This is a big, important paradigm shift, one of which we truly believe will help your patients be healthier!
We are offering a treatment guarantee for all patients who come to our office for initial OSA treatment. In other words, if a patient tries an oral appliance as first-line treatment and it doesn’t effectively treat their AHI*, we will transition treatment to a CPAP, at no additional out of pocket cost to the patient**.
The idea was conceived following a recently enforced Medicare rule which states Medicare will not pay for similar treatment within a 5-year period. This means if Medicare paid for a CPAP, and the patient has found themselves intolerant and unable to utilize it, Medicare will not cover the cost of an oral appliance for another 5 years. Unfortunately, this means for most Medicare patients, they go untreated and suffer the medical and social consequences of sleep apnea. We thought there must be a way to prevent this, but that would mean the patient would have to try an oral appliance first. We understand that in medical school and in practice, CPAP and Sleep Apnea go hand in hand. CPAP is fantastic treatment, so we understand that. However, seeing all the new studies that deem oral appliances equivalent when taking compliance into account, and seeing first-hand the number of people who go untreated after being prescribed CPAP, we are challenging providers to tweak their CPAP/Sleep Apnea association. We are challenging you to consider a patient for an oral appliance first for mild and moderate cases. If you do this and they are a good candidate, we will take it upon ourselves to make sure they are treated successfully regardless of modality – we don’t want cost to stand in the way of health. Note that we will be doing this for all patients, including both those with commercial insurance and Medicare. Please consider shifting your paradigm and begin to think about oral appliances first! Your patients and their families will thank you!
*AHI < 15
** Initial CPAP with initial mask and initial necessary supplies