I've been going around and around with this.  Had a recommendation for an oral appliance from the doctor who diagnosed my sleep apnea and did a procedure to clear an 80% blocked nostril.  Dentist (and a subsequent one) he referred me to are not in my dental plan, and when I got the codes from the dentist, they were medical and not dental codes.  So Aetna is saying just have the dentist who will create the device contact them for a pre approval, but they (both) don't do pre-authorizations.  I can give Aetna all of the codes and they can tell me those procedures would be covered, but they won't give me the name of anyone in my area who would do them (do not know why, other than they would actually have to provide coverage, shock!    

So, needless to say, I'm a little frustrated with this and wonder if anyone else has done it through Aenta and how they did it.

I am just now looking into getting the TAP.
I found a site that seems to have lots of good info for the TAP.
You can get the different codes to use and form letters, lots of great info:

http://amisleep.com/insurance.html

I think it is important to get every angle covered. My insurance seems to be deneying my sleep study claim ( I had 2 of them totaling aprox. $5,000). So I am in a state of shock - I think maybe the insurance companys are doing more damage to my health than sleep apnea-lol.

Good luck.

Keep us posted on your dealings with Aetna.  I have them as well and am just starting to research devices.

I manage a dental office that only treats sleep apnea. Aetna does cover dental appliances, but they are billed to the medical insurance not the dental (at least in our office we do). I've had patients receive payment for the appliance therapy but it will depend on your specific plan. Ever policy is different.

I don't know why your dentist won't do a medical necessity letter to the insurance company. We standardly send them off. But, again all we do is treat sleep apnea so perhaps we're slightly more familiar with handling the insurance process. Dentists are not in general accustomed to having to do medical billing. It's an entirely different system.

I believe the TAP website (mentioned below by schurst) has a sample medical necessity letter. Maybe you should type that off with your information and ask if the dentist would sign and send it for you.

Good Luck!

~M

I just called 2 dentists that provide the TAP device.....one in the town that I work in, and he has a reputation of being high-priced for everything.  His staff said that he charges $1600.  Then I called another dentist in a larger city, and they charge $900.............