Hi- I’m in a bit of a weird situation. My neuromuscular dentist I’ve been seeing for TMD issues and the sleep specialist are about 95% sure I have obstructive sleep apnea and that a prosomnis device will help. I have also covered my 2020 deductible and out of pocket expenses. The issue is one of timing:
-I can’t submit to insurance for coverage of the device until after it is already made and in my hands. This process takes about three weeks, and I’d have to start with the dentist this week in order to get it within the calendar year.
-It will probably also take three weeks to get prior authorization, do the in lab sleep study, and then get the results/diagnosis.
If I start working with the dentist on the device this week before I have an OSA diagnosis, if I get the diagnosis and recommendation for the device can I submit to insurance and have it covered as if I had done it after the diagnosis? Or will insurance not cover the device if I technically order it before the official diagnosis? I called BCBSIL and they couldn’t tell me but did encourage me to get it in 2020 (smh).
(caveat that I understand my question is based on the premise I do have diagnosable OSA; I know there is a possibility I don’t but I do believe it will help in my breathing regardless and would like to maximize coverage in 2020) Thanks for any advice, and apologies if my question doesn’t make sense or should be posted elsewhere. I also know that no one can say for sure other than my insurance company but advice appreciated.
submitted by /u/mccar231
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Hi- I’m in a bit of a weird situation. My neuromuscular dentist I’ve been seeing for TMD issues and the sleep specialist are about 95% sure I have obstructive sleep apnea and that a prosomnis device will help. I have also covered my 2020 deductible and out of pocket expenses. The issue is one of timing: -I can’t submit to insurance for coverage of the device until after it is already made and in my hands. This process takes about three weeks, and I’d have to start with the dentist this week in order to get it within the calendar year. -It will probably also take three weeks to get prior authorization, do the in lab sleep study, and then get the results/diagnosis. If I start working with the dentist on the device this week before I have an OSA diagnosis, if I get the diagnosis and recommendation for the device can I submit to insurance and have it covered as if I had done it after the diagnosis? Or will insurance not cover the device if I technically order it before the official diagnosis? I called BCBSIL and they couldn’t tell me but did encourage me to get it in 2020 (smh). (caveat that I understand my question is based on the premise I do have diagnosable OSA; I know there is a possibility I don’t but I do believe it will help in my breathing regardless and would like to maximize coverage in 2020) Thanks for any advice, and apologies if my question doesn’t make sense or should be posted elsewhere. I also know that no one can say for sure other than my insurance company but advice appreciated.
submitted by /u/mccar231 [link] [comments]Read Morer/HealthInsurance