Financial Policy and Insurance Concerns

At Kalamazoo Dental Sleep Medicine we are committed to you and your treatment. Payment of your bill is a part of your treatment. We are a fee for service practice, which means payment in full is due at the time of service. Payment options are available through Care Credit Finance, including a 6 month same as cash option, which should allow plenty of time for your insurance reimbursement to come back to you.

We do not accept assignment from Medicare and refunds are not given for oral appliance therapy treatment.

We will promptly file an accurate claim with your primary insurance carrier so that you receive your applicable benefits from the insurer. Filing for any secondary insurance will be your responsibility.

We cannot guarantee your insurance benefits. Disputes over coverage and/or benefits must be handled between you and your insurer according to your contract.

 

Information About Insurance Coverage for Oral Appliance Therapy

Do insurance companies cover oral appliance therapy?

Yes.  Most medical insurance companies cover oral appliance therapy for treatment of obstructive sleep apnea. Typically, over 90% of patients will have coverage for this treatment.  However, these companies generally do not cover treatment for snoring only. A patient must have a diagnosis of OSA from a sleep physician verified by a polysomnogram (overnight sleep study). It is also helpful to have a letter from the physician stating that CPAP was tried and not tolerated.

Do most insurance companies have providers (dentists) in the network for oral appliance therapy for sleep apnea?

No, most insurance companies do not have in-network providers (dentists) for this treatment.

Can I still come to see Dr. Beadling and get coverage for my treatment even if he is not a provider in my insurance network?

Yes.  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.  If there is an in-network provider, you can still see Dr. Beadling, and you would receive out-of-network benefits.

Does the office have payment options that will reduce my out-of-pocket expense for treatment?

Yes.  We offer interest free financing for 6 monyhs through Care Credit Finance. 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.

Why do I need to pay for care at the time of the visit?

Since 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.  It is our practice to require payment at the time of service, and you will be reimbursed by your insurance company according to your policy. 

How do I find out how much my insurance company will cover for this treatment?

Because we are a dental office and not a provider in medical insurance networks, we recommend that you call your insurance company to get that information.

Some of the questions you should ask your insurance representative are:

• What is my percentage of coverage for oral appliance therapy for treatment of Obstructive Sleep Apnea (code # E0486)?
• Are there any in-network providers for this specific treatment in my insurance plan?
• If there are no providers within the network, will my coverage be at an in-network percentage?
• If there are providers within the network, what is my coverage if I see an out-of-network provider?
• Do I need a referral from a physician to see the dentist who treats this problem?