Monday, November 23, 2009

A Quick Guide: Insurance Coverage for Oral Appliance Therapy

Sleep apnea is a serious medical condition. So claims for oral appliance therapy (OAT) will almost always be filed under your medical insurance, and not your dental insurance.

Many medical insurance plans in the U.S. provide benefit coverage for this treatment option.

Every insurance company has varying requirements and benefits for OAT. You will want to check with your insurance company about any specific requirements relating to coverage and deductibles.

Most medical insurance plans require documented proof that treatment is necessary. Keep these forms handy when contacting the insurance company to verify your benefits:

· Sleep study report documenting the presence of sleep apnea
· Diagnosis code (usually provided by diagnosing physician)
· Procedure code (provided by sleep disorders dentist’s office)
· Copy of physician’s prescription or letter of medical necessity for OAT
· Summary of dentist’s history and exam findings
· Evidence of health consequences associated with sleep apnea (if applicable)

If coverage is denied, don’t give up. Try writing a letter of appeal to your insurer. Explain your symptoms. Discuss the impact sleep apnea has had on your life. And clarify any problems that you’ve had with past treatments. Ask your physician and dentist to write similar letters. These letters may help you secure coverage.

Learn more here. Or speak with a dentist trained in OAT.

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The Official Blog of the American Academy of Dental Sleep Medicine (AADSM) is intended as an information source only. Content of this blog should not be used for self-diagnosis or treatment, and it is not a substitute for medical care, which should be provided by the appropriate health care professional. If you suspect you have a sleep-related breathing disorder, such as obstructive sleep apnea (OSA), you should consult your personal physician or visit an AASM-accredited sleep disorders center. The AADSM, and the American Academy of Sleep Medicine, as the managing agent of the AADSM, assume no liability for the information contained on the Official Blog of the AADSM or for its use.