| When contacting your medical insurance company regarding benefits available for oral appliance therapy in the treatment of Obstructive Sleep Apnea the following are pertinent questions to ask in order to determine your benefits. It is advisable that you let the representative know you have had a sleep study completed, you have a diagnosis of obstructive sleep apnea (medical diagnosis code 327.23) and you are CPAP intolerant. |
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Name of insurance representative with whom you spoke:
Call reference number:
Ask about in and out of network benefits:
Notes
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Deductible amount and has it been satisfied:
Deductible amount:
Has it been satisfied?
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Co-Pay percentage:
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Is pre-authorization or pre-determination required for the following codes?:
E0486
99203
99204
99205
95806
70355
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What is the fax number for the claim?
Attention:
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What is the mailing address for the claim?
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Additonal notes:
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Client name:
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Date of birth:
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| Once you have completed every space, be certain to first print a copy for your records and then click Submit and a copy will be sent to our Studio. |
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