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
Insights into dealing with medical insurers
Oral orthotics are considered a medical treatment for a medical disease; dental insurance will not cover this procedure. This arrangement makes it difficult for dentists to bill for the orthotic and requires significant effort on the part of the dental office staff. Dentists often have contracts with insurance companies as “dental providers” who are paid only for dental procedures. Physicians have contracts with insurance companies as “medical providers” and are NOT trained in the fabrication of oral orthotics that are accepted by the FDA for the treatment of obstructive sleep apnea.
Most medical insurers in the US have “Medical Policy Guidelines” that spell out what they will pay for as an insurer and what they consider ‘experimental’ and, therefore, will not pay for. They also set forth the guidelines a patient must meet before treatment will be covered. An example is a person who is diagnosed with “upper airway resistance syndrome” a level of sleep disordered breathing just below mild sleep apnea. Most insurers have guidelines that read “the patient must have more than 5 breathing events per hour AND two symptoms such as daytime sleepiness, high blood pressure, heart failure or stroke. Or: The patient must have 15 breathing events per hour if there are no other symptoms before coverage for treatment is allowed”. Each insurance policy holder has the right to contact his/her medical insurer and obtain a copy of the Medical Policy Guidelines for the treatment of obstructive sleep apnea.
Be aware that some insurance companies have made policy that declares oral orthotic therapy to be “experimental’ and do not cover any orthotics. This view is severely out of date and is something I consider to be a disservice to their members. The last insurance company I found that still had these out dated rules was Blue Cross Blue Shield of Alabama. Each patient might want to contact the medical insurance company by whom they are insured.
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/