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, Aetna 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 6 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?