Can I Use my Medical Insurance for Snoring and Sleep Apnea Appliances?

Can I use my Medical Insurance for Snoring and Sleep Apnea Appliances

By Mina Levi, DDS, 12/23/2014

If you suffer from sleep apnea or you snore at night, your Dentist San Francisco may recommend that you have an appliance custom-made for you, as untreated sleep apnea and snoring can lead to a number of issues. However, many patients are concerned with the relatively high cost of sleep apnea and snoring appliances and have questions about how they can have their dental or medical insurance cover the cost of the appliance. In this week’s article, San Francisco Dentist Mina Levi, DDS discusses medical insurance billing for sleep apnea and snoring appliances.

First, check dental:

If you are being seen by a dentist and the dentist is going to be fabricating the device for you, the first thing that you should check is your dental insurance coverage of the specific appliance code that the dental office gives you. For example, an occlusal guard has the code D9940, and some plans cover these types of mouth guards at 50% of the insurance company’s contracted rate. When speaking with your dental insurance company, you should ask three things:

1) What is the contracted rate for this procedure code?

2) Is this procedure code a covered benefit on my plan?

3) What is the coverage percentage rate?

Next, check medical:

Many medical policies offer coverage for oral appliances. Check with your dentist to see if they will be billing to your medical policy or if you will be needing to submit your own claim. If you are submitting your own claim, there are some things you will need to gather from the dentist:

1) A copy of the medical claim form (latest revision as of April 2014)

2) Exam notes and patient history (including symptoms, past treatments, exam findings, and treatment plan)

3) Radiographs such as an FMX or panoramic x-ray, or if those are not available then 4 Bitewings may be sufficient

4) The medical code for the appliance (this will be different from the dental code)

5) Letter/narrative of medical necessity

Another treatment that is also covered by most medical insurance companies is a sleep study, in which physicians monitor your sleeping patterns and diagnose your sleep apnea. The records from the sleep study can be sent in to the insurance company to ensure coverage of a sleep apnea appliance.

If you have questions regarding sleep apnea and related appliances, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, sleep apnea, sleep apnea symptoms, sleep apnea appliance, snoring, snore guard, snoring appliance, medical insurance, dental insurance, dental claim, medical claim, medical coverage, dental coverage, medical coverage oral appliance, dental coverage oral appliance, medical coverage sleep apnea appliance, dental coverage sleep apnea appliance, dental coverage occlusal guard, occlusal guard

Sleep Apnea Questions and Answers

Sleep Apnea Questions and Answers

By Mina Levi, DDS, 10/16/2014

There are many reasons that sleep can be disturbed, but one reason is a risk to overall health. Sleep Apnea is a condition that many people don’t realize they have and prevents the body from getting enough oxygen. This can be very detrimental to your health. Many people have questions about sleep apnea, and so Dentist San Francisco is sharing an interview with two sleep disorder specialists to answer some of those questions:

What is snoring?

Snoring sounds are caused by airway tissues vibrating in response to narrowing of the airway during sleep breathing. These sounds are rarely troublesome to the snorer but may be to the bed partner.

Why is snoring considered a sign of a serious medical problem?

Snoring may be a sign of sleep apnea, which results in poor sleep quality and can lead to excessive daytime sleepiness. Being fatigued is a major cause of work-related accidents, car crashes and loss of production.

What is sleep apnea?

Sleep apnea is a potentially life-threatening condition that requires immediate medical attention. In fact, patients diagnosed with Obstructive Sleep Apnea (OSA) can’t breathe despite effort several times an hour for 10 seconds or more – sometimes, hundreds of times per night – preventing the brain and the rest of the body from getting sufficient oxygen.

How is sleep apnea categorized?

Sleep apnea is categorized in one of the following forms:

1.       Obstructive Sleep Apnea (OSA): is the more common of the two forms of sleep apnea. Generally, OSA is caused by a blockage of the airway, when the soft tissue and/or tongue collapse during sleep.

2.       Central Sleep Apnea: As a result of instability in the respiratory control center, the brain does not signal the muscles to breathe, despite an open airway.

Who is at risk for Obstructive Sleep Apnea?

Anyone at any age can have obstructive sleep apnea. Common risk factors for sleep apnea include:

1.       Large neck size

2.       Large tonsils, a large tongue or a small jaw bone

3.       High-vaulted upper arches

4.       A family history of sleep apnea

5.       Gastroesophageal reflux (GERD)

6.       People whose bed partner has observed choking, gasping or loud snoring

7.       Nasal obstruction (deviated septum, allergies or sinus problems)

8.       Overweight or obese

9.       History of Hypertension, Chronic Heart Failure or Chronic Obstructive Pulmonary Disease (COPD)

What are the common signs and symptoms of Sleep Apnea?

1.       Loud snoring

2.       Choking or gasping during sleep

3.       Fighting sleepiness during the day (even at work or while driving)

4.       Morning headaches

5.       Memory or learning problems

6.       Feeling irritable

7.       Inability to concentrate

8.       Mood swings, personality changes, feelings of depression

9.       Dry throat when waking up

10.   Frequent night-time urination

What causes Sleep Apnea?

Under healthy airway conditions during sleep, muscles keep the throat open and tongue clear of the airway so that oxygen flows into the lungs. In Obstructive Sleep Apnea, however, the throat briefly collapses or the tongue blocks the airway causing a complete blockage of airflow. Along with those pauses in breathing, the oxygen level in blood may drop significantly.

What is the Sleep Apnea prevalence?

Over 18 million Americans suffer from sleep apnea. An estimated 12 million Americans remain undiagnosed. Over 50% of all apnea cases are diagnosed in people aged 40 or over.

How is Sleep Apnea diagnosed?

Sleep apnea is diagnosed by a properly trained sleep physician through the use of testing equipment designed to measure sleep breathing patterns. Testing may be performed at a sleep laboratory via a Polysomnogram or at the patient’s home using FDA-cleared ambulatory sleep testing equipment.

What is in Home Sleep Testing (HST)?

A home sleep test is a simple-to-perform diagnostic procedure that patients can take in the comfort of their own home. While sleeping, the home sleep test device monitors the patient’s sleep patterns to include any pauses in their breathing. These FDA-cleared devices are designed to provide data for physicians to diagnose sleep breathing patterns.

What are the benefits of a Home Sleep Test (HST)?

1.       The patient self-administers the home sleep test, and is able to spend the night in his/her own bed in familiar surroundings.

2.       Home sleep testing can be especially advantageous to the home-bound elderly who require specialized care such as a nurse or family member spending the night, expensive transportation costs, etc.

3.       HST is also beneficial for those with trouble arranging time out of their scheduled to spend the night in a lab.

4.       The typical cost of a home sleep test is only a fraction of the cost of an in-lab sleep study, and yields effective results in the diagnosis of Obstructive Sleep Apnea.

How do dentists treat patients with sleep apnea?

Dentists may treat patients that suffer from sleep apnea through the use of FDA-cleared oral appliances. In fact, the American Academy of Sleep Medicine promotes the use of oral appliances as a viable option for patients that suffer from mild-to-moderate obstructive sleep apnea or severe patients when the patient cannot tolerate the use of a CPAP machine. Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep.

What is the Dentist’s role in identifying patients with Sleep Apnea?

Dentists may detect the less evident symptoms of sleep apnea through a candid conversation with their patients during an exam that addresses the patient’s concerns and dental health details. A dentist may suspect a patient suffers from sleep apnea if the patient complains about lethargy, morning headaches, or dry mouth (typically caused by open mouth breathing during sleep or heavy snoring). If the patient shows enough risk of suffering from a sleeping disorder, dentists may prescribe a sleep study for the patient to rule out the condition. It should be noted that dentists are often the first professional to become aware of a potential problem since they are usually in contact with their patients more frequently than physicians.

Source: Drs. Justin A Fu, MD, FAASM and Payam Araii, DMD (Ez Sleep Pillow Talk)

For more information on sleep apnea, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, Sleep apnea, sleep apnea treatments, snoring, sleep apnea symptoms, San Francisco Dentist, CPAP, self test, sleep apnea self test, snoring, snoring diagnosis

Sleep Apnea

Sleep Apnea

Snoring has always been associated as more of an annoyance rather than a medical concern for most people. However, frequent and loud snoring can be a sign of a disorder called sleep apnea. Sleep apnea is a disorder in which breathing stops periodically throughout sleep. Sleep apnea is treatable, but can easily go without being identified or diagnosed. In this article, we discuss symptoms, causes, and treatment of sleep apnea.

What is sleep apnea?

Sleep apnea is a breathing disorder in which breathing periodically pauses for about 10-20 seconds throughout the night and can occur hundreds of times while you sleep. This irregular breathing pattern interrupts your natural sleeping pattern, even if you do not fully “wake up” from the breathing pauses. This causes you to spend more time in a lighter stage of sleep and less time in the deeper stages of sleep such as REM sleep, depriving you of energy and mental acuity. This chronic deep sleep deprivation can cause daytime sleepiness, slowed reflexes and poor concentration. Over time, sleep apnea can cause serious health issues including heart disease, heart attacks, stroke, weight gain, high blood pressure, and diabetes.

There are three main types of sleep apnea: obstructive, central, and complex. Obstructive sleep apnea is the most common type, and occurs when the tissues in the back of your throat relax as you sleep and block the airway. This usually causes loud snoring. Central sleep apnea is much less common and involves the central nervous system. Central sleep apnea occurs when the brain fails to send signals to the respiratory muscles that control breathing and so breathing ceases until other systems notice a decrease in oxygen. People with central sleep apnea do not usually snore, but have longer periods in which they are completely silent and breathing does not occur. Complex sleep apnea is a combination of both obstructive and central sleep apneas.

Sleep apnea symptoms

It is relatively difficult to identify sleep apnea alone, since the most prominent symptoms occur during sleep. A solution is to record yourself during sleep, ask a bed partner to monitor your sleep, or participate in a sleep study at a local hospital. The major symptoms of sleep apnea are as follows:

• Pausing when snoring followed by choking or gasping after the pauses
• Consistent sleepiness throughout the day
• Headaches or dry mouth upon waking up
• Inability to concentrate, including learning and memory issues
• Waking up frequently to urinate
• Mood swings, irritability, or depression

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores during the night. The biggest sign to test if you have sleep apnea or you just snore is how you feel throughout the day. Normal snoring should not interfere with sleeping patterns, so you shouldn’t feel exhausted during the daytime.

Sleep apnea causes and risk factors

Any person can have sleep apnea, but there are certain risk factors that are associated with sleep apnea that put people at a higher risk. You have a higher risk for obstructive sleep apnea if you are:

• Overweight
• Male
• Over 65 years old
• A smoker
• Related to someone with sleep apnea

You have a higher risk for central sleep apnea if you are:

• Male
• Over 65 years old

Central sleep apnea is often associated with serious illness such as heart disease, stroke, neurological disorder or brainstem injury.

Treatments for sleep apnea

Sleep apnea is a treatable condition and there are multiple treatments that can be done at home such as lifestyle changes or medically. Treatment options include:

• Lose weight. People who are overweight have extra tissue in the back of their throat, which can block the airway.
• Quit smoking. Smoking contributes to sleep apnea by increasing inflammation in the throat and airway.
• Avoid alcohol and sedatives. These drugs will relax the muscles of the throat and can cause difficulty breathing or worsen sleep apnea symptoms.
• Sleep on your side. Avoid sleeping on your back where gravity is working against you.
• Use a nasal dilator. Nasal dilators are helpful to open up nasal passages during sleep.
• Medical treatment with CPAP. A Continuous Positive Airflow Pressure (CPAP) is used commonly for moderate to severe sleep apnea. The CPAP device has a mask that provides a constant stream of air that keeps your airway passages open when you sleep.
• Medical treatment with BPAP. Bilevel Positive Airway Pressure (BPAP) devices are used for those who cannot adapt to using CPAP. This device automatically adjusts pressure while you’re sleeping, providing more on the inhale and less on the exhale.
• Mandibular repositioning or tongue retaining device. These two common oral devices open the airway by bringing the jaw lower or moving the tongue forward during sleep.
• Surgical options. Surgery to increase the size of the airway can reduce sleep apnea episodes.

 

If you suffer from symptoms of sleep apnea or have more questions regarding sleep apnea symptoms or treatment, visit San Francisco Dentist Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Sleep apnea, sleep apnea treatments, snoring, sleep apnea symptoms, San Francisco dentist