REIMBURSEMENT FROM MY INSURANCE?
Our office will contact your insurance to obtain all your benefits information and request any waivers if necessary. We will also submit all claims proving medical necessity to your insurance carrier. Our goal is to get the maximum reimbursement from your plan.