Addressing the Sleeping Elephant in the Room


Dentists planning to be in the business of treating sleep apnea have dealt with many hurdles.  I’m Manuel Fuentes and I am the Director of Operations for Medical Concierge Services (MCS) a medical billing company designed to put Dentists into the business of treating sleep apnea. In the many years that I have worked in this field the most frequently asked questions are, “So where do I start?” and “How do I start?” I will be sharing some of the main obstacles you may face and how to overcome them.

The answer to these questions starts with you, the Doctor and your staff.  Everyone must understand that like any service you provide, screening and treating sleep apnea adds a valuable service to your patient and will add to your bottom line revenue.  An office must deem themselves a fully comprehensive medical center.  There is a nexus between dental and medical services.  The connections are found not only in sleep apnea but in poor oral hygiene, TMD, posture, periodontal disease, and even cancer among many more conditions.  Our most successful practices understand that they are providing an overall health approach to their patients.

Many dentists want to treat sleep apnea patients but are deterred by two things; the clinical process and medical insurance.  Not having  medical knowledge about sleep apnea can make it difficult to be clinically confident when speaking to patients about Sleep Apnea. Once that step is taken, dental offices are left to face the difficult billing process of medical insurances. Offices know that treating sleep apnea is a lucrative way to add revenue, but it is not an easy task.  Knowing the steps of working with insurance is the first hurdle, but its completely different to the process of billing dental plans. Let us examine the reality of overcoming these obstacles.


At the beginning our clients do not fully understand how sleep apnea relates to dentistry and how to treat sleep apnea as a dentist. If you do not feel comfortable communicating the process of a root canal, implant, or o process, how do you expect a patient to feel comfortable?   It is important to learn how to approach patients with one’s services.   Becoming educated at a peer to peer level is the first step in overcoming this obstacle. Search for a qualified seminar with a dentist who has years of experience treating sleep apnea. You also  may want to search for any associations/study groups, and sleep medicine forums that relate to you as a Dentist.  Associations such as the American Sleep and Breathing Academy have educated thousands of dentist, medical doctors, staff, and coordinators. They also provide materials to educate the patient base. Aside from educating yourself, it is important to find ways to get your staff informed on sleep apnea to have them confidently  address patient questions or concerns. The office staff is vital to making your office a successful Sleep Apnea treatment center, they are part of the screening process and assist in answering patient questions.  They are also usually the first experience you’re your costumers have with your practice.  Overall your staff must be educated on the subject so your patients can benefit  and you can reap the financial benefits.

Being proactive in the sleep medicine community will strengthen your knowledge  and provide you with significant credibility. To further educate yourself, you may call your local dental society and ask for Sleep Apnea speakers to be scheduled at their next event.  Medical Concierge Services (MCS) uses a variety of educators.  In California our recommended seminar speaker is Dr. Dar Radfar  DDS, DASBA.   You can find his events at or at our client portal


In order to gain more from the services you already provide you can do the billing in house; however, this will require the office to know how to bill medical insurances.  If this step is taken, a dentist must ask if their staff understands the dynamic of billing and authorizing an appliance as an out of network provider. It may not be cost effective to invest in the training or hiring of someone in your office to fill this role because initially you may only have a few cases to treat    You could purchase medical billing software to aid your staff through this process, but this may pose problems as well. Most software that companies sell are “turn and burn” companies. They sell you the software and provide very little support on actual billing and collections.  They give you the tools to do something foreign to your practice.  Lastly, you can outsource the billing to a third party biller. Make sure that you weigh all the options that different companies offer. While third party companies will charge 8%-15%, will they charge a percentage of what is billed or paid by the insurance? Will they charge for each insurance verification, authorization, and appeals? These questions are important to address. Find a company that best suits you as you start your treatment center. A company with low signup fees, no monthly fee and no per patient charge is best as when you are beginning.   Submitting claims effectively will provide you will more revenue and overall ease of treatment for clients. Any of the solutions can work as long as they suit your needs and the staff.

Now that we have discussed the two main obstacles you may face and how to prepare your practice, there are typically 4 treatment office visits , as follows:

  1. Screening – Using medical history and an airway evaluation will make this process relatively seamless.   If a patient is at risk you should discuss ruling out sleep apnea and refer a patient for a sleep study. Find a lab where your patient can get diagnosed by a Board Certified Sleep physician. Search for a lab that can provide a home sleep test vs. an in lab test. Compliance is higher when the patient can test at home.
  2. Review Sleep Test – After the home sleep test is complete you must schedule your patient to discuss the sleep apnea report (must be diagnosed and signed by a Board Certified Sleep physician).  At this time you and your patient should go over the treatment options which include a CPAP, Oral Appliance, and Surgical Modification and identify what form of treatment the patient wishes to move forward.
  3. Deliver an FDA approved appliance – At this point you may take impressions and deliver the appliance.  This is the time when you bill the oral appliance.  At this point, ask your biller to submit your claim to the insurance.
  4. Follow up – Reschedule the patient after 30 days to gauge therapy and request a follow up sleep study with the oral appliance therapy. It is clinically correct to re-test the patient so that the patient can see the efficacy of the appliance.

With the acquisition of any new skill, the learning process may seem complicated or tedious but after a few experiences it becomes manageable and part of your practice. This is often the case when treating Sleep Apnea, especially for the practices that are completely unfamiliar with sleep disorders.  The first step is to get educated on the topic. It can start with seeking information through dental associations and enrolling in continuing educational courses or seminars. The other key step is  preparing the office staff on the screening and treatment process. Once you and your staff are comfortable with Sleep Apnea, you need to become familiar with the insurance process and how your office will bill for these services. After all these steps are taken, you will find it easier to confidently speak with patients about  sleep apnea and explain to them the medical and insurance process.



About Medical Concierge Services LLC:

We have been in the sleep industry for over 15 years and are very passionate about helping dentists grow their sleep apnea treatment center. We offer a streamlined solution that is easy to follow while also holding your staff’s hands through their first few patients. Our clients can utilize a portal that keeps track of their claims which allows their practice the flexibility it needs throughout the day. We are currently helping doctors in 19 states around the country and our oral appliance claims have an 86% success rate due to our easy to follow program. No software or equipment to buy, we only get paid when the doctor gets paid. Contact us today for more information 310-848-1329.



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