Information About Insurance Coverage for Oral Appliance Therapy
Do insurance companies cover oral appliance
therapy?
Yes. Most medical insurance companies
cover oral appliance therapy for treatment of obstructive sleep apnea.
In our office it is our experience that over 90% of the patients will
have coverage for this treatment. However, these companies do
not cover treatment for snoring only.
Do most insurance companies have
providers (dentists) in the network for oral appliance therapy for sleep
apnea?
No,
most insurance companies do not have in-network providers (dentists) for
this treatment.
Can I still come to see Dental Sleep Medicine of
new England and get coverage for my treatment even if he is not a
provider in my insurance network?
Yes.
If there is no in-network provider within the insurance plan then the
insurance company is required to pay the claims at in-network rates and
you should get your maximum coverage for the treatment. If there is an
in-network provider, you can still see us, and you would receive
out-of-network benefits.
Is
the Snoring and Sleep
Apnea Dental
Treatment
Center a provider for any insurance
companies?
Yes.
This office is a provider for Blue Cross Blue Shield Health Plan and
Harvard Pilgrim Health Plan.
Does
the office have payment options that will reduce my out-of-pocket
expense for treatment?
Yes.
We offer interest–free financing for up to 12 months on all office visits and
treatment. This usually allows enough time to receive your insurance
reimbursement so you can get your maximum insurance benefit while
reducing your out-of-pocket expense.
Why do I need to pay for care at the time of the
visit?
If
our office is not a provider in your insurance network, then we do not
have access to information about your insurance coverage rates,
co-payments, and deductibles. However, we will submit the insurance
claim for you and provide the necessary documentation to help you
receive your maximum insurance benefits, and we find that over 90% of
our patients have coverage for their treatment. It is our practice to
require payment at the time of service, and you will be reimbursed by
your insurance company according to your policy.
How do I find out how much my
insurance company will cover for this treatment?
Our office will send a letter to your
insurance company asking for a pre-treatment determination of benefits
under your policy. The insurance company will respond by sending a
letter back to you, with a copy to us, explaining your coverage for this
treatment. If the letter does not specify what percentage of the cost
is covered, we recommend that you call your insurance company to get
that information. Some of the questions you should ask your insurance
representative are:
 | What is my percentage of coverage for oral appliance therapy for
treatment of obstructive sleep apnea (code # E0486)? |
| What is the fee range of coverage? |
| Are there any in-network providers for this specific treatment
in my insurance plan?
|
| If there are no providers within the network will my coverage
be at an in-network percentage?
|
| If there are providers within the network, what is my coverage
if I see an out-of-network provider?
|
| Do I need a referral from a physician to see the dentist who
treats this problem? |
