Maximize Insurance Coverage with Sleep Apnea Medical Billing for Dentist

More than 25 million adults in the U.S. are currently diagnosed with sleep apnea. As a dentist, this provides you with an exceptional opportunity to offer them the treatment they need. However, by offering oral appliances for sleep apnea, you face certain challenges. Sleep apnea medical billing for dentist is a challenge– not just for you, but for the patient as well. You can help your patients maximize the value of their insurance with simple tips and tricks.

Understand Medical Policy Guidelines

A physician is contracted with medical insurance companies to offer the diagnosis for patients as a “medical provider;” however, they are not able to fabricate the oral appliances needed to treat the condition. Despite the FDA’s approval as effective for treatment, the oral appliances can only be provided by a dentist.

As a dentist, you cannot bill the patient’s dental insurance. Instead, you must bill their medical insurance. There are strict medical policy guidelines that showcase what the insurer will pay for when needing sleep apnea treatment. To ensure you are abiding by the policy guidelines, you need a firm understanding of the policy, such as what treatments are covered using an oral appliance.

Become an In-Network Provider

Some insurance companies have a network gap of exception or network insufficiency, allowing a dentist to become an in-network provider for oral appliances. If the insurance company currently does not have someone trained in oral orthotics, they will have to pay higher rates. As a result, they look for those who are in-network.

Contract with Medicare

Medicare will only reimburse contracted providers. With Medicare broken into two categories, physicians and medical providers, you can be contracted under the area of medical services. By doing so, you will have a DME contract to provide medical goods, including CPAP machines and oral appliances.

Understand Federal Blue Cross Blue Shield

Blue Cross Blue Shield is among one of the largest medical insurance companies in America. However, be aware Federal Blue Cross Blue Shield does not prior-authorize DME coverage or pre-certify payment for oral appliances. However, they may cover a portion of the costs under certain insurance plans.

Abide by Tricare’s Guidelines

Tricare does cover oral appliance therapy, but only when the patient is seen by a contracted provider. In order to be covered, the patient must have a referral form from their primary care physician. Their level of coverage will vary depending on their specific policy.

Outsource Medical Billing

Medical billing for dentists offering sleep apnea treatment is very complex. Simple mistakes could lead to costly errors for your dental practice and your patients. By outsourcing your medical billing for sleep apnea, you will ensure the claims are properly submitted and the patient’s medical insurance is utilized to its full value.

With a team of experts handling the billing, oversight of potential cost-saving opportunities will be prevented while ensuring the proper reimbursement of treatment. Brady Billing offers medical billing for sleep apnea to help your dental office maximize your patients’ insurance coverage. Contact our office today to learn more about our sleep apnea billing services.