The majority of our patients have a medical problem with a dental solution, and therefore we submit to the medical insurance company. On occasion, we do submit to the dental insurance company. Dr. Abbott participate with Medicare, Tricare, and the local Carefirst and BlueCross BlueShield plans. Those insurance plans require referrals. For all other insurance plans where you can go to an out of network provider, our office will be happy to submit your claim forms for you but our policy is that you pay us and your insurance company reimburses you directly. Our office will also work with you where necessary to help get preauthorization for your oral devices.
Insurance coverage for oral devices for sleep apnea: Most insurance companies do cover oral devices for sleep apnea if they determine it to be medically necessary. Some insurance companies require preauthorization and others do not. To be sure, it is suggested you call your insurance company to determine if it is a covered service and how much you might expect to be reimbursed. Secondly, ask if it needs to be preauthorized or precertified for medical necessity. Tell them you have obstructive sleep apnea with a diagnosis code G47.33 and need an adjustable mandibular repositioning appliance with a procedure code of E0486 (durable medical equipment). If you determine it needs to be preauthorized ask where the information needs to be faxed. Our office will be happy to fax this information to your insurance company after receiving a copy of both sides of your insurance card and a copy of your original sleep study.
Medicare Patients: As a participating provider most services are covered by Medicare and your supplemental insurance company. You may have to pay something if your secondary insurance does not cover their portion or a charge has gone towards a deductible.
- TMJ/FACIAL PAIN PATIENTS – Medicare currently covers the initial consultation and x-ray. All subsequent treatment is covered on a case by case basis. In the majority of cases appliance treatment is not covered.
- SLEEP PATIENTS – Dr. Abbott is now a durable medical equipment provider and a sleep appliance will be covered if you meet certain requirements. Our office will review these requirements when you call.
Tricare Patients: You need an authorization from your MTF or PCP to come to our office. Normally, our office receives fax authorizations by the time you phone us. If you or your dependent is active duty there are no co-pays. If you have Tricare Prime and are inactive or retired there is a co-pay at each visit. If you have Tricare Select, there may be additional costs which will be discussed.
Carefirst BlueCross BlueShield Patients: Coverage for Carefirst and BlueCross plans varies widely among each group. You must be aware of the rules unique to your group as regards co-pays, deductibles, and co-insurance as well as the need to obtain a referral from your primary care provider. We will preauthorize those services that need to be preauthorized. Some procedures may not be covered under your plan or require a co-insurance and you will need to make payment arrangements prior to the start of treatment. Co-payments are due at each office visit.
All other Patients: If your medical insurance is an HMO, you must check with them to see if they have a participating provider in your plan that can help you or if they will give you a referral to come to our office as a non-participating provider. If your medical insurance is a PPO and you don’t regularly need a referral to go to an out of network provider, you should be able to come to our office. Hopefully, this has answered the majority of your questions. Please call if you have additional questions, or would like to set up an appointment. You may leave a message on our answering machine and your call will be returned on the next business day.