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kyhrsluvr
Unread post  Post subject: dentists not able to submit medical claims  |  Posted: Thu Oct 13, 2011 5:01 pm
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I don't know if this is the same all around the country, but today I went to an appt I had with a dentist to do an evaluation to be fitted for an oral appliance device, and was told he could not submit a claim for this due to the fact he is not an MD. In essence, I would be looking at a self pay. I was not mad at the dentist, he was actually very informative as he himself has both a cpap and an OAD, but at the sleep center who gave me his name without informing me of this information. All they keep telling me is that they do not know if insurance will pay for the OAD. Rather they should have informed me that going to a dentist, one of 2 in the local area that fit OAD's, would result in a self pay situation. I called to complain, and I mostly got excuses. I told them they need to BETTER inform their patients and she finally relented and agreed that she would do this next time.
So now I am looking for an oral surgeon or some other MD in my general area, that can both fit me with an OAD and bill my medical insurance (or at least submit a claim). I have also gotten the number and contact name of the medical supply company to potentially start looking at cpap's :cry: . I seem to be striking out on the OAD route.


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TheLankyLefty
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Thu Oct 13, 2011 7:58 pm
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That's interesting. I'm not familiar at all with the Oral Appliance route of treatment with regards to payment.

I was under the impression that if your Sleep Doc referred you to a dentist for fitting, then it would be covered as treatment for Sleep Apnea for most insurances.

I just rechecked the notes of one of the lectures that I just heard about the subject. All kinds of information except for reimbursement. It may be self pay if the insurance provider doesn't recognize it as a proven treatment. There was a journal article that only shows it as being effective for apnea in the mild range or when someone is positional. (pretty much what I said :D )

I would think that with PPO's you would only pay around 20%. Would dental insurance pay for any of it?

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kyhrsluvr
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 4:17 pm
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I checked my dental insurance coverage, and it only covers "mouth guards" for bruxism which I do have sometimes at night. Not sure if it would be the kind of device I would need though....I'm guessing not. However it only pays 50% even if it was approved. My medical insurance coverage for durable medical equipment which the oral appliance falls under, is covered at 85%. Actually, if I myself was fairly certain it would work, I would consider paying for it out of pocket. Not surprising that insurance companies don't like to take the risk either :( .


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TheLankyLefty
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 5:35 pm
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I would definitely try the CPAP route first. If after 3 months you decide that it is just awful, then I think most insurances will take a more serious look at OAT devices.

With the right mask, I think that you may be surprised at how effective it is. It does take some getting used to for some people, but there are many that prefer it immediately as they feel they are getting more air.

You haven't tried CPAP in a lab setting as of yet....right? Would you be sent back in for a titration night recording?

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kyhrsluvr
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 5:59 pm
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You're right....I have not yet tried cpap and yes, the dr did have on her summary report that I was to go back in for a titration recording. The dentist I talked to yesterday actually said that he liked his cpap best but got an oral appliance due to the ability to take it on camping/hiking trips. We'll see come Monday....maybe I'll give the home medical company a call (if there was a scared face, I'd put it in here). Scared of what, I don't know. My mom had cpap....never used it, hated it, but that was 15 years ago probably and I don't think she had any good follow-up care. Also scared of losing some independence I guess and my sense of healthfulness, something I have strived for diligently ever since I gave up smoking many years ago. I'll get used to all of that I'm sure :) I'm sure you will say I will feel more healthy and happy than I've felt in a long time.....I sure hope so :!:


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TheLankyLefty
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 6:17 pm
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kyhrsluvr wrote:
My mom had cpap....never used it, hated it, but that was 15 years ago probably and I don't think she had any good follow-up care.


This cracks me up. :lol: I don't doubt it at all! CPAP used to be awful compared to now. Back then the masks were made of this...well they were like small toilet seats with balloons attached. Then a broccoli rubber band to hold it do your head. The CPAP blowers were the size of a suitcase (I kid you not) and sounded like a Volkswagon Bug from the 60's.

I guess it's a little like saying I'm afraid of flying today because I saw the Wright Brothers Video. ;) Sorry, that's just the image I got. Masks today are much lighter and more comfortable. I just finished reviewing a mask that is all cloth! Masks have come a long way. Then the CPAP machines are very small and quiet. They also have all kinds of bells and whistles to make them more comfortable.

If anything, treating apnea with CPAP will bring back your health. It exacerbates problems like hypertension, diabetes, COPD, depression, and overall quality of life.

Is there any reason to call the medical supply company before you have your CPAP titration night in the sleep lab?

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kyhrsluvr
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 6:32 pm
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I know, I know......a little humor goes a long way. You made me smile also :)

Fortunately, I do not currently have hypertension, copd or diabetes but my mother had all of the above. Diabetes is so rampant in the family (both sides) it's ridiculous. That's why I've been trying hard to live a more healthful life. I've seen first hand what these diseases do to a person.

I guess I thought I needed to call the home medical people first....it's what I was lead to believe by the sleep center. Not true :?:


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TheLankyLefty
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Fri Oct 14, 2011 7:20 pm
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kyhrsluvr wrote:
I guess I thought I needed to call the home medical people first....it's what I was lead to believe by the sleep center. Not true :?:


There's nothing for them to do for you until they have a prescription for a mask and a machine from your doctor. I can't imagine they would have either since you've never tried CPAP in the lab. Nobody knows what mask is appropriate for you. Nobody knows what CPAP pressure works for you either. If you think otherwise, give the sleep lab a call and see what their protocol is.

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kyhrsluvr
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Sat Oct 15, 2011 5:52 am
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My dr, on my summary report (not the same one I sent you) listed under recommendations, said "The patient will be asked to start an empiric trial of Auto PAP at pressure limits of 6/16 cm. The patient will be scheduled for a formal titration study afterwards".
I think the name I was given is a nurse who works as a sort of liason between the sleep center and the medical supply company to get patients started or fitted or whatever, on cpap. Is it presumptuous of the dr to already have the pressure limits set? In any case, I will call and get more info on Monday.
Thanks so much for your help Jason :!: Even though I'm an educated, intelligent person who happens to work in the health care field, I still feel like a fish out of water in ways :? . It's so great to get your insight and expertise in all of this. I and the rest of the people in this forum I am sure, are forever grateful :D


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TheLankyLefty
Unread post  Post subject: Re: dentists not able to submit medical claims  |  Posted: Sat Oct 15, 2011 10:05 am
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TheLankyLefty wrote:
My dr, on my summary report (not the same one I sent you) listed under recommendations, said "The patient will be asked to start an empiric trial of Auto PAP at pressure limits of 6/16 cm. The patient will be scheduled for a formal titration study afterwards".
I think the name I was given is a nurse who works as a sort of liason between the sleep center and the medical supply company to get patients started or fitted or whatever, on cpap. Is it presumptuous of the dr to already have the pressure limits set? In any case, I will call and get more info on Monday.


Yes, it is very presumptuous to just start someone on CPAP. BUT...... :o It's okay because you have already had a baseline study which shows you're positive for some form of sleep apnea. Putting you on an Auto Titrating CPAP (APAP) with a very reasonable range without having any data is seen in this case as being proactive. You are going to be getting some form of treatment. It may not be perfect, but you'll have treatment while you're waiting for the more "dialed in" pressure prescription.

Once you have your titration night study, the doctor will likely change the range on the APAP and tighten it up a little based on the data that is collected. This is the part that makes me nervous about this though. Just know that there are tons of masks out there. If you haven't already, check out my website and look at the mask reviews I've done. It's good to have some names in mind and know what a quality mask looks like. Otherwise you'll get stuck with a complete piece of garbage. I have a couple I haven't put up yet, but will be up probably by late Sunday. (one I think you'd likely do very well with)

The timing is funny with the APAP. I've been working on a new video on this very subject and my microphone went out when I was trying to finish it up yesterday.

So yes, it definitely sounds like you are supposed to contact them if you want to get started on a CPAP trial before your titration night.

You are welcome for the insight. I know that it can be a very frustrating thing to find straightforward information.

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