Payment & Insurance

Payment Options

  • Credit Card: Visa, MasterCard & Discover
  • Check
  • Care Credit
  • Payment Plan

Insurance

Dr. Brady is medically credentialed by many insurance companies to provide services for Appliance Therapy as an in-network provider.

We are in-network with:

  • United Healthcare
  • UMR
  • Tricare with pre-authorization
  • VA with pre-authorization
  • DME Provider for Medicare – Sleep Appliances Only
  • Kaiser – Sleep Appliances Only

We are happy to file to any private insurance group we are not contracted with, but we do not file or accept Medicaid. We cannot file to Medicare for treatment related to TMJ/TMD.

At the Craniofacial Pain & Sleep Center in Fort Collins we strive to provide you with as much information to make an informed decision for your well-being. Please find Frequently Asked Questions related to insurance below:

What is the difference between in-network vs out-of network?

  • In-Network – A provider that has been medically credentialed by an insurance company to provide services to their members. The provider’s background, education and experience are reviewed by a board of medical doctors.
  • Out-of-Network – A provider that has not been medically credentialed by your insurance company to provide services to their members.

How does seeing and in-network vs out-of-network provider affect my financial obligation?

In-Network means:

  • Pre-negotiated prices established by your insurance company with the provider
  • Lower deductibles, or no deductibles
  • Co-pays are applicable
  • A greater percentage of coverage
  • More savings and less out of pocket for the patient

Out-of-Network means:

  • Higher deductibles
  • Less percentage of coverage
  • Less savings, more out of pocket expense for the patient
  • Not a medically credentialed provider. This may affect coverage if the provider is not qualified to perform the services.

What happens if my insurance excludes TMJ/TMD?

It is not uncommon for certain insurance plans to exclude coverage for services related to TMJ/TMD. When this occurs, the patient will be responsible for the entire costs associated with treatment. This will be true anywhere you go. Call your insurance company and find out your benefits so you are informed of your economic responsibility.

Will my dental insurance cover services for TMJ/TMD?

Some dental insurance plans may provide partial coverage for exams and the appliance. Each plan is different. Call your dental insurance to find out your specific coverage.

Will Medicare cover services for TMJ/TMD?

TMJ/TMD is an excluded benefit on all Medicare related plans. No matter where you go, this will be an out of pocket expense.

Will Medicare cover custom Sleep Appliances?

Medicare will provide coverage for a custom Sleep Appliance. However, only certain appliances are Medicare approved, and the patient needs to see a DME Provider. The Craniofacial Pain & Sleep Center is a certified DME supplier for Medicare.

Will insurance cover a custom Sleep Appliance for snoring?

Snoring is not a covered benefit. In order for your medical insurance to cover a custom sleep appliance, you must have the following:

  • A recent sleep study
  • Diagnosed with Sleep Apnea
  • A script for the custom Sleep Appliance from your Primary Care Physician (PCP) or Pulmonologist.

Please note, not all diagnosis related to Sleep Apnea are covered. Make sure you see a provider and work with an office that is experienced in filing with medical insurances.

If you have any questions, do not hesitate to contact our office in Fort Collins or Denver. Our trained staff is here to help you through the complexities of insurance.

As the patient, you are the best advocate for your well-being. Wherever you go, make sure you check the provider’s background and continuing education to properly treat your condition.