Medical Insurance Coverage for Sleep Apnea Treatment, with Dr. Stephen Gillespie, Gillespie Dentistry, Vancouver, Washington
An oral appliance repositions the jaw during sleep to enable the oxygen flowing to the lungs to be increased. Sleep apnea is defined as an absence of the reduction of oxygen during sleep, so an oral appliance helps to eliminate that condition, says Dr. Stephen Gillespie, of Gillespie Dentistry in Vancouver, Washington.
There are regulations reflecting what a dentist and a physician can do, says Dr. Gillespie. A physician isn't licensed to treat sleep apnea with an oral appliance, even though it's a medical condition, so the physician will refer patients to a dentist for this type of oral appliance treatment.
Once the condition has been diagnosed by a physician and there's a sleep study to indicate this, then a referral is made to the dentist and the dentist is then authorized to bill the patient's medical insurance. The key to understanding how medical insurance is different from dental insurance is that patients need to understand that sometimes, medical procedures are not paid for in a dental office, says Dr. Gillespie.
At Dr. Gillespie's dental practice, Gillespie Dentistry, they utilize a company who are experts in billing medical insurance for sleep apnea patients. This allows his office to make a pre-determination of benefits so they know before treatment is started, the out of pocket expenses the patient will be responsible for. There are no financial surprises for the patient, Dr. Gillespie says and because of the experience of this billing company, they're often able to obtain in-network benefits even when they're not in-network providers. Dr. Gillespie is an in-network provider for many insurance companies, which is a huge benefit for his patients because it maximizes their benefit and expedites the approval process and payment of claims.
Dr. Gillespie believes he is the only dental office in his area authorized to bill Medicare for dental appliances to treat sleep apnea, which is a very valuable service he's offering, considering a lot of the aging community has sleep apnea.
Dr. Stephen Gillespie is a dentist in Vancouver, Washington, with Gillespie Dentistry. He is a leading sleep expert with Sleep Better TV, providing online, on-demand, sleep breathing disorder video content. Sleep Better TV is a featured network of Sequence Media Group.