Insurance Questions
Information About Insurance Coverage For Oral Appliance Therapy Do insurance companies cover this type of therapy?
Most medical insurance companies cover oral appliance therapy for treatment of OSA. It is best to read your policy carefully and speak to your insurance representative prior to your visit with us. However, many companies generally do not cover treatment for primary snoring (snoring only) appliances. It is imperative that you know your policy—it is your best tool to stay one step ahead of the insurance companies.
Do most insurance companies have providers (dentists) in the network for TMJ disorder therapy and oral appliance therapy for sleep apnea?
Most insurance companies do not have in-network providers (dentists) for this treatment.
Can I still come to see Dr. Ron Loftus and get coverage for my treatment even if he is not a provider in my insurance network?
If there is no in-network provider within the insurance plan, then the insurance company may be required to pay the claim at an in-network rates (this is called benefit exception) and you should get your maximum coverage for the treatment. If there is an in-network provider and you see Dr. Ron Loftus, 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 claim for you and provide the necessary documentation to help you receive your maximum insurance benefits. 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?
Once you have been in for our Preliminary Diagnostic appointment, our office can 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.
Questions you should ask your insurance representative:
- What is my percentage of coverage for oral appliance therapy for sleep disorders?
- 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?
- The medical diagnosis code for Obstructive Sleep Apnea is 327.23. Is that a covered diagnosis?
- The medical procedure code for Oral Appliance Therapy is E0486. Is that a covered procedure?
- I am CPAP intolerant. Do I need pre-certification from my sleep physician to verify this?