How to Refer a Patient

How to refer your patient to the dentist for obstructive sleep apnea therapy.

doctorDear Medical Colleague, if you are considering referring your patient to our office for an oral appliance (Mandibular Advancement Device), thank you!  We appreciate being a part of the team treating Obstructive Sleep Apnea.  It has been our experience that approximately 20% of new psg studies completed result in a diagnosis of early or moderate OSA in patients that are excellent candidates for oral appliance therapy as a first line treatment.  The AASM has recommended this treatment option since 2006.

That does not include patients who may be candidates for co-therapy with PAP therapy, which often allows lowering PAP pressures up to 6 cm.  As you know, lower pressures are more comfortable, and are likely to increase patient compliance, as well as allowing them to use much less obtrusive mask options.  Lastly, there is a large population of people who should be using a PAP device, but are simply unable or unwilling to do so.  As you know, this patient population, who have “fallen off the wagon”, remain at risk of serious co-morbid issues like stroke and myocardial infarction.  Many of them would be willing and able to utilize an oral appliance if it was offered to them as an option.  Even if this approach did not result in an ideal AHI below 5 and Oxygen saturation level at 90% or above in all cases, any improvement would certainly lower their overall health risks.

In fact, there are some cases of even severe OSA patients being brought into the normal or near normal range with an oral appliance alone.  Of course, PAP therapy remains the “Gold Standard” for those patients in the severe category, and every attempt should be made to get them and keep them on PAP therapy.  However, for those who simply can’t or won’t, an oral appliance may be of significant help.  For a patient in this category, lowering a patient’s AHI by 50% should be considered successful in having reduced the patient’s overall health risks as compared to untreated OSA, even if they have not reached normal values.


Please have your staff gather the information listed below from your records, including a signed prescription for the device.  We must have the information below before we can see the patient for an exam.  Our Office Sleep Coordinator will send in the information to our medical billing service for a preliminary benefits check.  Once completed, she will call the prospective patient and go over the estimated insurance coverage and patient portion.  Our office has signed up as a Participating Provider for most of the common insurance plans in our area, and we can usually obtain a GAP exception for those that aren’t on the list.  We want this life-saving treatment to be as affordable as possible for your patients, and we will handle the billing and insurance issues for what we provide.  Most dentists who are trained to provide this care require the patient to pay in full, and are not Participating Providers in insurance plans.

Once the benefits check is complete, our office Sleep Coordinator will then call the patient to appoint them for a comprehensive exam, and necessary impressions and bite records.  Our office will keep both the Sleep Specialist AND the primary care MD apprised of the patient’s progression through the entire treatment process via FAX.

Once the patient has the MAD, and is comfortably wearing it all night, we will refer them back to the Sleep MD for a titration psg to reach maximum medical improvement.  We have trained the sleep techs at the lab on how and when to adjust the device, as well as how to report the results broken down in correlation with the adjustments so that our office can verify the best ultimate position.

Our office will keep you apprised of the patient’s success and future compliance.  We are committed to follow up, and will continue to recall the patient on an annual basis to ensure continued compliance and effectiveness of the device.

Thank you again for the opportunity to participate in this life-saving therapy.  If I can ever assist you or answer any questions about this approach, please don’t hesitate to call or email me.  I look forward to working in partnership with you for the benefit or our mutual patients.

Most Sincerely,

Stuart Rich, DDS, PS. 253-236-5240.  Member AADSM, AACP and the ACSDD

When you are ready to refer a patient for evaluation, simply write a prescription for an oral appliance, code E0486 and indicate a diagnosis of Obstructive Sleep Apnea, G47.33, and fax it to 866-861-6286.  The prescription must be signed signed by the referring physician, and a copy of the diagnostic (not spit night) sleep study included, in order for us to obtain a pre-determination of benefits for your patient.

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