David Dorn, President, Better Sunrise Corp.

Do you make sleep apnea oral appliances for your patients?  Do you have patients pay out of pocket, because you have had difficulty with insurance reimbursement in the past?  

If you answered yes and yes, you may be missing out on the opportunity to provide potentially life saving treatment to a number of patients.  Treating sleep apnea with oral appliance therapy can be one of the most powerfully effective ways you can impact the overall health and wellness of your patients.  Oral appliance therapy for sleep apnea can only be provided by a dentist, however it is a treatment for a medical condition and is covered by health insurance, not dental insurance.  And with health insurance allowable amounts for oral appliance therapy ranging up to $ 6,500, it makes good financial sense to create a robust sleep apnea program in your practice.

By following some key guidelines, and outsourcing a few specialized processes, it is possible for you to provide life changing sleep apnea treatment to your patients and grow the profitability of your practice.  Here are the key components of an effective dental sleep apnea program:

Screening
The screening process involves determining which patients are at risk for sleep apnea and should be tested. The Epworth test and the STOP Questionnaire are great tools to incorporate into your patient health history forms.

Testing

Make sure your patient has had a sleep test and that treatment with an oral appliance is indicated.

Patient Education

One of the key factors to successful treatment is patient education on the risks of untreated sleep apnea and the benefits of therapy.  The more patients understand the problems caused by sleep apnea, and the benefits of treatment, the more likely they are to comply with recommendations and do well.

Treatment

Once your patient has been diagnosed with sleep apnea, take impressions and choose a sleep apnea appliance that you feel will best meet their needs. 

Claims Billing

The costs of sleep apnea testing and oral appliance therapy are covered benefits of many health insurance plans.  These costs are not covered by dental insurance.  Assign someone in your office to work with health insurance companies to determine coverage and benefits and submit claims.  Alternatively, consider using an outside provider to work with health insurance plans on your behalf, to manage the process of pre-authorization of oral appliance therapy; claims submission and problem claim follow up.

Confirmation of Efficacy

A follow up sleep test is always recommended to document efficacy of treatment or determine the need for further titration of the appliance.

Implementation

The key to successfully integrating a sleep apnea component into your practice is effective implementation. Develop a plan that will result in all of your staff members understanding their role in the process and the opportunity they each have to save a patient's life.