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In-Network Medical Insurance Coverage for Dental Care

Many dentists don’t want the hassle of dealing with medical insurance providers in order to offer sleep apnea therapy. The complicated claims, varying coverage, and other issues all in addition to handling complex dental insurance policies makes handling medical billing a struggle for many dentistry practices. You don’t want to waste time you could be spending with your patients struggling with complicated medical billing, but you also don’t want to forego medical coverage when it could benefit your patients. That’s where Brady Billing comes in. Our team of dedicated professionals can take the hassles of medical insurance billing out of your office. Call our team to learn more about how to offer in-network medical insurance coverage for sleep apnea patients, and how Brady Billing can help.

Steps to Getting In-Network Coverage

As dentists, most oral appliance therapy providers are not in-network with medical insurance plans, and there are not options available yet for dental practices to become traditional in-network providers for medical insurance policies. However, there ways to offer patients in-network coverage for their custom crafted oral appliances. It involves making phone calls to each patient’s medical insurance provider. The insurer will then search the area for other providers that are in-network. If none are found, they will likely extend in-network benefits to your patients. In most cases, all providers of oral appliances are dentists and will not be in-network with medical policies, so there shouldn’t be any issue receiving in-network coverage.

While the process of calling and working with medical insurance providers for each patient isn’t necessarily difficult, it can be extremely time-consuming, especially for dental offices that provide sleep apnea appliances regularly. That’s why many dentists don’t bother to do the extra work to offer in-network medical insurance coverage for their patients who want to receive a custom sleep apnea appliance.

Benefits of Offering In-Network Care

person with paperwork, computers, and calculator spread across deskWhen you offer in-network care for sleep apnea sufferers, the patient receives the care they need at the most affordable price. If your office doesn’t do the legwork to provide patients with in-network medical insurance coverage, other dentists will. That means you are at risk to lose your patients to other dental practices. Keep your patients in the office by offering them the coverage they deserve and have already invested in by working with Brady Billing to help patients receive in-network medical insurance coverage for all of their sleep apnea therapy needs in your office.

Reasons to Choose Brady Billing

Man and woman looking at clipoboard with paperworkThe Brady Billing team has years of experience working with dental practices to offer maximized medical insurance benefits for sleep apnea sufferers. Oral appliances are best crafted by a dentist, but technically, they’re a medical device that is often covered by medical insurance. It can be difficult to handle the nuances of medical insurance and billing, but our team can help. We are happy to handle medical insurance claims, billing, preauthorization, and gap exception for your office. You can rely on us to get your patients the best coverage, and you can continue to focus on your patients.

In-Network FAQs

A billing statement with a pen and stethoscope laying on top it and a calculator nearby

Understanding how in-network medical insurance works when providing sleep apnea treatment via a dentist’s office isn’t always easy. From navigating claims to understanding levels of coverage, it is comforting to know that companies like Brady Billing have professionals who can handle it all, so you and your staff can continue to take care of your patients. But it’s also that you have the information you need to make decisions about your practice and how it operates alongside medical insurance companies. To provide additional clarity and information, we have compiled some frequently asked questions about being in-network with different medical insurance companies. We invite you to contact us with any additional questions after reviewing the following information.

What can happen if I choose not to be in-network with medical insurance?

Should you choose to remain out of network with medical insurance companies, there are a few things that can happen, including:

  1. If your patient’s treatment is billed under dental insurance, it will be considered out of network since oral appliance therapy is considered a medical treatment, not dental. As a result, patients will likely spend much more on treatment since the insurer will pay a significantly lower percentage of the claim than if it was considered an in-network covered treatment.
  2. Your patients will seek out other sleep apnea dentists in the area who are in-network with medical insurance. As a result, you could potentially lose clientele.

What does it mean when a policy has a network gap exception?

If the contract contains a network gap exception, this means as an out of network provider for oral appliance therapy, you can request to become an in-network provider with the patient’s medical insurer. If there are no additional providers offering the same type of service within a specified distance of the patient’s residence, it is possible to receive an exception. This will ensure your patient pays less for their oral appliance therapy.

What is the best way to ensure a network gap exception is approved?

Because most medical insurance companies view oral appliance therapy (OAT) as a “want” and not a “need,” it will be important to provide official documentation that details why OAT is a necessity for a particular patient. Oftentimes, these individuals are CPAP intolerant, making an oral device the only way they can achieve relief and experience life-changing results. By providing us with as much documentation possible, we can move forward with the process to become in-network with fewer barriers in the way and a greater possibility of success.

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