Insurance

Oral appliances are unlike other services provided by a dentist because they are typically not covered by dental insurance.  This is because sleep apnea is a medical problem that can only be treated after diagnosis and referral by a physician.  Oral appliance are therefore billed to medical insurance.  The offices of Bruce, Ririe and Bruce are trained and experienced in submitting medical insurance preauthorizations and claims to your medical insurance.

As mentioned before, an oral appliance can only be made by a dentist after a referral by a physician.  Most insurances will also require a sleep study that diagnoses obstructive sleep apnea.  Some insurances plans may also have certain restrictions on coverage.  Medicare, for example, will only cover an oral appliance in a patient with mild sleep apnea who also has one or more other health problems known to be associated with sleep apnea.  It is often best to contact your medical insurance provider and find out what your specific policy coverage is.  The medical code for an oral appliance is E0486, which is helpful to know when contacting your insurance.

After referral from a physician, our office can also preauthorize your appliance with many of the insurance companies.  Although not a guarantee of payment, this is an estimate of your benefits.  This step is being required by more and more insurance companies before proceeding with treatment.  We have experience in receiving payments and use an electronic claim submission program for faster processing.

It is important to understand that our relationship is ultimately with the patient.   That is why it is very important to understand your coverage benefits and limitations.  Our office is happy to answer any questions, is possible.