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This depends on a number of factors including: allowable amount; billed amount; deductible and co-insurance. For illustration purposes, let’s use these amounts:
Billed amount for the oral appliance: $ 3,500
Deductible: $ 1,000; amount met: $ 350
Co-insurance: 80%
Out of pocket maximum: $ 5,000
The allowable amount is determined by the health insurance plan at the time the claim is processed, for out of network claims. If a practice is contracted as an in-network provider, they can determine the contracted allowable amount for the service in advance. However, most dental practices are non-contracted providers, so the allowable amount will not be available until the claim is processed.
For the above example, if the insurance company allows $ 3,000 for the appliance, the allowable amount will be $ 3,000. To this, the remaining deductible of $ 650 will be applied. The co-insurance amount on this plan is 80%, so of the $ 2,350, the plan will pay 80% (or $ 1,880) and apply 20% (or $ 470) to the co-insurance amount that will be the patient’s financial responsibility.
In this case, the plan will pay $ 1,880 and the patient will be responsible for the remaining deductible of $ 650; the co-insurance in the amount of $ 470, and the $ 500 which is over the allowable amount as determined by the insurance plan.
Sleep apnea oral appliance therapy is covered by health insurance, not dental insurance.
Billed amounts are typically in the $ 2600 – $ 3500 range
Dental consultations regarding sleep apnea and oral appliance therapy are covered by many health insurance plans – with some caveats. You can bill for a consultation prior to the date of service of the oral appliance. You cannot bill for a consultation on the same date of service as the oral appliance; the health insurance plan will not pay for both the equipment and a consultation on the same date. You also can bill for follow up consultations beginning 90 days after the appliance is delivered. Most health insurance plans will bundle charges for follow up visits in the first 90 days after delivering the appliance, into the fee that is paid for the appliance.
Better Sunrise provides health insurance coverage and benefit information for our clients – generally within 24 hours.
Snore guards are not covered by health insurance plans – snoring is not considered a medical problem.
You request a home sleep study for your patient. A representative with Better Sunrise will contact the patient; answer any questions they may have about the test, and schedule the study. Your patient uses the unit for one night while they sleep at home in their own bed.
All results are interpreted by a physician board certified in sleep medicine. You receive results in about 1 week with treatment recommendations. Your patient also receives a copy of the sleep study report and is instructed to return to your office for follow up.
Yes, most all health insurance plans cover home sleep testing.
Polysomnography, (PSG) is the gold standard test for diagnosing all forms of sleep disordered breathing. Obstructive sleep apnea (OSA) is by far the most prevalent form of sleep disordered breathing. For diagnosing obstructive sleep apnea, (OSA) the home sleep test (HST) correlates 98% with PSG. · A home test is often a more convenient and economical option compared with a PSG study, and offers more representative sleep data – the patient is tested in their normal home sleeping environment rather than a laboratory. The cost of a PSG is $ 3,000 – $ 5,000; the cost of an HST is typically 10% of the cost of a polysomongram.
A report from a home sleep study is generally ready in about 1 week.
Fax in a Home Sleep Test order form to Better Sunrise. We will contact the patient to answer any questions they may have and schedule the study
Patients see the dentist more frequently than their primary care physician. Physicians often have 15 minutes or less to address the main issue with the patient during the visit. Primary care physicians do not generally inquire about snoring or sleep apnea.
Sleep apnea is primarily an issue of the upper airway – there are many dental signs and symptoms that are correlated with obstructive sleep apnea.
By offering an in-home sleep testing option for diagnosis, and oral appliance therapy for treatment, a dentist is able to offer a much more preferable alternative to patients than an overnight lab sleep test, and CPAP.
Research has shown that sleep is foundational to health – when better quality sleep is restored by treating sleep apnea, patients are able to heal more quickly; reduce inflammation, and boost their immune system function.
Treating sleep apnea in your practice begins with a conversation. The more comfortable and knowledgeable your staff is about sleep apnea, the more conversations they will have with patients. This is key to every successful dental sleep apnea program. Better Sunrise offers effective and affordable staff training in sleep apnea dentistry, and ongoing support for questions that may arise in the future.