Medical Insurance Information

Oral appliance therapy is a medical treatment and is usually covered by medical insurance. Dental insurance does not cover sleep apnea treatment.

In today’s insurance environment we have found that it is up to the consumer to know their insurer’s benefits and limitations and to actively pursue claims. Our insurance department is happy to assist in obtaining coverage for your oral appliance therapy.

Dr. Mogell is currently a provider for traditional Medicare and Florida Blue Cross Blue Shield. Please note that Medicare Advantage (HMO) plans may or may not provide coverage. Standard Medicare and secondary carriers cover oral appliance therapy at this time as long as certain medical criteria have been met. Our staff is happy to confirm these criteria with you prior to treatment. All deductibles and co-insurance amounts will be collected once treatment has begun.
 


Other commercial PPO insurance plans will normally cover treatment once it has been pre-authorized. Our staff will work with you to obtain proper documentation required for coverage approval. HMO plans are more restrictive and referrals from a primary care provider may be required.

You, as the patient, are your own best advocate and the contract is between you and your insurance company, not your doctor and the insurance company. For maximum success in reimbursement the following records should be maintained.

•    Any written correspondence from insurance company
•    Log all phone calls with the insurance company including a call reference number
•    Any written appeals and responses

More and more insurance companies are familiar with treating sleep apnea using oral appliance therapy. However, some employees at these companies have not been adequately trained and, because the oral appliance is coded as durable medical equipment, they will attempt to refer patients to a wheelchair or CPAP provider. Please ask for a supervisor for help. If your insurance company states that the treatment is not covered, ask for the specific exclusion from your policy that states the benefit is excluded.

All insurance companies, including Medicare, require certain documentation including a diagnostic sleep study, notes from the referring physician that discuss the sleep apnea and any other conditions (hypertension, depression, heart disease, etc), a Letter of Medical Necessity from the referring doctor, and in some cases a form stating you are CPAP intolerant. Your sleep physician and/or referring physician should be able to provide all of these documents.

Our office will file all insurance claims electronically. In rare instances the insurer may send payment directly to the patient, not the doctor. In this case you will be responsible for sending that payment and a copy of the Explanation of Benefits directly to our office. We accept all major credit cards, cash, checks, and financing may be available through Care Credit.

 

 

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