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Searching: insurance denials
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Message Board
Views: 44 | Replies: 3
Anyone submitting to medical insurance for sleep apnea appliances? If so, would you mind stating how to do it? Thanks This is far too complicated to explain here. I suggest using a 3rd party to help you. Kent is being quite accurate. You can buy CE courses to learn the ways of billing medical
May 12, 2026
Sleep Apnea / Snoring
Message Board
Views: 2448 | Replies: 84
them that they have deep pockets, I will testify and ERISA does not protect them. They usually agree. When insurance companies refuse to pay for sleep studies send them a Wickline Letter. This is a formal protest per the Wickline decision of your inappropriate denial of patient care This give them
November 07, 2019
Sleep Apnea / Snoring
Message Board
Views: 59 | Replies: 2
and wait until I could start again! Like I said, not a PITA pt. at all, but MY GOD, sleep apnea is SCARY when you see it first hand Yes, it is, Shervin, and these patients rarely know they have a problem. Most are in denial, so it's our duty to educate and...I was working on a patient a few years
July 27, 2016
Sleep Apnea / Snoring
Message Board
Views: 105 | Replies: 1
Hello all, I m about to take impressions for my first oral appliance to treat osa. Do i need to alert my malpractice insurance company? What precautions do i need to take from medico legal point of view? Please advise. Thanks You just might need to after you change the occlusion, permanently
April 25, 2018
Sleep Apnea / Snoring
Message Board
Views: 166 | Replies: 4
Could I get the name of a company that will bill a patient's medical insurance for their appliance? I keep getting patients who want these, but I don't want to put any effort into the paperwork part. Thanks! We use a company called Pristine Medical Billing. For sleep appliances. Did not need them too much unfortunately, but I don't thing we are unhappy with them. My OM does most of the work.
January 11, 2022
Sleep Apnea / Snoring
Message Board
Views: 343 | Replies: 5
I'm just now trying to get into sleep dentistry and the medical billing side of it. We are using an outside company to do the med billing for us and he have to descide how much to charge for cash customers. I know that w/ medical insurance unlike dental insurance you can write off copays legally
May 18, 2015
Sleep Apnea / Snoring
Message Board
Views: 2448 | Replies: 84
to a group representing dentistry. Let's not talk about history of specialty. I assume this means you think previous denials were political only. That would mean you are declaring that the ADA has been unethical in the past. This is the exact point of why the OFP does not meet #1 of ADA requirements
November 10, 2019
Sleep Apnea / Snoring
Message Board
Views: 523 | Replies: 8
Anyone have any good ideas as to how to become a participating provider with medical insurance companies for sleep apnea appliances? As a general dentist, it seems as if it is almost impossible. I have a lot of patients on Blue Cross/Blue Shield but am finding it impossible to become in network
December 28, 2016
Sleep Apnea / Snoring
Message Board
Views: 428 | Replies: 9
Has anyone used American Sleep Dentistry for their services to get credentialed for Medicare and Medical Insurance and attracting new patients? I'm being hunted by two of their sales person. I was completing the process -- sent them my info, completed the application, etc etc... and now, they sent
April 20, 2025
Sleep Apnea / Snoring
Message Board
Views: 581 | Replies: 12
I'm talking about the initial HST that would be given to a patient that has been screened through a questionnaire and consultation and determined to be at risk for OSA. Can I bill their medical insurance for the HST? Thanks. The better question is do you want to bill out an HST as a dentist
September 20, 2019
Sleep Apnea / Snoring
Message Board
Views: 675 | Replies: 18
to bill $7-$8000 for an appliance to get insurance to reimburse at the max rate (assuming out of network), but I always wonder.... if you are billing $7000 for an oral appliance, doesn't that mean the patient has a huge out of pocket expense assuming they have not met their deductible (typically
November 09, 2021
Sleep Apnea / Snoring
Message Board
Views: 79 | Replies: 1
good/bad experience with them? Also, what are the pros and cons to add sleep appliance therapy in office? SGS says its medical billing (all handled by them), so patients don't have to pay much unless they have a very bad medical insurance. Thanks. What is a small company? SGS? And the reason more
September 09, 2025
Sleep Apnea / Snoring
Message Board
Views: 208 | Replies: 8
am in-network with BCBS of Texas medical insurance. They will not tell you their fees, and no medical insurance company will. I had a patient that I removed her jaw and reconstructed it for cancer. I submitted a pre-authorization for dental implants. They approved it and said I just have
September 04, 2015
Sleep Apnea / Snoring
Message Board
Views: 113 | Replies: 5
integrating the medical insurance administration into this new office. The insurance person is very eager to learn but is overwhelmed with the demands in administering the other 3 dentists dental insurance. My question is this: What do you know regarding using a 'remote 3rd party to handle all of the medical
November 12, 2017
Sleep Apnea / Snoring
Message Board
Views: 264 | Replies: 4
If you are doing appliance therapy for obstructive sleep apnea in your practice do you outsource your medical billing portion and if so, who would you recommend? And are you happy with that company? I think this is the main problem with sleep dentistry...You can bill their dental insurance and get
August 08, 2023
Sleep Apnea / Snoring
Message Board
Views: 147 | Replies: 10
I haven't seen this before from insurance. The want a ceph analyisis. Any recommendations as to how to go about this and who would do the analysis? Maybe the Insurance company wants ceph numbers to show the patient is a class 2 skeleton due to a mandibular retrognathism? But what they should
July 01, 2019
Sleep Apnea / Snoring
Message Board
Views: 420 | Replies: 23
them for a fee and letting them contact their insurance if they choose. The dentistry for these is, by far, the easiest part.It is indeed very difficult. Only problem is, patients expect you to take it, so if you want to do much of this in your practice, you must buckle down and learn the nuances
January 13, 2019
Sleep Apnea / Snoring
Message Board
Views: 278 | Replies: 8
I have made several sleep apnea appliances in my program, but I do not have a full appreciation of the process of getting the appliances approved by insurance, which is a big stumbling block. Say I have a patient come in who states they snore routinely and they often wake up choking
October 19, 2016
Sleep Apnea / Snoring
Message Board
Views: 126 | Replies: 1
so my patients are being told that they cannot do the device at my office, they must go to the other office or the insurance will not pay at all. It is frustrating that I go through the screening, referral, diagnosis and tx planning only to have the whole project killed by the insurance company
February 05, 2016
Sleep Apnea / Snoring
Message Board
Views: 318 | Replies: 7
is not cpap compliant and needs the oral appliance made by dentist. The patient brought the letter to us. what would be the next step? I know we need to bill to the medical insurance. Do we need to call the patients medical insurance to prepare for pre-authorization for oral appliance? What
March 07, 2020
Sleep Apnea / Snoring
Message Board
Views: 3851 | Replies: 65
I have a patient is having an EMA device made and wanted to know if we could bill her medical insurance. Has anyone has any success billing for this device and if so any tips? Thank you for any help! That's a good way to make sure no physician every refers for a sleep appliance... A lot
March 28, 2017
Sleep Apnea / Snoring
Message Board
Views: 216 | Replies: 10
is severe then CPAP indicated. If she is intolerant to CPAP, can get a MAD. A dentist I know asks for a prescription from MD for oral appliance. Not required but he does it.Some Primary care doctors are not allowing, or making sure their patients are not waving there rights with medical insurance
April 19, 2019
Sleep Apnea / Snoring
Message Board
Views: 3851 | Replies: 65
Medicare, medical insurances, and state boards are starting to get into discussions and setting standards. There is confusion and people giving false information. Medicare is not a get rich quick program.Most likely those checks of 3K to 6K are from UHC, Aetna, or Cigna that are non Medicare plans
November 17, 2018
Sleep Apnea / Snoring
Message Board
Views: 153 | Replies: 6
I have a patient who runs a local sleep lab. Hadn't seen him in about a year. He tells me that things at the sleep lab have really gotten slow. They used to see over 80 pts a month and now are lucky to see 40. Tells me the problem is insurance has raised the co-pays for the patients
June 12, 2014
Sleep Apnea / Snoring
Message Board
Views: 839 | Replies: 20
I want to bill medical insurance in house, instead of farming it out. Anybody use an online fillable PDF version of the claim form? I have found a number of sites that offer this with a large variance in their charges. Any suggestions or tips? Hi Alex, There are several options for billing directly
July 23, 2014
Sleep Apnea / Snoring
Message Board
Views: 223 | Replies: 11
to get one made that will be covered by your health insurance. The patient returned with a prescription that says: RX MOUTH GUARD dx: OSA and Bruxism My question is if I make the patient a Mandibular advancement device will it be covered by insurance or should I call the physician and ask
May 31, 2017
Sleep Apnea / Snoring
Message Board
Views: 369 | Replies: 8
doing them since some were MDs which made billing medical insurance easier. (Their knowledge of what they were doing and their followup was questionable but that's another story....) Now there is a closed group of dentists that one of the major insurance carriers has contracted with to do all
March 21, 2019
Sleep Apnea / Snoring
Message Board
Views: 402 | Replies: 18
that medical insurance will not cover an OA, am I correct? Would you fabricate a snoring appliance in this instance? If so, what would you suggest? Thanks, Braden Hey Braden, How old is the psg? If older, the patient might now have OSA. Regardless, in our office, we do a baseline HST on every
January 01, 2014
Sleep Apnea / Snoring
Message Board
Views: 288 | Replies: 12
, you can have an HST read and interpreted by a sleep phycisian and a prescription given, then you can treat. If you want to file insurance than you have to follow the insurance rules. The main thing is you do not diagnose and prescribe the appliance yourself. With insurance or Medicare don't use
October 11, 2016
Sleep Apnea / Snoring
Message Board
Views: 173 | Replies: 2
I am looking for presentations that my front office staff can utilize to better understand Medical Insurance billing re: Dental Sleep Medicine. Below is a module on the AADSM website. Comments/Recommendations are welcome. Thanks! Coding and Billing for Dental Sleep Medicine Recorded:1/21/2016
February 03, 2018
Sleep Apnea / Snoring
Message Board
Views: 860 | Replies: 31
is not paying so no big deal there.Some examples of complications: 1. Insurance company rep makes a decision different than their stated policy. Peer to peer required to straighten out their MD. You have to be smarter than the MD who gets PAID to deny the claim. 2. Insurance denies due
May 05, 2018
Sleep Apnea / Snoring
Message Board
Views: 339 | Replies: 7
Hello, I am interested in billing for snore guards/ sleep apnea appliances to Medical insurance. How much do you bill for? Fee for mandibular advancement appliances...? If you are billing what are you getting in return? Do they cover the whole fee or a percentage like fee's in the dental insurance
December 28, 2015
Sleep Apnea / Snoring
Message Board
Views: 46 | Replies: 1
Have medical insurance companies been shying away from paying for the Somnomed Flex appliance? We used to get good coverage for it but recently were told this appliance isn't on their approved list of appliances anymore. Anyone have similar experiences? It was recently given the K code, so if you have been filing the E code, you will need to switch. Are you using a billing company? Keep in mind that some are unwilling to bill the K code.
February 26, 2025
Sleep Apnea / Snoring
Message Board
Views: 1319 | Replies: 23
trying to get paid by medical insurance companies. We have had accounts take over a year to be paid on. The biggest insurance carrier in my area contracted with a handful of providers that are the only dentists they will pay. Hours and hours of wasted time. All for about $600-700 of profit since
October 02, 2020
Sleep Apnea / Snoring
Message Board
Views: 114 | Replies: 0
We are currently weighing options of going 'In' or 'Out' of network with the local PPO's and Medicare. PRO's for going in network= higher case acceptance and more referrals from sleep docs/physicians. CON's= fee cut in half, applying and getting accepted to insurances, extra work to us
November 23, 2015
Sleep Apnea / Snoring
Message Board
Views: 295 | Replies: 15
for the appliance and the cost of the pharngometry for the patient? Also, how much does insurance reimburse for the pharngometry and the fee for the OAT? ThanksMartin, that is a great question about reembursment. It will get you an endless amount of different answers. For the Rhinomiter and pharyngomitor
November 18, 2016
Sleep Apnea / Snoring
Message Board
Views: 1408 | Replies: 20
I'm frustrated for two reasons: 1) even after telling the patient that it needs to be outside of their medical insurance, some still ask my office manager to try. After a year of hard labor she gets them to pay. When not, patients will pay the full amount, but only after having us go through many
November 21, 2022
Sleep Apnea / Snoring
Message Board
Views: 371 | Replies: 16
Hello I'm thinking About joining a partnership with a company called dedicated sleep and implants. Has anyone had any success with them or heard of them? I'm pretty skeptical because they have some heft claims. Any help would be appreciated.I dont know the company. May I ask what kind of insurance
May 04, 2024
Sleep Apnea / Snoring
Message Board
Views: 579 | Replies: 43
that they must sign and return to my office to allow for medical insurance coverage. This is where I am running into a lot of problems. Most of the MDs either don't get back in a timely manner or they recommend to the patient that they get a CPAP (even if my pre-treatment letter specifically states
June 11, 2014
Sleep Apnea / Snoring
Message Board
Views: 55 | Replies: 1
, and insurance works a little different here. 1. I feel it's like many things in dentistry (especially dentures), if you only do one or two a month, it'll be hard to get good and efficient with it, and likely isn't worth doing (from a business standpoint). 2. Lots of people that lecture talk about
July 24, 2018
Sleep Apnea / Snoring
Message Board
Views: 1456 | Replies: 30
and other OA manufacturers with high lab fees. Presently few dentist involved in DSM are contracted in-network providers for this field. Of course the dental psyche thinks dental, I can charge what I want and the patient can submit their own insurance. Only problem is that this therapy
February 05, 2018
Sleep Apnea / Snoring
Message Board
Views: 795 | Replies: 16
pitch from some appliance designers comes across as we can rape the insurances because they just think its cheaper than c-pap. When I was in undergraduate dentists were listed as one of the most trusted professionals! Now we are close to car salesmen. Well, first of all, if you only pay $99
June 28, 2015
Sleep Apnea / Snoring
Message Board
Views: 516 | Replies: 15
in making it financially possible for a patient to have the study completed if their insurance does not have a suitable benefit. I have 4. I couldn't live without them. Hello - thank you for posting this as I can tell you that I hear this story described over and over and over in our dental sleep
October 19, 2015
Sleep Apnea / Snoring
Message Board
Views: 1229 | Replies: 17
the fee is, they are no longer interested. We explain that we gladly file insurance for them but because we are out of network we cannot guarantee re-imbursement. Many patients have a high dedcutible which has not been met which would also mean out of pocket expenses for the patient. Here is my
July 02, 2014
Sleep Apnea / Snoring
Message Board
Views: 481 | Replies: 7
treatment and manage complications? Also, was there any emphasis on billing medical insurance? From what I understand, dealing with insurance on these cases can be just as tough as the treatment itself. Interested to see what you have to say. I attended an intro to sleep medicine lecture
May 01, 2015
Sleep Apnea / Snoring
Message Board
Views: 444 | Replies: 7
So I am determined to become proficient in sleep dentistry. I have looked into the sleep solutions software and the dentalwriter in order to aid with forms and billing medical insurance. I like the sleep solutions, its just that is is $250 a month (after initiation fee) and I am more of a buy
May 10, 2014
Sleep Apnea / Snoring
Message Board
Views: 153 | Replies: 5
When a new patient calls for a consult appointment, we usually will take the insurance info and do a pre-estimate before the patient arrives. Sometimes this involves a fair amount of time for my front desk staff. We typically do this in situations where the patient has a sleep study and a script
February 22, 2017
Sleep Apnea / Snoring
Message Board
Views: 125 | Replies: 10
diabetes. The moment you are diagnosed your insurance goes up since it will cost them more to treat. A person can take a piece of cake instead of the horrible sugar water and at least enjoy it. If he tests higher than normal, guess what? Diabetes mellitus can be controlled with food if caught early enough
April 05, 2016
Sleep Apnea / Snoring
Message Board
Views: 363 | Replies: 8
. Thanks, Tony All will be revealed on May 9th/10th Hi Tony, Yes you can send a preauth, if you are not in network. It might be possible to get a GAP exception often called a GAP waiver. There are other things that you can check on based on the insurance. I know Kent will be going over
July 25, 2015
Sleep Apnea / Snoring
Message Board
Views: 467 | Replies: 11
if it's worth it for me. My patients do stuff that is covered by insurance. It's just a fact. If I take the class, I need to be able to have some kind of ROI. Would like to heat opinions of others that have gotten into the sleep apnea treatments and / or invested in an expensive class like this one
January 24, 2020
Sleep Apnea / Snoring
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