Insurance Coverage for Oral Appliance Therapy
A word about insurance:
Medical insurance can be confusing. Many medical insurance companies provide coverage for oral appliance therapy if the patient has been diagnosed with obstructive sleep apnea, but your policy will specify your level of coverage. We have been effectively advocating on our patients’ behalf with insurance companies for over 25 years. We look at each patient’s individual needs and help you to obtain the maximum insurance benefits possible.
In our practice we will always make treatment recommendations based on what we believe is in your best interest to improve your sleep and your health. We will help you understand the cost of your treatment so you can make an informed decision about oral appliance therapy (OAT). We will also explain how your insurance benefits can help you with the cost of treatment. To that end, we can send a pre-treatment determination of benefits to your insurance company prior to your pursuing treatment.
We hope you will see us as a resource in helping you make healthy choices. We intend to be in a relationship with you for a long time so your long-term health is important to us.
Here are some questions we hear frequently about insurance:
Do insurance companies cover oral appliance therapy?
Yes, many medical insurance companies cover oral appliance therapy for treatment of obstructive sleep apnea. It is our experience that over 90% of patients have plans that cover all or a portion of this treatment. Can I still come to see Dr. Horner and get coverage for my treatment even if he is not a provider in my insurance network? Yes, there are usually specific provisions within most insurance plans to cover a portion of services from out-of-network providers. Often, out-of-network providers are reimbursed at a lower percentage of coverage, which may increase your “out of pocket” portion. We recommend that you check with your insurance company to confirm your percentage of coverage for in-network and out of network services. NOTE: If there is no in-network provider within the insurance plan, then the insurance company is required to pay the claims at in-network rates and you should get your maximum coverage for the treatment.
Is Dr. Horner an in-network provider for any insurance companies?
Yes, we are in-network DENTAL providers for Blue Cross Blue Shield of Alabama, Cigna (DPPO), Delta Dental (Premier), Metlife, Southland, and United Concordia. Other plans may reimburse at a reduced rate. *Note: Your oral sleep apnea device is billed through MEDICAL insurance. At this time we are not in network with any of the Medical plans.
Does the office have payment options that will allow me to pay for treatment over time?
Yes, we offer interest-free financing through a variety of programs and payment plans can be structured for your specific needs. This usually allows enough time to receive your insurance reimbursement so you can get your maximum insurance benefit while reducing your out-of-pocket expense.
Do I need to pay for care at the time of the visit?
Yes, if we are out-of-network providers for your medical insurance carrier. It is our practice to require payment at the time of service and help you get reimbursed by your insurance company according to your policy. If our office is not a provider in your insurance network, we do not have access to information about your insurance coverage rates, co-payments and deductibles. However, we will submit the insurance claim for you and provide the necessary documentation to help you receive your maximum insurance benefits. We find that over 90% of our patients have coverage for their treatment.