You are our patient, and we work for you. We base our treatment and treatment decisions on you, your condition, and the management of your healthcare. We will collect the fee for services rendered at each appointment based on our fee schedule. You will also be provided with an insurance form (Superbill) at each appointment, which you can then submit to your insurance company for possible reimbursement from your insurance provider. Almost every procedure/treatment Dr. Virk provides can be billed to your medical insurance.
We will write and provide you with a Letter of Medical Necessity if needed. We will also write a detailed case report, which contains your diagnosis and treatment plan, which can be sent to the doctor that referred you to our office, and any other professionals that you want, as well as to your insurance provider.
One of the first things we will do when you contact our office is asking for your medical insurance information. We do this to know what your insurance coverage will be before Dr. Virk performs any necessary treatment.
Please note that we are an out-of-network provider for all insurance plans and we are not Medicare providers. At Texas TMJ & Pain, we understand that navigating insurance can be difficult and overwhelming. Please let us know if you have any questions or need any guidance. We will be more than happy to help you understand how insurance works in our practice. We offer various payment methods including all major credit cards, cash, check and care credit. Payment plans and financial arrangements can be made on the case by case basis. We openly invite you to discuss all payment options with our staff prior to your initial appointment.
Insurance coverage for TMJ/TMD & Orofacial Pain:
TMJ treatments are filed with medical insurance. Our goal is to support our patients in any way we can. Therefore, as a courtesy, we gladly assist in the filing of claims, excluding Medicare/Medicaid. We feel it is important for you to understand your plan and its payment allowances, as typically TMJ may be an exclusion from insurance policies.
Once Dr. Virk has evaluated the patient, developed a diagnosis, and a treatment plan has been created,we will send the appropriate information to our medical billing company to assist with required authorizations and to create the claims for our patients. The process of gathering the necessary information required for the billing company may take up to a week.
Once claims are created by our medical billing company they will be forwarded to the patient. It is then the patient’s responsibility to mail the claim, along with any other required documents, to their insurance company. This process may take 3-4 weeks to complete, however, it will allow all insurance payments to be sent directly to the patient or redirected to the patient if received by the practice.
Insurance coverage for oral devices for sleep apnea:
Most insurance companies do cover oral devices for sleep apnea if they determine it to be medically necessary. Some insurance companies require preauthorization and others do not. To be sure, it is suggested you call your insurance company to determine if it is a covered service and how much you might expect to be reimbursed. Secondly, ask if it needs to be preauthorized or precertified for medical necessity. Tell them you have obstructive sleep apnea with a diagnosis code G47.33 and need an adjustable mandibular repositioning appliance with a procedure code of E0486 (durable medical equipment). If you determine it needs to be preauthorized ask where the information needs to be faxed. Our office will be happy to fax this information to your insurance company after receiving a copy of both sides of your insurance card and a copy of your original sleep study.
For sleep apnea patients we can check their insurance benefits, get pre-authorizations if needed and can file insurance claims on your behalf to maximize your insurance benefits.
Some people choose to pay out of pocket or finance their treatment for sleep apnea so they don’t get flagged as having a pre-existing medical condition. People who have been classified as having a pre-existing condition, such as sleep apnea, may experience a rise in their insurance premiums. Some people are unable to qualify for insurance (both health and life insurance) if they have been diagnosed with sleep apnea.
Hopefully, this has answered the majority of your questions. Please call our office at 817-251-9985 if you have additional questions, or would like to set up an appointment.