• Insurance Coverage

  • Scroll down to see the insurers with whom we are contracted.

    Because Obstructive Sleep Apnea is a medical disease, reimbursement falls under your Health Insurance Plan not your Dental Care Plan. Most health plans provide benefits for treatment. Contact our office if you would like to speak directly with our Insurance Coordinator. She can answer questions about your specific coverage.

    If you have an HMO policy, you will require a referral from your Primary Care Physician. Contact your doctor to request a referral. Our team will take it from there. We work closely with referring doctors to make sure your treatment is authorized by your health plan. We also inform your doctor of your treatment plan and progress.

    If you have a PPO policy, you can contact us directly. We follow the same process  described above.
  • What Type Of Oral Appliances Are Covered By My Medical Insurance?

    Healthcare plans do cover Oral Appliances for Obstructive Sleep Apnea (OSA) when they are custom-made oral appliances inserted by a qualified dentist and are FDA approved. Dr. Eli is the only post graduate trained Sleep Specialist in the San Diego area. Sleep Treatment Specialists is the only clinic that offers all non surgical sleep apnea treatments. This allows us to match you with the most appropriate care for your level of disease, coupled with our disease management program that follows your care and progress. OSA is a lifelong illness and a single treatment given at a single time will never be able to keep you in ideal treatment without a follow up plan and ability to modify treatment when indicated.

    How Do I Know If My Insurance Policy Covers Oral Appliances?

    Almost all medical plans can be verified in advance for coverage of oral appliances. Our staff are very knowledgeable about each of the insurance plans we accept. We work very closely with our patients to make sure that pre authorization and coverage are arranged before treatment begins so that there are minimal surprises. We do all we can do to make your experience with our office and staff the best possible.

    Will My Medical Insurance Tell Me How Much They Cover For A Mouthpiece Or Appliance?

    The good news is that an insurance representative known as a “benefit estimator” should be able to determine coverage under your policy. Although the insurance representative may not be able to determine your exact reimbursement in advance, he/she can indicate if coverage is included in your plan. Deductibles, copayment and the statement of “not a guarantee of coverage” listed on all insurance documents remind us all that we will do the best we can for our patients.

    What About Deductibles?

    Your deductible may differ from your usual insurance deductible since most carriers categorize oral appliances for obstructive sleep apnea as equipment, a.k.a. Durable Medical Equipment. Equipment such as oral appliances or even CPAPs often carry a separate deductible, so check your deductible for medical DME benefits.

    Does The Affordable Care Act (ACA) Affect My Insurance Coverage For Oral Appliances?

    Yes, under the ACA (also known as Obamacare), coverage for oral appliances or other types of devices have improved. Your variables will include deductibles or copayments, depending on your plan.

    “Oral appliances are considered Durable Medical Equipment” says Dr. Bradley Eli from Sleep Treatment Specialists. “It’s good to know that coverage of Durable Medical Equipment is one of the Essential Health Benefits in the Affordable Care Act (ACA), commonly known as Obamacare. Most states have adopted some form of this insurance mandate.”

    Does Medical Insurance Cover Snoring Mouthpieces?

    No. Medical insurance considers custom mouthpieces only “medically necessary” for treatment of OSA. However, snoring is the primary risk identifier of OSA, but not all snoring patients have OSA. What we are saying is that snoring is often the sign of something more, but without testing you don’t really know. No questionnaire, survey or other non-sleep test has been validated to be able to predict the presence of OSA!

    Even though snoring may stop with a device you obtained on your own, you or your bed partner still could be having sleep apnea episodes. For this reason current standard of care protocols and all providers agree that without testing treatment of “only my snoring” doesn’t provide you the assurance that you should demand. This is to ensure that you receive the best possible care.

    Medical insurance only covers custom mouthpieces fitted and inserted by a trained dental specialist, as the teeth and jaws are effected as well. Dr. Eli is the only post doctoral trained specialist in this specific field in the greater San Diego region.

    I’m A Senior and Have Medicare. Does Medicare Pay For Sleep Apnea Oral Appliances?

    Medicare Policy states that certain oral appliances used to treat obstructive sleep apnea are covered when specific Medicare approved criteria are met. Medicare provides reimbursement for oral appliances under the Durable Medical Equipment (DME) benefit. This means that, in order to bill Medicare for these items, a dental specialist trained in sleep apnea, must enroll as a Medicare DME Supplier. In order to provide the most ideal care only a licensed dentist is permitted to bill for custom oral appliance therapy for a Medicare beneficiary. The dentist providing this therapy can also be a Medicare provider if he/she meets the necessary training and education requirements.

  • Contracted insurance’s listed Below:

  • Blue Cross Blue Shield Federal Employee Program PPO

    You may call our office directly to schedule your first appointment.

  • Blue Shield PPO

    You may call our office directly to schedule your first appointment.

  • Cigna PPO

    You may call our office directly to schedule your first appointment.

  • Graybill Medical Group

    This is an HMO. Ask your primary care doctor’s office for a referral and authorization.

  • Greater Tri-City Medical Group

    This is a HMO. Ask your primary care doctor’s office for a referral and authorization.

  • Great West PPO

    You may call our office directly to schedule your first appointment.

  • Health Net PPO

    You may call our office directly to schedule your first appointment.

  • Medicare

    We are a Medicare provider for Custom Orthodontics. Please reference the Medicare Website Medicare.gov This status is difficult to obtain and represents individuals and organizations that are focused on assisting patients and patient care. Medicare recipients are not generally ever asked to “pay for care”, and then let Medicare pay them back.

  • Mercy Physicians Medical Group

    his is an HMO. Ask your primary care doctor’s office for a referral and authorization.

  • Primary Care Associates Medical Group

    This is an HMO. Ask your primary care doctor’s office for a referral and authorization.

  • Sharp Community Medical Group

    This is an HMO. Ask your primary care doctor’s office for a referral and authorization.

  • Scripps Physicians Medical Group

    This is an HMO. Ask your primary care doctor’s office for a referral and authorization.

    Scripps Affiliated Medical Groups
     
    •      Scripps Coastal Medical Group
    •      Scripps Clinic Medical Group
  • Tricare

    In network for all Tricare Plans

  • United Healthcare PPO

    You may call our office directly to schedule your first appointment.