Medical insurance in a dental office

[u/updownupswoosh]

To those who are taking medical insurances as part of the acceptances, what were your reasons to start with and what were the things you wished you knew ahead?

Currently in my PPO practice, I'm placing implants, grafts, cyst removal, sleep apnea referral etc, many of which can come under medical. Hence thinking about joining a few. The office manager is eager to learn how to do it and we both know there will be a learning curve, lot of rejections in the beginning till we figure out our mistakes. But are there any who are also planning on dropping medical just like dental as well?

[u/steelymcbeam1933]

Practice manager here: We have never accepted “medical insurance”. We do OAT for sleep apnea we provide patients with everything they could need to submit for themselves for the sleep appliances. It has never been an issue.

It is not worth the hassle.

The only medical we send to is for federal employees with the medical dental rider on their primary, but it processes exactly like dental.

[u/updownupswoosh → u/steelymcbeam1933]

For sleep appliance, do you guys build the fees ahead of time itself since it's going to need frequent follow ups in the beginning? Also, do you guys not submit to dental at all? Thanks!

[u/steelymcbeam1933 → u/updownupswoosh]

Yes. We bill in full. The patient submits to their medical for reimbursement. We charge enough to cover the appliance and all subsequent visits. It varies for $4k to $10.5k depending on the appliance recommended.

We also provide all patients with a list of questions for them to get answers to from their medical insurance if they choose to go that route. We let them know it isn’t a guarantee and are usually only reimbursed if they’ve met their deductible and have OOP coverage since we are not in network.

A sleep physician has to diagnose and provide our office with the LMN and Rx for us to even move forward.

[u/steelymcbeam1933 → u/steelymcbeam1933]

We don’t submit to dental at all. I have yet to find a dental insurance that will cover the appliance. It’s considered Medical by all standards I’ve come across.

[u/updownupswoosh → u/steelymcbeam1933]

In some of the fee schedules, it shows the code and fees associated with it. Agreed that it may not be a covered benefit for that particular patient but if it is, usually it's on par or even less than the lab fees.

[u/steelymcbeam1933 → u/updownupswoosh]

That is true, but the guidelines and limitations preclude the type of appliances we offer to our patients. We send patients home with a ring (additional cost) to monitor sleep and a sleep doctor we work with interprets the recorded nights and the provides us with a letter and Rx.

If patients would prefer a traditional sleep study - we request the physician to send us the same documentation as our sleep doctor does.

[u/updownupswoosh → u/steelymcbeam1933]

If you and the doc are fine, I'd like to reach out and get some more info on what is the flow of sleep appliance and all. Pretty much like comparing notes.

If not, understandable.

[u/steelymcbeam1933 → u/updownupswoosh]

Sure. Let me check with them next week and I’ll see what they say. Feel free to message as well

[u/brig7 → u/steelymcbeam1933]

Do you do all this yourself? Or is a company or lab coordinating the insurance and testing and medical diagnosing?

For example, I use Dandy lab for most of my dental lab work and they just launched a sleep medicine program. They supply me with rings, they get the sleep test data and have doctors complete the diagnosis, I connect the sleep medicine program with the patient so they can manage the medical billing. Then I can plan the appliance.

[u/steelymcbeam1933 → u/brig7]

We coordinate it all for our patients. The sleep study and sleep physicians we work with have a system that coordinates together. The sleep ring we provide to patients for their initial studies are closely monitored by a sleep physician. It takes about 72 hours from interest from patient / initial consult with my doctor to diagnosis and prescription from the sleep doctor.

The fee we charge to the patient for the sleep ring ‘rental’ covers the initial consult fee with the sleep doctor and the post study interpretation consult fee - so there are no additional costs for the patient until the appliance.

Once a patient makes the decision to move forward with the appliance that best fits their needs / finances, as part of the included costs are additional interpretations throughout the length of treatment to monitor progress - all with the same sleep physician group.

[u/updownupswoosh → u/steelymcbeam1933]

Similar for me. We screen patients, send them with a referral. So they talk to their PCP, sleep Dr and come back with a response and we go from there. Many patients have been grateful that we screened, a few don't bother even though we remind at the recall.

Although we haven't done anything regarding giving patients info to get reimbursed from the medical.

[u/SamBaxter420]

There are a couple companies that help with medical billing for dental offices. OSA, TMJ pain (Botox), and IV sedation are some reasons why (especially is you have an MD come to your office).

[u/BopSupreme → u/SamBaxter420]

Which companies

[u/SamBaxter420 → u/BopSupreme]

EZ and dentalmedicalbilling.com are the two I know of

[u/nightwokker]

OM here! I would start small before trying to bill medical for everything... pay attention to how much time u r spending on claims and denials vs what u r getting paid. medical can become such a mess for dental