Very frustrated with Anthem insurance and oral appliances

[CruzTerri]

Go to your employer's benefits person and ask for the SPD - This is the complete information on your coverage. Ask if you can have a copy of it. This will provide additional information. Much more so than what is in the "plan booklet" you may get.

The "SPD" will have information on how to appeal the decision, etc. It's the complete "policy" document.

Good Luck.

Thanks for your adivse but that's something that I am trying to avoid.

I work in a very small company and everyone can easily find out about my condition if I go to HR.

Actually, you don't have to tell them what you're looking for. You are entitled to review that document (I know I work in HR). Good luck to you.

[So Well]

Actually, you don't have to tell them what you're looking for. You are entitled to review that document (I know I work in HR). Good luck to you.

Yeah, don't tell them what is wrong with you.

Then they'll think you have AIDS.

[robertin75]

Ok guys after talking and talking for weeks with an Anthem supervisor I came to the conclusion that my only choice is to fill an appeal.

They suggested me to write a letter and send it to the committee and they would take a decision.

Other thing that I was told is to talk to Dr. Urban's office to see if we can get to an arrengement as far as the cost of the appliance which I doubt.

They also suggested an in network oral and maxillofacial surgeon (Dr. Alex K. Walker in Muncie,IN, anyone knows him) that does the oral appliances but he is not a dental sleep specialist and he is far away from where I live.

Would it be worth to try it? The amount of money that I would have to pay him compared to Dr. Urban is ,uhhhh,mmmm like night and day

Anyone knows if I can get help from Dr. Krakow to write the appeal letter?

Or maybe someone who has gone throught this process could give me a hand?

Thanks,
Roberto

[josh816]

I found a few links that are designed for the Sleep Dentists, but these should have everything you need and more. My dentist was a great help in getting all the information that the insurance company requested:
http://www.somnomed.com/files/files/US% ... %20OSA.pdf
http://www.comfortacrylics.com/applianc ... manual.pdf
http://www.nti-tss.com/DDS-Billing/Oral ... sement.pdf

Ok guys after talking and talking for weeks with an Anthem supervisor I came to the conclusion that my only choice is to fill an appeal.

They suggested me to write a letter and send it to the committee and they would take a decision.

Other thing that I was told is to talk to Dr. Urban's office to see if we can get to an arrengement as far as the cost of the appliance which I doubt.

They also suggested an in network oral and maxillofacial surgeon (Dr. Alex K. Walker in Muncie,IN, anyone knows him) that does the oral appliances but he is not a dental sleep specialist and he is far away from where I live.

Would it be worth to try it? The amount of money that I would have to pay him compared to Dr. Urban is ,uhhhh,mmmm like night and day

Anyone knows if I can get help from Dr. Krakow to write the appeal letter?

Or maybe someone who has gone throught this process could give me a hand?

Thanks,
Roberto

[Imacpaper]

I'm going to jump in here and let you know what I've been playing around with.

I was going on a trip and was going to spend some time above 12,000 ft. I was worried about bringing my cpap along so I looked into an oral appliance. I couldn't afford the $1500+ price so I decided to "lab rat" it. I looked at various devices and found out it is all about jaw position. It doesn't matter what holds it as long as the jaw is in the right position.

I bought several boil and bite mouth guards from Walmart (only $1 each) and started playing. I fused two together and fitted it with a 3mm extension. I then set my apap for the range of 5-12 and went to bed. In the morning I looked at the result and discovered that I needed more. Long story short, (I know too late) I found out that at 5mm I didn't use any of my pressure. I then used a oxy meter that I borrowed and discovered my O2 levels were fine without using the Apap. The last step was to go to my daughter's orthodontist and show her what I had created. She then took that and made a mold of my teeth and by the next day she made a custom fitted professional appliance. She only charged me $200 (the price she charges for a retainer).

I got home from the trip feeling fine and have continued to use it for the past few weeks. I have less than $220 invested and couldn't be happier.

One last thing, I talked to my local dentist and he said he would size me up for a TAP III for only $600. No support for it beyond the fitting but if we can figure out the whole cpap thing why can't we figure this out as well.

Take what you want from this.

[robertin75]

I'm going to jump in here and let you know what I've been playing around with.

I was going on a trip and was going to spend some time above 12,000 ft. I was worried about bringing my cpap along so I looked into an oral appliance. I couldn't afford the $1500+ price so I decided to "lab rat" it. I looked at various devices and found out it is all about jaw position. It doesn't matter what holds it as long as the jaw is in the right position.

I bought several boil and bite mouth guards from Walmart (only $1 each) and started playing. I fused two together and fitted it with a 3mm extension. I then set my apap for the range of 5-12 and went to bed. In the morning I looked at the result and discovered that I needed more. Long story short, (I know too late) I found out that at 5mm I didn't use any of my pressure. I then used a oxy meter that I borrowed and discovered my O2 levels were fine without using the Apap. The last step was to go to my daughter's orthodontist and show her what I had created. She then took that and made a mold of my teeth and by the next day she made a custom fitted professional appliance. She only charged me $200 (the price she charges for a retainer).

I got home from the trip feeling fine and have continued to use it for the past few weeks. I have less than $220 invested and couldn't be happier.

One last thing, I talked to my local dentist and he said he would size me up for a TAP III for only $600. No support for it beyond the fitting but if we can figure out the whole cpap thing why can't we figure this out as well.

Take what you want from this.

That's where I would probably start.

I made an appointment with my general dentist who I trust (all my co-workers go with him) to discuss about my problem.

His assistant told me he does some type of device for snoring so I hope we can work something out.

Another good thing is that he is an in network provider.

Regarding the appeal I think I would still continue working on that. I already emailed my sleep doc (Dr. Krakow) to see if they can help me filling the appeal.

Who is the one writing and sending the appeal? Me? My sleep doc? The dentist?

Thanks,
Roberto

[cat dean]

ADSM . org This is the source for trained sleep dentists!
custom made can work but the long term risks are tmj pain / and uncontroled teeth movement.
the titration of the walmart speical was a very logical aproach to telling IF oral aproach would work
As long as his use is intermitant he should be fine.

[robertin75]

ADSM . org This is the source for trained sleep dentists!
custom made can work but the long term risks are tmj pain / and uncontroled teeth movement.
the titration of the walmart speical was a very logical aproach to telling IF oral aproach would work
As long as his use is intermitant he should be fine.

I know about that website and unfortunately the only sleep dentist in my area is out of network.

Custom made does not necessarily mean cheap model. That same general dentist can take impressions and order for example a TAP oral appliance.

[Pitt]

Call Harold Smith, DDS in Indianapolis for treatment with oral appliance therapy. He is in-network the Anthem BCBS of Indiana to provide this treatment. He is also credentialed by the American Board of Dental Sleep Medicine to provide oral appliance therapy for sleep apnea. Call his office at 317-585-0008.

[Imacpaper]

custom made can work but the long term risks are tmj pain / and uncontroled teeth movement.

This is why I went to the orthodontist for the final build. These are issues I wanted to avoid. As far as quality of the device, I showed her pictures of all the devices I could find and she said that most of them were just modified oral appliances that she has dealt with before.

My dentist also does a snore device called the Silent Nite but it isn't approved for apnea so if this is the device your looking at you may have problems with getting insurance to pay.

[robertin75]

Call Harold Smith, DDS in Indianapolis for treatment with oral appliance therapy. He is in-network the Anthem BCBS of Indiana to provide this treatment. He is also credentialed by the American Board of Dental Sleep Medicine to provide oral appliance therapy for sleep apnea. Call his office at 317-585-0008.

Thanks Pitt.

Have you been a patient of Dr. Smith?

Could you share your experiences?

[Alex Sirlom]

Can anyone help me find a good dentist in Austin?

There are a lot of good dentists in Austin, so finding one is really more about personal preference and convenience. A great place to start looking for a dentist in Austin is on Yelp or a similar review site, since it will allow you to look in your particular area. You should also look around dentists’ websites, as this is the best way to learn about their education and training, as well as their licensure and accreditation. In the end, a little bit of research on your part can easily turn up a good dentist in Austin.

[Alex Sirlom]

Can anyone help me find a good dentist in Austin?

There are a lot of good dentists in Austin, so finding one is really more about personal preference and convenience. A great place to start looking for a dentist in Austin is on Yelp or a similar review site, since it will allow you to look in your particular area. You should also look around dentists’ websites, as this is the best way to learn about their education and training, as well as their licensure and accreditation. In the end, a little bit of research on your part can easily turn up a good dentist in Austin.

[Alex Sirlom]

Can anyone help me find a good dentist in Austin?

There are a lot of good dentists in Austin, so finding one is really more about personal preference and convenience. A great place to start looking for a dentist in Austin is on Yelp or a similar review site, since it will allow you to look in your particular area. You should also look around dentists’ websites, as this is the best way to learn about their education and training, as well as their licensure and accreditation. In the end, a little bit of research on your part can easily turn up a good dentist in Austin.