The term "dental sleep medicine" has come to describe the unique area of practice that partners physicians and dentists in the battle against snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). While dentists may provide many effective treatments for these conditions, sleep disordered breathing remains a medical condition. As such, the dental treatments are not covered by dental insurance. Any type of reimbursement claim must be submitted through a patient’s medical insurance.
This practice requires payment at the time of service. Dr. Strauss is not a participating provider with insurance plans or a provider for Medicare or Medicaid. Patients may be eligible for reimbursement through treatment by Dr. Strauss as an out-of-network practitioner according to their specific plan or type of insurance plan. Third party insurance provision is an arrangement between the policy holder (patient or group provider) and the insurance company. Further information can be found in the FAQs section of this website.
Prior to beginning treatment, some patients prefer to have a pre-treatment determination of benefits (whether they are covered) from their insurance company to document their insurance coverage. This requires a short note or letter of medical necessity for OAT from their physician. Details regarding this can be found in Insurance Documentation for Oral Appliance Therapy. Most insurance carriers will reply by fax or mail within 4 weeks, unless the case is sent to a medical reviewer for determination. This can delay the actual reply an additional 2-3 weeks.
Appealing a Denial of Benefits
Insurance reimbursement for oral appliance therapy is not always authorized. It is possible to reverse a denial of benefits if the patient’s policy does not specifically exclude oral appliance therapy and even if it does exclude it (Our practice can provide specific advice on this.). The appeal must be focused on the medical necessity of an oral appliance for treatment of obstructive sleep apnea and supported by the referring physician.