Relationships can be saved with oral appliance therapy in addition to saving lives. Helping patients manage obstructive sleep apnea (OSA) is, therefore, something that many healthcare practitioners find to be quite rewarding. Medical insurance cover eXciteOSA, so getting ready for paperwork requirements from your insurance is a good idea. The most frequent inquiries we get about mouth appliances and medical insurance payments are there in this article.
Documentation insurance companies require
A copy of the sleep study results from the Epworth Sleepiness Scale, clinical notes from the sleep apnea screening appointment, and a CPAP rejection or intolerance affidavit are the minimal requirements for documentation and paperwork. On the other hand, the insurer can have different requirements. A lot of insurance companies demand a copy of the doctor’s written order (the prescription for the oral appliance) and ask that the patient sign a “Proof of Delivery” form. One can include any important medical history information, such as high blood pressure or other illnesses that was mentioned.
How to know if medical insurance covers an oral appliance
By calling the eligibility and benefits division at the numbers listed on the patient’s medical insurance card, one can get started. The degree of OSA should be known before the benefits can be established. So, it is crucial to get sleep study data before the benefits verification call. Oral appliances for OSA are often covered under the policy for durable medical equipment because the majority of health insurance policies classify them as medical equipment (DME). DME is the benefit category for medical equipment like wheelchairs and walkers, as well as electronic pain stimulators.
Billing codes
Currently, there is only one medical diagnosis code available for OSA. ICD diagnosis code G47.33 will appear on the sleep study if the patient has this disorder. The insurance company will also need to know the billing code for the personalized sleep equipment, which is:
E0486 – Oral Device/Appliance Used To Reduce Upper Airway Collapsibility, Adjustable Or Non- Adjustable, Custom Fabricated, Includes Fitting And Adjustment
One can ask about initiatives and program policies because there’s a strong chance the oral appliance will need to be approved beforehand. If a preauthorization is necessary, it’s crucial to hold off on providing the oral appliance until the approval has been given.
Type of oral appliances covered by medical insurance
For personalized sleep appliances, doctors have access to more than 100 FDA-approved oral appliances. Medicare and even some private insurers stipulate that be covered. An oral appliance will be there on Medicare’s published Product List.
Does Insurance Cover eXciteOSA?
While most medical insurers do provide coverage for oral appliances with a diagnosis of OSA, it is vital to understand that snoring alone is not a covered condition. For mild to moderate OSA, custom mouthpieces are important. Additionally, if the patient cannot tolerate CPAP or in rare circumstances if the patient refuses CPAP, oral appliances are typically there for severe OSA.
A simple daytime therapy for observable nighttime results is provided by eXciteOSA. 90% of patients said their snoring time had decreased. 89% of bed partners claimed that their snoring has decreased. 79% of patients with sleep apnea had their symptoms improve. eXciteOSA is compatible with FSAs and HSAs but is not currently covered by insurance.
More Information, Click Here to find some valuable information on eXciteOSA and it benefits for sleep apnea.
