Getting off CPAP and Fighting to get Dental Device covered

[RickRed]

To All,
I haven't visited this forum in a while and I must say it was great to see how many new people are seeking info/alternatives to CPAP.

Getting your insurance company to agree to pay for a DENTAL appliance is not always easy. My insurance company denied payment twice and I had to pay my expenses out of pocket, but after two appeals, I just got a letter yesterday indicating what I knew all along...that a dental device is durable medical equiptment, and is covered under my policy. After 16 months at least 18 phone calls, and many many letters my second appeal reversed the denial! Yahoo!

For those who are trying to get off CPAP and are relatively new to the dental forum I will share what I did to get off CPAP.
My first ENT decided I needed my tonsils out, a deviated septum fixed, and a UPPP

He made these decisions after looking at my nose and throat for less 15 seconds. Went to the apnea forum and discovered that too many people were getting the exact same advice. Therefore I went to a second ENT who said he would scope me before making any recommendations. I knew right away I would follow his advice. Amazingly enough he told me my septum was not deviated in any way which needed fixing, and that my tonsils were not enlarged and certainly did NOT need to come out. He told me I had two problems, enlarged turbinates, and a long, weak, and vibrating pallet. He suggested a nasal somnoplasty for the enlarged turbinates. It was a painless procedure and within 4 days I was able to give up a more than 20 year habit of taking a decongestant at night in order to breath. Next I went for the Pillar Procedure to strengthen my Pallet. This procedure was a disappointment in that 3 months later I saw zero improvement with my snoring. However I noticed that Paul and Stoboy had both needed to use a dental device after a pillar, so I decided to get one as well.
Had a sleep study performed using the dental appliance and was given the green light to put away my CPAP machine. It's been 18 months and I feel great.

I wish everyone much success in their journey, you don't find much medical support, but who cares. My Sleep Dr is still on CPAP because he has apnea. He showed little interest or support though my whole process, nor was he very much interested in my success. I feel bad for his patients.

I hated CPAP so badly, that I still thank God every night that before I fall asleep, that I'm rid of that form of treatment.
Rick

[Dickman]

Rick, I am amazed that you don't have any jaw pain or misalignments. This is really rare that after 8 hours of pulling lower jaw out it exactly goes back to where it was and you don't have a slight sore! This is exceptional.

[RickRed]

Dickman,
For the first few months, I did have minor jaw pain which was easily worked out within a few minutes of chewing gum. Now I don't have ANY pain. Perhaps this is a function of how little my jaw is moved foward. I believe it is about 3mm which is a very small amount. However at that level my sleep study showed 0 apnea events.
Rick

[edD]

rick, i am fighting with the insurance company currently for payment of the exam testing and the device. what info did you send them. what codes did they bill. any help would be greatly appreciated. i love my oral appliance but am out 1500 bucks.

[RickRed]

EdD,
If your insurance company will pay for durable medical eqipment they should pay for a dental device. However they don't know that. So you must
1. Make sure both the treatment and device you select has FDA approval

With the Pillar my ENT wanted to bill insurance for snoring as my primary dx as opposed to sleep apnea. Since my snoring was so bad it woke me every night, it didn't matter to me which dx he used to get the bill paid. So, often it is how something is billed for the insurance company to pay.

With the dental device I had to submit the following to my Medical Insurance Company
A. FDA approval number for the device
B. The Hycpic number (I still don't know what that is)
C. The medical code for the dx of apnea
D. Documentation that I wasn't tolerating CPAP
E. Results from a Sleep Study proving the dental device was succesful in treating apnea.

It took almost 1.5 years and two appeals before the insurance agreed to pay and only at 70% because that's the amount covered in my policy.

What exam is your insurance company refusing to pay for...The dental exam?
They won't unless the dentist knows how to bill for a medical claim. My dentist did not know the medical code for apnea, so he billed incorrectly. Not just once but a minimum of 3 times. Neither he or his staff knew the medical code for apnea, and neither he or his staff were willing to take the time to call my Sleep Dr. I had to do all the work myself for him. Once he had the correct code he still did not submit the claim correctly. This was one of the reasons my claim took so long to resolve. Apparently many Dentists don't have much experience dealing with medical insurance as opposed to Dental Insurance.

Hope this is helpful.
Rick

[snork1]

Nice to hear when it works out. Dental devices are a gamble, but what isn't in the fun filled world of apnea treatment?
I am also pursuing getting a dental device with a similar hatred of CPAP. First my wife kicks me out of the bedroom due to snoring, then due to CPAP equipment. Net gain zero....in addition to a number of other issues with CPAP.

I had a very good ENT scope and Catscan me which resulted in surgery of my nose that was required even to get CPAP working. THAT surgery was not expected to cure my apnea. The ENT did NOT suggest going further with surgery because anything short of an MMA was not likely to do further good. I applaud her for knowing when to stop.

The surgery did GREATLY improve my apnea and lower my pressures and numbers though.

I just had my first appointment with a CERTIFIED dental sleep and TMJ specialist dentist a few days ago. Because I came in with pulse ox results, a referal letter from my pulmonary sleep doc and promising results from a tongue restraining device, he was able to evaluate me and make impressions in one visit.

The dentist office is attempting to put through a medical claim with the proper billing for durable medical equipment. Apparently the billing codes have JUST been changed, so I will be the first one to find out if that makes any reimbursement better or worse. Of course between getting hit with a $600 deductible, and out of network rates and all sorts of other tricks of the insurance trade, even if I get reimbursed for any part of the $1625, it will be pretty minimal.

IF it works to get rid of my need for CPAP, I will consider it a worthwhile investment, until something better comes along. My regular sleep doc can't imagine why I would want to dump all my nice CPAP equipment for a tiny dental device. Of course he doesn't use CPAP himself, so how could he possibly understand.

I went with the low bidder CERTIFIED sleep dentist in our area, although he doesn't seem to be a compromise compared to the other quotes of $2400 and $3500. Apparently Seattle is a pricey area to get dental appliances!

The one "catch" is that this dentist is a strong believer in the TAP devices and will only use those unless there are strong indications otherwise. The good news is that the new TAP Titanium apparently became available just a couple of weeks ago, and I will get the "latest technology".

I get the device in 3 weeks, and then I have to be VERY PATIENT getting used to it. From what I have read, the biggest issue in comfort and success is VERY slowly making the adjustments and adapting to it. I also am of the opinion that going through a dentist that also specializes in TMJ will make a better bet for success. He was very careful in analyzing my bite and setting up the impressions.

GAWD! I hope this works!!!!!!!!!!!!!!!!!! Although I know its a pricey gamble.

I have my own pulse ox machine to track results, in addition to tracking how I feel and REM sleep. Also the dentist has his own preferences for tracking results and finally I will get another sleep study in about a year with the device....assuming its working, with my regular sleep doc.

I have asked the ENT and sleep dentist about pillar implants in addition to the device and FOR ME, neither one thinks the pillar will help with my geometry.

I also do NOT have a weight problem, so the apnea is indeed structural and not just masses of fat crushing my breathing tube.

Thats my current path to try to bail on CPAP....

[RickRed]

Snork1
I didn't realize you hated CPAP. You seemed so good at working out problems, finding the best solutions various issues with masks, so I thought you were one of the fortunate who copes well with CPAP. Your story surprised me. I don't think the TAP will be an expensive gamble. The thing about TAP is you can adjust it as far out as needed until your airway is clear. I would ask my dentist how far he will take it out and how long with each new setting will he give you to in order to get your jaw use to tolerating the push foward. I think you'll do great and before you know it your wife will be pleased to have you in the same room again!!!
Keep everyone informed of your progress, and think of it this way, how much did you spend out of pocket for new masks, very soon I hope those days will be a distant nighmare.
Rick

[snork1]

Rickred,
The reason i have been so good with CPAP workarounds, is that I have been so desparate to "make it better", figuring there HAS to be a better way.

I am indeed figuring I can justify the cost of the appliance by comparing all the out of pocket money I have spent on masks, heated hoses, special pillows, my portion of deductible and "percentage" (which just went through the roof with my new coverage).

And traveling with CPAP is just plain a pain, especially with businesses going cheap on business travel, besides my own cheap travel, which requires overnight flights. Besides all the fun of traveling with CPAP.

And I have had some physical issues with CPAP, such as constipation, which seems to be a rare CPAP side affect that no one wants to talk about.

And yes I was being 100% compliant, and yes CPAP stopped snoring, but I am just as drowsy during the day as when I started, although the headaches did go away at least.

So I am still searching and the dental device seems like a fairly safe reversible thing to try. I will definitely post my results. I am wondering if this topic has so little traffic because the devices don't work, or if they do work well for many people so they have no reason to come back, unlike with CPAP where the issues are endless to make it work.

I also note that mentioning dental devices in non-dental apnea forums makes it open season for people seeming as though they don't want to hear that something else might work for some people and shouting it down.

[Limeygirl]

[Sleepy Stoboy]

I think if most people had tried both CPAP and a dental device, there wouldn't even be a close choice. Once your device is properly adjusted, it seems so much more comfortable, portable, and just plain simpler, that you can't imagine why it isn't the "gold standard" of treatments. I know some people have TMJ and dental concerns, but I also think a lot of these same people get scared off when they have a few nights of sore jaw, sore teeth (which is common to everyone regardless of pre-existing concerns),

I am so thankful I chose this route and had the support of several trailblazers before me. This is a great option, but sadly still, a very well kept secret for many people.

[snork1]

I would assume that dental devices won't work for everyone. Seems like if the apnea was JUST weight related the dental approach might NOT be effective. (just a guess though) And some people will have jaw problems that just aren't compatible.
People seem to seize upon the (few?) cases that don't work out and toss out the baby with the bathwater.

What I find odd about the "sore teeth/jaw" complaint, which I have seen as the most common objection in my research, is that people will put up with all sorts of pressures and pain with CPAP. My Activa presses heavily on my upper gum/teeth area and if weren't for mask rotation that might be unbearable and I am concerned about what THAT might do to my bite and teeth alignment in the long run. There are many other CPAP examples. Yet people seem to gloss over those problems and seize on dental device issues.

I think another source of dental device bad publicity could be the uncertified and unqualified dentists plunking in the dental devices for quick money. To his credit, my regular dentist refused to set me up with a device because he wasn't trained in the field. I think its important to go to a certified sleep dentist that has TMJ experience. I feel lucky to have found the low bidder(as found in the sleep dentist referal web site) in my area has the correct credentials and I am hoping that optimizes my chance for success.

[Tweak48]

[macsanje]

Good morning! It's 2:30 AM and I can't sleep. I thought I'd surf. I was very interested in your comments about achieving a dental appliance.

I've been feeling rotten for 20 months, and it was probably creeping up on me for years before it got my attention. I retired from teaching thinking I was getting too old - memory problems, confusion (I'm sick of looking so stupid and out of it in front of others), falling asleep at inappropriate times, losing things, getting lost myself, headaches, low energy, bed wetting, all the typical symptoms. I'm not typical though. I'm female, not overweight, physically fit, and happy with my life.

I told my family doctor last fall that I'd been feeling extra tired for about a year. He did a blood test and found my thyroid needed a boost. Helped slightly. Gave me a higher dose. Helped slightly. But that took 3 months. It took 6 weeks to see the pulmonologist. 6 weeks till the sleep study. A week to get the report which showed hypopnea, UARS. But the sleep lab didn't do any titration. So it was another 6 weeks for another sleep study, and another week till the report. We're at 8 months since I raised the red flag.

My doctor seems knowledgeable, and I'm at a university sleep lab. However, he's completely lacking in sympathy or compassion. He's focused on what the report tells him, slaps out his findings, and that's that. He offers no encouragement, just the results and the next step. He keeps telling me he knows what he's doing after 20 years, but he hasn't the foggiest notion of how to get through the insurance process. He can't answer most of my questions unless they refer to the condition or the study. I have 23 years of teaching experience and I wouldn't dare talk down to parents about their child with the pompous approach and comments he made.

My blood pressure is wildly out of control in spite of the cardio and lifting I do. He ignores that. I'm so depressed I don't care about anything most days. He ignores that. I'm so tired of being tired. Like others I've read on this board, I am so grateful that what I have has a treatment and isn't life threatening. Except if I have a stroke slit my wrists, or have a heart attack waiting to resolve it, then it becomes life threatening.

I didn't tolerate the CPAP at all well on my second sleep study. I needed 90 minutes of sitting up in bed trying to accommodate it. Then, it took 90 minutes to get to sleep. I slept less than 3 hours, and then tried to go back to sleep unsuccessfully for another 90 minutes. They sent me home. I didn't get into REM sleep or the 3rd and 4th levels of rest on either study. I breathe shallowly rather than stopping, so my brain spends the night oxygen deprived, trying to get me to sleep, and then trying to wake me to breathe. I wake with an unbelievable headache. I used to have migraines, and this is just as bad.

I want to try the dental device, but my doctor wants me to do the CPAP. He was useless for any information about how to get either one going with my insurance. His office staff said they would fax an oral surgeon and my insurance company who would have the CPAP delivered to me. Who's going to show me how to use it and care for it? At the lab the highest pressure they used was 8. The doctor wants the machine set for 10, no adjustments, no adjusting for needs during the night or for exhaling. I felt like I was drowning in air with the mask on. The pillows wouldn't stay put. My neck hurt the next morning (I have problems there too) from the weight, sleeping position, and cumbersome head gear.

I really don't want to purchase the CPAP (can you rent them?). I want to try the oral device. How long does it take to go through that process? What is the process? What oral devices meet with the greatest success? Do any allow you to close your mouth once they're in? Do they gag you? Is there anything I can boil and bite to test? My doctor knew nothing.

I can't contact the dentist or insurance company until Monday. I'm supposed to do 4 weeks of titration, and then see the dr again in 6 weeks. That leaves 2 weeks to get one or the other treatment set up. Is that realistic? I want relief yesterday, and everything seems to work in the direction of stopping forward progress.

Do you have experience with any of my questions? Advice? Hope? Encouragement? Comfort? I need an attitude adjustment, and I can't seem to get over the depression and anxiety.

[Wanna Snooze]

[snork1]

My impression of mine and maybe most apnea certified pulmonologists, is that they should really be called "Sleep Study Specialists". Many, PROBABLY not all, seem to only be able to give and READ a sleep study. At which point they take a wild shot at the CPAP settings, based on their many years of NOT listening to patients after giving out settings, and then hand you over to a DME supplier, which is basically a minimally trained tech. (if you are lucky to get that much).

My pulmonologist was shocked that I would prefer a dental device over CPAP, if the dental device route would work for me.

He has obviously never used CPAP.

But yes, you are REALLY on your own if you want to optimise your apnea treatment and YOU must coordinate between dentist, ENT and pulmonogist (for the sleep study) and battle with insurance or expect to pay a LOT out of pocket. (and it might be worth every penny! )

You can track down a certified sleep DENTIST through

http://www.dentalsleepmed.org/FindaDentist.aspx

MY personal opinion is that dentist should also be an expert in TMJ, and you should check his resume for that skill.