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Will Medical Insurance Cover Sleep Apnea?

November 11, 2020

Filed under: Uncategorized — bradybilling @ 8:06 pm
A doctor wearing a lab coat and stethoscope writing the words “Sleep Apnea”

You want to provide your patients with the ability to seek treatment for their sleep disorder, but you know it’s not typically covered by dental insurance? What can you do? Will medical insurance cover the cost of sleep apnea therapy? If so, how can you incorporate it into your practice without causing your administrative staff to scramble to learn a new system? Read on to find out if you can help your patients save more money by using medical insurance to cover the cost of treatment and how best to help your staff adjust to this new form of billing.

Will Medical Insurance Cover Sleep Apnea Therapy?

Although it is never a guarantee, there is a good chance that your patient’s medical insurance will cover the cost of their oral appliance. Designated as durable medical equipment (DME), these benefits are considered essential in the Affordable Care Act (ACA). But ultimately, it comes down to medical necessity and how the paperwork is filled out and presented to the insurance company.

If you’re wondering how the medical billing process works, it can be broken down much like the following:

  1. Collect the insurance information from the patient when they call to schedule an appointment.
  2. Verify the patient’s insurance card upon arrival for their appointment to make sure all information is correct and nothing has changed.
  3. Apply for coverage preapproval with the patient’s medical insurance before offering to provide treatment.
  4. Once verified, make sure their billing information is updated to ensure they get the maximum benefit.
  5. Talk to patients about the billing process to help keep them informed of what is happening.

Because this process can take ample time, causing staff to spend more of their day away from patients and instead, talking to insurance representatives, it is advised that you outsource this type of billing to a third-party company that employs experts who can more easily navigate the process.

Are Sleep Studies Covered?

A majority of health insurance companies do indeed reimburse for home or lab-based sleep studies. While some prefer that the former be used to cut down on costs for the insurance company, it also helps to keep patients from paying larger co-payments. Not to mention, most patients prefer to have their sleep tests done at home where they are more comfortable.

Why Would an Insurance Company Deny Coverage?

It is important when filling out the necessary paperwork for a patient to receive approval for treatment that you clearly indicate and provide evidence that this method is a medical necessity. Otherwise, the insurance company is likely to deny it. According to a study in the Journal of Clinical Sleep Medicine, more than 70% of people with sleep apnea are misdiagnosed as having depression. Because many of the symptoms are alike, medical professionals often miss the signs that point to a sleep disorder. This is why dentists can be an ally. You can more easily identify the signs and recommend a patient for a sleep study based on the clinical symptoms you find during an examination.

Providing this type of evidence will make it more likely for an insurance company to readily approve a sleep test or oral device and keep costs lower for your patients.

About Brady Billing
Looking to outsource your medical billing? At Brady Billing, we specialize in dental offices that provide sleep medicine services and offer billing services for dentist offices throughout the country. By offering a range of billing services, we can assist in answering your questions and providing a complimentary consultation to discuss available services. To find out how we can help you, visit our website or call (844) 424-5548.

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