Sleep Apnea FAQ
You can come in for a consultation to start. We can help determine if you are snoring, or if there are underlying sleep apnea issues. If you aren't suffering from any of the other symptoms of sleep apnea, we can make you a snoring appliance to help alleviate your snoring.
We may be able to correct anatomy and airway issues permanently using orthodontics.
You need to start with a visit to your PCP who can refer you for a sleep study. The sleep study will determine if you have sleep apnea and whether it is mild, moderate, or severe. They will also recommend either a CPAP or oral appliance therapy. If you prefer oral appliance therapy as your initial treatment, you can let them know at this time.
We want to be sure your existing teeth and gums are healthy and capable of supporting an oral appliance. We also need to take our own scans to ensure the appliance will work for you.
In most cases, it's not! We can fit you for an appliance, and may be able to get your medical insurance to pay for the alternative treatment of the oral appliance.
The sleep apnea appliance is not covered under your dental insurance, but it may be covered under your medical insurance. The medical code we bill is E0486 and is under your Durable Medical benefits. In order for insurance to approve benefits, certain criteria must be met (based on your plan's policies). This usually includes a diagnosis of mild to moderate sleep apnea and a current sleep study.
Another caveat worth noting is that we are not an in-network provider for any medical plans. This means we will be viewed as an out-of-network provider, and your out-of-network deductible and benefits will apply UNLESS your plan will allow you to obtain an "out-of-network exception" or "gap exception". These exceptions are agreements that your insurance will pay us as though we are an in-network provider, and in-network benefits will apply. This is generally an easy ask from insurance, as there are no in-network providers who provide this service, and medical providers who are in-network aren't capable of providing the service.