The big question with sleep apnea appliances is "are they covered by insurance"? The short answer is YES! Although Dr. Callender is an orthodontist, all services are billed to MEDICAL INSURANCE not dental as we are treating a medical condition.
In order for the insurance to consider oral appliance therapy as medically necessary, there must be a diagnosis of sleep apnea as recorded by overnight sleep study performed either at a sleep laboratory or by home study. For severe sleep apnea (above 30 events per hour) Medicare is requiring that the patient have tried CPAP and documented the reasons why they are unable to tolerate the CPAP. Our office will help obtain all required documentation and authorizations required by the insurance to establish coverage. This is considered durable medical equipment (DME) and coverage is usually subject to plan co-pay, co-insurance and deductible.
Dr. Callender is contracted with the following medical insurances to provide custom appliances for sleep apnea:
- United Healthcare
- Anthem Blue Cross Blue Shield (including the Federal Employee Program)
- Aetna
- CIGNA
- PacifiCare / Secure Horizons
- Sloans Lake / Cofinity
- Rocky Mountain Health Plans
- TriCare (TriWest)
- Humana
- Medicare
Currently Great West Healthcare and GEHA have not allowed us into their network as they will not contract with a dentist no matter what treatment is being provided. We are still able to bill to them if you have out of network benefits.
For all other insurances not listed we are usually able to obtain a network exception to be considered as in-network.