Help! My Patient Doesn’t Have a Sleep Test!

This is a common problem for our medical billing clients. As a dentist you are in a unique position to talk with and counsel patients who suffer from sleep apnea and may or may not be currently treating it. Dental providers are the only providers in many states that can fabricate and titrate a mandibular advancement appliance to treat sleep-disordered breathing. However dental providers cannot diagnose sleep apnea and many medical insurances will not cover an appliance for snoring alone. Here are your options if you are screening patients in your practice and need to have sleep tests performed to meet medical necessity for an appliance:
1.)    You can pursue the appliance without a sleep test if you are treating for snoring only. The patient will likely not have a paid medical claim however they can pay out of pocket for this treatment.
2.)    If the patient has had a sleep test in the previous three years you can have them request a copy and either bring it to the office or have it faxed to you from their PCP or sleep doctor. For the majority of carriers a sleep test done within the last three years will be acceptable but some require within the past two years so make sure to check before fabricating the appliance in case the patient needs a rest.
3.)    The patient can be referred back to their PCP or sleep doctor to have a sleep test ordered either in home or in a lab.
4.)    You can contract with a home sleep test provider like EZSleep. This provider will send you a designated number of home sleep test kits that your patients can take home, overnight, and use to test themselves for sleep apnea. They return the kit to the office within a few days and you will upload the data to the company’s web portal where it will be reviewed by a sleep technician and then a physician (usually a pulmonologist, neurologist or ENT). Diagnosis is confirmed by the reviewing physician who then signs the sleep study.
Don’t feel constrained to picking one avenue to getting your patient’s studies performed to diagnose their sleep apnea. Every patient is different so offer options. Some won’t want to go back to their PCP and will be eager to take the test through your sleep provider. Some will not want their personal information given out to a third party and would prefer to see a provider that they know and have experience with. The important thing is to ensure your patient is getting the best care possible and is being treated in the optimum way to resolve their sleep apnea symptoms.