Your Role in Dental Sleep Medicine P8
2014
Dr. Lavine:
Okay. Do you believe the PSG is critical for diagnosis of OSA or CPAP before treatment?
Dr. Elliott:
No, not all the time. If the patient has a previous heart attack, if they have high blood pressure and stroke and those kinds of patients that have a health history a mile long or if they have severe tiredness and bad insomnia that maybe you think they have a different type of sleep disorder, then I would definitely request a PSG. Most of the time, I would leave it to the physicians, and my sleep physicians really are open to home sleep studies. A lot of insurances are even going that way, too, where they require a home sleep study before a PSG.
So, no, I don’t always require a PSG because honestly, patients don’t pursue treatment if they know they have to sleep in a sleep lab, and when you open it up to possibly having a home sleep study, they say, “I can do that.” It’s amazing how many more people you can help in that situation.
Dr. Lavine:
Yeah. It makes sense. When you’re seeing adolescents, can you estimate how many percent are being sent for removal of their tonsils or adenoids?
Dr. Elliott:
Of all the children I see?
Dr. Lavine:
Yeah.
Dr. Elliott:
The ones that I send most of the time have their tonsils out because it is so severe. A lot of times I bypass the pediatricians because they’ll tell that they have sore throat, they’ll outgrow it. They’re fine. I don’t send four, five year old unless they’re really bad because the surgeons really don’t like taking tonsils out like they used to. So, when they’re six or seven, they’ll have that long face, that look. Most of the time, the ENTs are willing to look at it even without a sleep study. They sometimes bypass the sleep study and take the tonsils and adenoids out. My hygienist’s niece actually just went, and they put a scope up her nose. They saw her adenoids were almost 100% blocking her nasal passageway. So, she’s going to get those out.
Dr. Lavine:
Okay. Two more questions here. Where did you get the Schwartz Gauge that you showed?
Dr. Elliott:
The George Gauge?
Dr. Lavine:
Yeah.
Dr. Elliott:
Yeah, just on the net. You can order them online from several different labs.
Dr. Lavine:
Okay. If someone doesn’t have full blown OSA, will these devices work just to prevent snoring?
Dr. Elliott:
Yes, and I do treat them in a little different way. With snoring, medical insurance won’t cover snores. So, sometimes they don’t even cover for mild sleep apnea, but I could get into that more in the course. With the snorers, I make an appliance that costs less, Silent Nite®. Like I said, we make those snore-guards, but I know my patients are screened for it. It’s just snoring. So, the Silent Nite® is common because it’s cheap.
So, I’ll just do it. I think we charge $850 for that, or I’ll make them a SomnoDent. I just charge a flat rate. As long as my lab fees are covered, I think we charge $1100, and the reason why I can charge so cheap is because there’s no follow-up appointment. I don’t have to do the follow-up appointment or home sleep study. We basically deliver it, show them how to advance it, and send them on their way. There’s not much follow-ups for just snoring. So, you can do a couple of different ways.
Dr. Lavine:
Okay. We have two more questions. I certainly want to stress, and I know you’re being modest about this, Erin, but the point of the webinar was just to get people an overview of what’s out there, what they should know about. I would imagine that your course would cover all of these and a lot more, which is a three-day course, correct?
Dr. Elliott:
Two day course.
Dr. Lavine:
So, that’s a lot of information in two days, but certainly, that was never the goal of the webinar, to get people 100% confident with it. I think the course would be a good place to start. A couple of insurance questions here. If you don’t know if there insurance will pay, do you request a part of the fee up front?
Dr. Elliott:
Yeah, we usually do. That’s something that I would do in the course, give you the call intake form and insurance verification form, and it sets you and guides you up. When the patient walks in, we know their deductible hasn’t been met, and they’re going to need this much out of pocket. We usually request on the day of the impression a $600 down payment. That will cover the lab fees, and that’s all we care about. So, after that, if the insurance needs more, we can collect at the delivery appointment.
It’s really hard to convey sometimes to patients. They don’t understand that it’s mostly paying up front because most of the time if you think about going to the doctor or for surgery, you just wait for the bills to arrive, but I think they can understand why we’re asking them ahead of time. Most of the time, they’re pretty open to doing that.
Dr. Lavine:
Okay. Also with insurance, do you have any experience dealing with insurance in Canada?
Dr. Elliott:
Yeah. You know what? I’m friends with a Canadian dentist who’s actually doing dental sleep medicine solely now. She sold her practice, and whenever it comes to medical insurance, she tunes it out because it doesn’t really apply there. There’s this huge waiting list for the sleep lab so I don’t really know how she does it with the sleep system, but she’s working with a sleep physician now. It has made her life easier.
Dr. Lavine:
Okay. This one here is probably a questions for you or Curt, really critical question: Will there be good snacks at the course? I love some of these questions. I assume the answer is “yes”.
Okay, just a couple more question here. Can finger pulse oximetry used with the [01:36:28] Maneuver reveal a high risk in an OSA patient? Is it enough positive diagnosis to initiate treatment with sleep breathing or oral appliance without a PSG?
Dr. Elliott:
No, that is not. The only test they have seen work to use as diagnosis is the PSG, the home study, or a sleep MRI, and they only use that for research. It may show you if they have a high probability. It can be used to screen, but it cannot be used to diagnose. That can only be done by a sleep physician with those sleep tests.
Dr. Lavine:
With all the HMOs out there, you’re not a participating provider. Can you still submit to those insurance companies?
Dr. Elliott:
Yes, and that’s the trick. Most dentists I hope do not become network providers because they really lower the fee quite a bit. I’m in network with [0137:33] of Idaho only because I know the person that’s in charge of it, and they’ve had special meetings for me for this to try to get me reimbursed at an appropriate rate.
If you are out of network, that just means that the patient needs to pay more. They pay at a lower percentage, or you can get a gap exception so that if there’s no other dentist in a 50 mile radius that is not in a network, then, a lot of times they will cover you as a network provider if that makes sense.
Dr. Lavine:
Okay. Last question, and I’m sure you’ll probably cover this in the seminar as well in your course. Is there any one external market method that you have found to be very effective? Obviously, it depends on the area that you’re in, but have you found luck with print, radio, TV, social media? What do you find good for you?
Dr. Elliott:
It does depend on the area that you’re in, and I’ll tell you what, I love the marketing part of it. So, I have all sorts of ideas, and I think it takes a few touches before someone will actually pick up the phone and call. I have a website, and I have a Microsoft Tag and QR code that leads to my website. I’m sure most of the patients here don’t even have a computer. So, social media’s good. I’ve been on the radio, and there’s such so many ways and so many things to approach people with it because it affects them in different ways. So, this is something I love talking about it and ideas or ad design, too. There’s no one thing.
Dr. Lavine:
Good. Erin, thank you so much. We had great questions, great content. I would highly recommend people to consider going to the course. It’s in a month or so and all of this stuff and a lot more. You can see the information on the screen. You can go to their website, to GoldenDentalSolutions.com, use the sleep code. Call them up. We’ve had great luck working with Golden Dental Solutions over the years.
We actually have a workshop in a week or so on using the Physics Forceps. For those of you that are not doing extractions, that’s because you find them very difficult. This will completely change your life, and I highly encourage you. If I you haven’t received an invitation, send me an e-mail. I will get you an invitation, but we already have a lot of people signed up for that one as well.
Thanks, again, Golden Dental Solutions for sponsoring the webinar and making the course available, and they will be providing a free CE for everyone as well. So, thank you, Erin. That was fantastic. I really appreciate you being here.
Dr. Elliott:
You’re welcome. I had a great time. I hope people see the need for it and the love for it as much as I do.
Dr. Lavine:
Well, I think it’s great. It’s fantastic because it’s something, like with all the webinars that I do, that general dentists may not have gotten to in dental school, but we absolutely have the skill set to be doing this. All you need is a little bit of training, a little bit of confidence, and I can see the passion that you have and the passion that your patients have in what you have provided for them.
I think it’s something that we should strive for, to have these happy patients singing praises. What a great service if you can change someone’s life around. You don’t typically get that tooth service amalgam, but something like this would change their life.
So, I want to thank everyone for being on the webinar. Stay tuned for future webinars. We have one next week with Dr. Louis Malcmacher and Dr. [01:41:08] talking about Physics Forceps. We’ve got more in the future as well
Erin, do you give out your e-mail address if people want to send you a question?
Dr. Elliott:
Oh, sure. That would be great. I actually even showed it in the Dental Economic article so I know I won’t get too bombarded. It’s erinElliotttdds@gmail.com.
Dr. Lavine:
Great. Thank you everyone for staying up with us this evening. It was a great webinar, and maybe we’ll bring you back in a few months. This is a great topic, and there seems to be a lot of interest. So, thank you, again, Erin. Thanks, everyone, for joining us, and we look forward to seeing you on future webinars. Good night, everyone.
Dr. Elliott:
Good night.