Billing Process
- Verification of Benefits
Generally, the billing process will start with verifying that the patient has benefits for the Oral Appliance. We do this automatically for patients who complete their Sleep Test with us, but we can also check benefits for other patients as well.
The benefit report will be sent out along with the sleep test results and will include:
Whether or not the Oral Appliance is a covered benefit.
Whether or not there is a preauthorization or predetermination.
The Patient’s total in and out of network deductible and how much is remaining on each.
The coinsurance percentage in and out of network.
Unfortunately, the one thing that the insurance will not share prior to processing the actual claim is the allowable amount that they pay for each procedure. We can estimate based on past payments for other patients, but there is no way to know for sure.
If a verification is needed on a patient who has had a sleep test elsewhere, just send a copy of the patient demographics and insurance information and request a benefit check. The results will be sent back within a few days.
- Preauthorization/Predetermination
If a preauth or predetermination is available, the insurance will need to see chart notes which document the sleep apnea symptoms and reasons for treatment and sleep test results. Simply send this information to us and we’ll get the auth taken care of. It can take anywhere from a few hours to a couple weeks depending on the insurance company.
- Oral Appliance Claim
Once the appliance is seated, the claim can be submitted. If we have already received a preauth, the insurance will just want to see chart notes from the seat date with the claim. If there is not a preauth, we’ll need to submit chart notes from all office visits relating to sleep apnea (ordering the sleep test, discussing therapy options, seating the appliance) along with the sleep test results.
A superbill is the easiest way to quickly let us know what you’d like us to bill. Simply fill out the superbill and send it to us along with any chart notes or test results that we do not already have. Once the claim is submitted, it generally takes about four weeks for the insurance to process. If the insurance denies the claim or requests more information, just forward their communication to us and we’ll get it taken care of.
- Office Visits
When billing an office visit, simply send us the superbill and the chart notes from the office visit and we will submit the claim to the insurance. Office visits can be billed anytime you are managing or treating a medical condition such as sleep apnea.