When calling the insurance company to verify coverage for sleep appliances, some key questions to ask include:

Is oral appliance therapy for sleep apnea covered under my plan?
What are the specific requirements or criteria for coverage of oral appliances?
Are there any limitations or restrictions on coverage, such as waiting periods or pre-authorization requirements?
What documentation is needed to support a claim for oral appliance therapy?
It's generally advisable to obtain pre-authorization for sleep appliances to ensure coverage and avoid potential denials. This can help clarify any coverage limitations and streamline the claims process.

As for filing claims, the time it takes for processing can vary depending on the insurance company's procedures and workload. When mailing claims, it's recommended to allow several weeks for processing and receipt of reimbursement.

For more information on whether Medicare covers oral devices for sleep apnea, you can visit this link.

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Hi Debbie!

Great questions:

1) For the questions to ask during an insurance benefit verification call - you can use the QuickLetter in DentalWriter in the "Sleep Dentistry" category of QuickLetters, labeled "Sleep: Insurance - Verification of Insurance Benefits". A few examples of the main questions are:
- (if you are an out of network provider) does this policy have out of network benefits?
- (if you are an out of network provider) is a GAP exception/network deficiency available for this policy?
- What is the patient's deductible (for in and out), and how much is left for the year?
- Does this policy offer coverage for DME? (durable medical equipment)
- At what percentage does this policy pay for DME in and out of network?
- Is a pre-authorization required for E0486? (HCPCS code for oral appliance for OSA)
- If pre-auth is required - how should i submit that pre-auth? (generally fax or mail)

2) Some policies will require pre-authorization for oral appliance for OSA, some will not. If it is the first time you are working with a new medical policy, it is always best to call and ask if the pre-authorization is required or not!

3) If you submit a paper claim to a medical insurer, you are generally looking at anywhere between approximately 30-60 pays for turn around for processing of the claim (if a reimbursement check is due to the provider or patient once the claim is processed, check generally go out within the week the claim completes processing). Keep in mind - this is assuming everything on the claim is properly completed and the necessary documentation is sent, or pre-authorization obtained.
Turn around time for a paper claim will depend on the insurer as well - for example - Medicare has a mandatory 28 day hold on any paper claims received before they begin the processing!

Hope this helps - please feel free to contact us with any further questions!