Insurance Covering our Sleep Apnea Treatments in Arvada
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 medical 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. This study must be ordered by a medical physician, then the physician should review the results of the study to determine which treatment option best fits the needs of the patient.
For mild to moderate sleep apnea (5-30 events per hour) the patient can choose the oral appliance rather than CPAP as initial therapy. For severe sleep apnea (above 30 events per hour) most medical insurance policies require that the patient complete a 30-45 day trial with the CPAP and prove to be non-compliant by means of a CPAP compliance report or data download along with physician notes documenting the reasons why the patient was unable to tolerate CPAP therapy.
Regardless of severity, the following documentation is required by medical insurance:
- Copy of recent diagnostic sleep study (must have been done within the last 5 years)
- Face to face notes from treating physician prior to ordering the sleep study
- Face to face notes from treating physician reviewing treatment options and/or discussing CPAP compliance
- Order / script for the oral appliance from the treating physician
Our office will help obtain all documentation and authorizations required by the insurance to establish coverage. The oral appliance 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
- United Healthcare AARP Medicare Complete / Secure Horizons
- Anthem Blue Cross Blue Shield (excludes CU Central)
- BC/BS Federal Employee Program (requires all sleep apnea patients, regardless of severity to trial CPAP)
- CIGNA / Great West
- Sloans Lake / Cofinity
- Rocky Mountain Health Plans
- TriCare (TriWest)
- Approved VA Vendor (requires a valid referral and authorization from the VA)
For all other insurances not listed we are usually able to obtain a network exception to be considered as in-network.
In House: We can break up your out of pocket amount into three installments. The first payment is due when we prepare for the appliance, the second when we place your appliance and the thrid a month after that.
CareCredit: If you require a longer payment plan, we offer up to a year No Interest with CareCredit. Get pre-approved online at www.carecredit.com.
If you have questions or concerns about your insurance covering sleep apnea treatments in Arvada, contact us!