Thrive FAQ

• How do I know if I have sleep apnea or sleep obstructive breathing? I haven’t been diagnosed but I think I have an issue.
• How do I get a sleep study? Will I have to go somewhere overnight? Does a doctor need to prescribe it?
• Does my insurance cover my treatment for sleep obstructed breathing or sleep apnea?
• Do you participate in my insurance as an in-network provider?
• Do you accept Medicare or Medicaid? What if I do not have medical insurance?
• What if my insurance carrier is not one of the major ones listed? What are OUT-OF-NETWORK benefits and how does it work?
• Will my dental insurance cover any costs associated with treatment?

How do I know if I have sleep apnea or sleep obstructive breathing? I haven’t been diagnosed but I think I have an issue.

Many people have symptoms related to sleep apnea/airway restriction that don’t present as traditional snoring or “choking” awake. If you are struggling with issues like restless sleep, TMJ pain, teeth grinding, daytime sleepiness, and/or weight gain – you might have sleep obstructed breathing. The easiest way to find out is a sleep study.

How do I get a sleep study? Will I have to go somewhere overnight? Does a doctor need to prescribe it?

A sleep study does not have to be a major inconvenience in your daily life. The staff at THRIVE Sleep and Breathing can help you set-up an at-home sleep test. The kit for the sleep study can be picked up at a THRIVE location or sent to your home directly. Once you receive your kit, you will work with THRIVE’s clinical staff to conduct the sleep test in the comfort of your own home. Once you are finished with the kit you just return it to a THRIVE location or send it back to the office. A certified sleep doctor will coordinate with the THRIVE team to analyze your sleep study and provide a diagnosis.

Does my insurance cover my treatment for sleep obstructed breathing or sleep apnea?

The answer is it depends on your personal situation. You could have up to 100 percent coverage. Insurance coverage for sleep apnea treatment typically depends on your medical and/or dental insurance plan and your individual deductible(s). The traditional co-pay costs associated with your insurance plan may also apply. Each person’s diagnosis, treatment plan, and insurance coverage are different so, at THRIVE, we work with you to get an understanding of the insurance coverage you can expect and any out-of-pocket costs (if applicable) while you evaluate your treatment options.

Do you participate in my insurance as an in-network provider?

THRIVE is an IN-NETWORK provider for medical insurance companies Aetna, Blue Cross Blue Shield (BCBS), Cigna, United Healthcare (UHC), and United Medical Resources (UMR). As a contracted provider, we have the ability to offer in-network benefits. THRIVE is also part of a national Medical Specialty group called Dedicated Sleep. Dedicated Sleep has board certified sleep specialists that coordinate diagnosis and care with our staff. Dedicated Sleep also employs a full-time insurance team to seamlessly submit and maximize your medical benefits- reducing your out-of-pocket costs to the absolute minimum.

Please remember to provide your MEDICAL INSURANCE information during your first consultation so that we can assist you with all insurance coverage related questions.

Do you accept Medicare or Medicaid? What if I do not have medical insurance?

We do accept Medicare, however the coverage depends on your selected policy. We can work with Medicare for the approved oral appliance (mandibular advancement appliance) to treat sleep apnea.

Unfortunately, THRIVE currently does not participate with Medicaid. The approved treatments and reimbursements for sleep apnea are limited within the Medicaid network. If you are seeking an alternative to the CPAP to treat your sleep apnea, THRIVE can work with you as a fee-for-service patient.

If you do not have medical insurance, THRIVE can work with you on a variety of financing options and payments plans to keep your treatment costs and case fees to a minimum.

What if my insurance carrier is not one of the major ones listed? What are OUT-OF-NETWORK benefits and how does it work?

Every policy is different and some patients might have OUT-OF-NETWORK benefits. Contrary to popular belief, unless your policy explicitly states that you do not have OUT-OF-NETWORK benefits, being OUT-OF-NETWORK does NOT mean that you cannot use your medical insurance to cover treatment costs at a non-participating provider. Instead, it means that the provider does not have a contracted rate with the insurance carrier and that the provider reserves the right to bill their practice fees (within the usual and customary range). To find out more about your specific insurance coverage, please ensure that THRIVE has all of your MEDICAL INSURANCE information at your initial appointment.

Will my dental insurance cover any costs associated with treatment?

Depending on your case and choice of treatment, your dental insurance might cover some costs associated with the treatment plan. For example, your dental insurance could cover the costs of certain X-RAYS or devices involved in moving teeth to treat TMJ pain. THRIVE would bill your dental insurance as an OUT-OF-NETWORK provider.

Sleep apnea and sleep obstructed breathing are consider a MEDICAL condition and, as such, your medical benefits are the most important piece of the treatment conversation.