What you should know before implementation
by Kevin Henry, DE Managing Editor
For more on this topic, go to www.dentaleconomics.com and search using the following key words: sleep apnea, sleep disorders, insurance reimbursement, oral appliance therapy.
Oral appliance therapy (OAT) has become a solid revenue source for many dental practices. Many of the companies in this industry promise to be helpful during the learning curve. The reality is that while these appliances themselves are easy to use, the process of prospecting patients, creating awareness, and overall implementation can be quite difficult. Many of the companies abandon dentists once they have purchased their products or used their services.
To have a better understanding of these difficulties and how to work through them, I spoke with Dr. Tom Glibert from Danville Family Dentistry in Danville, Ohio. He has successfully associated with the Sleep Optima Dental Network, a company dedicated to helping dentists become successful in the sleep apnea market. Dr. Glibert has been implementing OAT for a few years now and has been a member of the network since October 2010.
He explained that working with the appliances is easy, but dealing with the patients and costs associated with treatment is very difficult. This therapy can be expensive, and patients simply are not willing to pay for it out of pocket. Medical insurance companies do pay for the therapy, but they are very difficult to deal with, such that submitting claims to medical insurance companies for reimbursement becomes total guesswork for dentists.
Dr. Glibert would attempt to bill both dental and medical insurance companies, but had little success gaining claims approval. He told me that practices will still take the time to submit and manage claims, yet they are left with the uncertainty of receiving reimbursements.
In order to use the OAT appliances and get insurance reimbursements, the patient must be diagnosed with obstructive sleep apnea (OSA). Dr Glibert said that many sleep labs are willing to work with dentists to get a diagnosis, but a high percentage of patients, once sent to a sleep lab, never return to their dentist. It is very common for sleep labs to prescribe patients a continuous positive air pressure (CPAP) machine.
This process is very uncomfortable for patients because they are forced to conduct the study away from home in a foreign environment, where they are unaccustomed to sleeping. A sleep study at a sleep lab is also very expensive, and most likely not an option for patients who do not have insurance.
A great alternative to a sleep lab for dentists is home sleep testing (HST). Home sleep testing allows a dentist to receive a diagnosis from one of the many FDA-cleared home sleep testing devices, and therefore not lose the patient to the lab. When I asked Dr. Glibert his thoughts on HST, he stated, “Having the ability to conduct home sleep testing is much more realistic than using a sleep lab. Even the concept of being in the comfort of one’s own home makes more sense and is much more affordable.”
HST is much more convenient and affordable than sleep lab testing, not to mention the fact that the dentist will not have to worry about losing the patient. The drawbacks to HST are the costs of the equipment, ongoing costs for support, portal usage, and in some cases, disposable parts. The dentists will then have to have a member of their staff upload the data, handle the entire shipping and patient interface, and get a diagnosis from a certified sleep specialist.
OAT is a solid revenue source, but the vast majority of dental offices are simply not set up to succeed. As previously stated, there are many companies that will offer various products and services that may help with a certain aspect of this offering; however, attempting to piece all of these services together — from insurance billing to home sleep testing to marketing — can be overwhelming and very expensive.
Dr. Glibert is now implementing all the aspects of sleep apnea dentistry by participating in the Sleep Optima Dental Network. The services include education and training (with CE credit), proper medical oversight, home sleep testing services, extensive screening process of the current hygiene pool, and new patient marketing.
When his office began the screening process, he could not believe the number of his own hygiene patients who were at risk for OSA or were already using a CPAP machine. He was also amazed to know that more than 92% of the time the Network receives reimbursement from the insurance companies!
He also takes advantage of the insurance preauthorizations that are offered for the patients who are not willing to move forward until they know what will be covered by their insurance company.
Overall, Dr. Glibert was very happy with the work of the dedicated account management and with the ability to consult the medical directors from Sleep Optima, LLC. Dentists are supported every step of the way, and are assisted in realizing the expected results while implementing sleep dentistry into their practices.