insurance coverage for oral appliances

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, our experience has been 90% of patients will have some coverage for this treatment. These companies generally do not have coverage to treat 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 Dr McCrillis 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 Dr. McCrillis and you would receive out-of-network benefits.

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 with all the necessary documentation to help you receive your maximum insurance benefits and we find that 90% of our patients have some 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.

Does the office have payment options that will decrease my up-front expense for treatment?

Yes. When you call us, we can give you specific details for your situation and coverage.

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 compnay 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 benefit is payable, 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 #S8260)? Some companies prefer to use codes unique to their system. We can provide that detail to you.
    • Are there any in-network providers for this specific treatment in my insurance plan?
    • If there are no in-network providers, will my coverage be at in-network percentage?
    • If there are in-network providers, 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?