B. Gail Denko, DMD PC, Dental Sleep Medicine. Specializing in the treatment of patients with snoring and obstructive sleep apnea.
“Anyone can escape into sleep, we are all geniuses when we dream, the butcher's the poet's equal there.”
Emile M. Ciora
Insurance billing for oral orthotics
How does a patient find out if oral orthotics are a covered service?
1. Get a copy of the medical insurers “Medical Policy Guidelines on the treatment of obstructive sleep apnea.
2. Call the members services department and find out if the policy covers ‘durable medical equipment’ (DME). This includes the part of insurance that covers items you can buy for medical care: crutches, sugar monitors, wheelchairs, etc. It is best to know that the most common billing code used by insurance companies for oral orthotics is S8260. Ask the representative if the code S8260 is payable under the contracted policy.
- You must also find out what percentage they pay to “out-of-network” providers (the patient pays the balance)
- Is there an annual deductible? (An amount the patient must pay before the insurance company pays anything at all)
- Is there an annual maximum? (Some policies only have a $1500 annual limit. This means that is the patient has used part of the money set aside for DME purchases such as a CPAP machine, then there may be very little money leftover that year to pay for an oral orthotic. This means that the patient pays more of the dentist’s fee.
What stumbling blocks does the medical insurance company, who covers oral orthotics, put in the way of the patient receiving care from a dentist?
The Medical Policy Guidelines of most medical insurance companies require that every patient diagnosed with obstructive sleep apnea use CPAP as their first mode of therapy. The guidelines allow surgery or oral orthotics ONLY if the patient is intolerant of CPAP. This is based on the guidelines issued by the American Academy of Sleep Medicine where physicians have proven that CPAP is the most reliable, most effective, and creates the best improvement in all the medical problems created by sleep apnea. All other treatments are considered “second best”.
Dentists play an important role in the team approach to the treatment of obstructive sleep apnea.
Physicians, dentists, psychologists, and respiratory therapists all pool their knowledge to treat each patient appropriately and effectively.
Dentists who are specifically trained in aspects of sleep medicine and have a command of multiple appliance modalities are of great help to physicians in treating patients with sleep disordered breathing problems.
AVALABLE OFFICE HOURS:
9:00 t o 5:00 (Mon)
9:00 to 5:00 (Wed–Sat)
12:00 to5:00 (Sun)
CALL 617.964.4028
in Massachusetts
317.842.9866
in Indiana
The National Center on Sleep Disorders Research, can provide you with sleep education materials. As well as publications on heart, lung and blood research:
Two Rockledge Center, Suite 7024, 6701Rockledge Drive, MSC 7920, Betesda, MD 20892-7920
(P)301.435.0199 /
(F) 301.480.3451
www.nhlbi.nih.gov/about/ncsdr/
Information about sleep disorders may be obtained from NHLBI:
NHLBI Information Center
P. O. Box 30105, Bethesda, MD 20824-0105
(P) 301.251.1222 / (F) 301.251.122
www.nhlbi.nih.gov/