Hi Guest!

All great questions. So first off - no not all medical insurers currently require a prescription from a physician for custom made oral appliance for OSA - although many these days do (i.e. Medicare, Aetna, most BCBS's, etc). Also, it is a recommendation of the American Academy of Dental Sleep Medicine (AADSM). Also side note - most medical insurers will accept the Rx from an MD, DO, PA, NP or CNS working within their scope of practice.

And yes absolutely, the patient always has the option to be cash pay and not file insurance. But keep in mind, if you do the appliance without a physician order on file (insurance or not) and attempt to manage the OSA on your own from there, that does add a lot of liability that the dentist may not be properly trained in. But yes, EY is the proper modifier to use as the description of the modifier is "EY - No physician or other licensed health care provider order for this item or service".

As far as that sleep study - although it may not be extremely common for a primary care physician to want to be the one to order the study, it does not surprise me at all. In fact, some medical insurers do require that the patient have a face to face evaluation with a physician prior to getting the sleep study (i.e. Medicare), so the physician has to been the one to order it order for the study to be covered, and in turn any therapy recommended/prescribed from there would run the risk on non-coverage if the means of diagnosis was considered non-covered as well. The physician may very well want to make sure that there aren't other symptoms/conditions present that need to be addressed along with the oral appliance therapy (or whatever therapy the physician deems appropriate for the patient) - i.e. restless legs/plm's, hypertension, mood disorders, central apneas etc etc etc etc...... he/she is probably not trying to be difficult, just trying to following recommended guidelines it sounds like :)
(Also if you make sure to keep that physician flowing with referral for evaluations for sleep patients, you will likely see referrals back for patient's who are appropriate for OAT! Or if you don't - schedule a call/lunch with the doc to introduce yourself......)

And the good news on that sleep study - if you do refer the patient back to the PCP to get an eval for a sleep study - the patient may very well qualify for a home sleep study! (depending on the insurance and the patient's condition). Many insurers do offer coverage for home studies as long as the patient does not have certain conditions that may degrade the accuracy of a home sleep test (COPD, PLM's, etc).

Hope this helps!