Questions: Answers: Will my insurance company pay for my Oral Appliance Therapy Program? Most medical insurance companies provide coverage for Oral Appliance Therapy. Major insurance companies like Blue Cross Blue Shield, United Healthcare, Aetna, Humana, Cigna and Medicare have policies that outline the criteria they require for coverage. Once you provide your medical insurance information to our team, we'll check with your insurance company regarding your specific coverage. Each insurance plan is different, and your total out-of-pocket costs will be determined by your co-pay, co-insurance and/or deductible. You may also be able to take advantage of PPO discounts, if your insurance allows them. Once we know you have coverage, we start a pre-approval process known as pre-certification or pre-determination. This gives the insurance the opportunity to review your case for approval. Will my insurance company approve my Oral Appliance Therapy Program? We have a team of dedicated professionals in our Insurance Department continually working with insurance companies. For the majority of our patients, the insurance company requires prior notification to ensure the oral appliance therapy program is medically necessary for you. In order to prove medical necessity, we will submit an array of medical information about you and your sleep-related breathing disorder. It may take 30-60 days for your insurance to review the documentation we've submitted and make a decision. Our Insurance Team follows your request for coverage throughout the process, ensuring a favorable outcome. Will my insurance company cover my Oral Appliance Therapy in network? We are network providers with most major medical insurance companies. Please call our office to verify if we are in-network with your specific insurance company. Will my HMO provide a referral for my Oral Appliance Therapy?
We are participating providers with numerous HMO Groups throughout the Chicagoland area. Please call our office and provide one of our team members with your HMO insurance information. If we are a participating provider with your particular HMO, we will work with your physician's office to obtain a referral. We have a team dedicated to managing HMO referrals for our patients. In general, the referral process with your HMO may take up to 30 days before approval is granted.
What if my insurance denies coverage for Oral Appliance Therapy?
We understand that there are some medical insurances that are still developing their criteria for coverage of Oral Appliance Therapy. Our expert team in the Insurance Department is devoted to the education and collaboration needed to build strong cases for coverage of your treatment. Even if your insurance doesn't normally cover Oral Appliance Therapy, we may be able to get your treatment considered.
When will my Oral Appliance be ready?
As a general rule, we will have your oral appliance ready for delivery within 30 days from when your insurance company provides us with an approval.
Will the Oral Appliance be comfortable?
The oral appliances we use have a hard outer shell and a soft inside that provides for maximum comfort. Usually after the oral appliance has been worn for a short period of time the patient reports they feel strange if they are not wearing their oral appliance at night. Unofficially, the adherence rate for patients wearing the oral appliance seven nights a week for seven hours or more is in the 90th percentile.
Will the Oral Appliance work for me?
We adhere to the practice parameters established by the American Academy of Sleep Medicine for the treatment of snoring and obstructive sleep apnea with oral appliances. We evaluate our patients on a regular basis for the first few months they are treating their sleep related breathing disorder per our oral appliance therapy program. We use their subjective symptoms such as a decrease in snoring and/or feeling more rested during the day. Once the patient has adapted to their oral appliance and is feeling better, we refer the patient for a follow up sleep test in order to determine the efficacy of their treatment with the oral appliance. The patient's physician(s) will review the results of the sleep test with the patient and determine if the oral appliance is treating the patient's sleep related breathing disorder. If for some reason, the oral appliance is not successfully treating the patient's sleep related breathing disorder, we have alternative treatment options (see tap-pap) that we may present to the patient. As with any medical procedure, there are no guarantees, however; we are fully committed to doing everything within our power to make oral appliance therapy a successful treatment option for our patients.
Will wearing an Oral Appliance change my bite and/or shift my teeth?
The oral appliance may possibly change your bite or minamally shift teath with time. To minimize this movement, we teach our patients morning exercises and the use of a custom made AM aligner. The AM aligner is basically a thin piece of plastic that is softened and is inserted in the patient's mouth 30 minutes after the appliance is removed in the morning. The patient gently bites into the AM aligner for five minutes each morning and this helps to reposition the bite and minimizes shifting of the teeth. We monitor patients at their follow up appointments and many times these bite changes are so mild, the patient does not realize there has been any movement.
May I use my Oral Appliance without having the Prevident prescription filled? Yes Do I use the Prevident toothpaste to clean my Oral Appliance? No How do I properly clean my Oral Appliance? Please refer to the Oral Appliance Cleaning Instructions that were provided with your appliance at delivery. If you have additional questions, you can call our office and one of our Clinical Professionals will be happy to assist you.