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Judy
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Experience:  RN in ICU for 35 years
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Medicare form for submitting oral appliance for sleep apnea

Resolved Question:

I have sleep apnea and I am attempting to have medicare pick up the cost of the ORAL appliance that I paid to have made to successfully correct the problem. I do not know how to submit the documentation for the claim. I do have a M.D. Rx covering the request for the DDS appliance.
Submitted: 7 years ago.
Category: Health
Expert:  Judy replied 7 years ago.
May I ask in what state you are located? I am trying to find a Medicare rep for you. I bill Medicare for a physician who specializes in sleep disorders, but she is not a dentist. So my experience in that area is limited. I will try to contact her to see if she knows what you may need to do. I am guessing that from the doc who is ordering your sleep apnea treatment, a letter of medical necessity and perhaps notes from the chart in his/her office noting the change in sleep disorder with vs without the appliance may be helpful. This will point out to Medicare that this is not dental services that you are billing for (they as you know do not cover dental work), but in actuality it is a medical "treatment."
Customer: replied 7 years ago.
I am in the Tucson area of Arizona. I was diagnosed with apnea years before I was on Medicare. The only symptoms are that my old appliance was falling out of my mouth while I was asleep and therefore it was time for replacement. It lasted five years longer than was expected the way it was. I told my MD that I needed a replacement and I went to a certified sleep qualified dentist (Dr. Rick Light) in Tucson to have the new appliance made. I agree it is a medical treatment but how do I get medicare to pay for it? The whole bill comes to almost $3,000 because I had not been to the DDS before as we just moved here from Hawaii. He had to do all the calculations all over again. The new appliance is fabulous. It is saving my life but you have not answered my question. I need to get Medicare to pay for it.
Expert:  Judy replied 7 years ago.
Hi, I am glad you are having good results from the appliance.

I have just talked with my specialist/boss. She says that it is unlikely that Medicare will pay for the appliance because they are pretty strict about not covering what they consider to be dental work. But you can and should try anyway - submit the letter as I mentioned along with a prescription from your doc - stating specifically that the oral appliance is for treatment of sleep apnea. You will also need a copy of the sleep study or documentation that a sleep study was performed and the need for the appliance is proven - a dictated report from your sleep doc to the medical doc would be or should be sufficient if you can't get the actual sleep study report.

I am still trying to find out for you where to get the forms for submitting - she was not sure what to tell us about that piece of the problem. I will continue to search and I will get back to you with whatever I find!

OK, I have found this [too easy] number 1-800-MEDICARE !! This is posted at the medicare site for patients for help with Medicare.
Also here is a site that tells you what to do to file a claim when a doc does not accept Medicare [or I guess isn't eligible to accept Medicare]: http://www.medicare.gov/Basics/FAC.asp
Judy, Nurse
Category: Health
Satisfied Customers: 914
Experience: RN in ICU for 35 years
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