How insurance works at our office
We want you to know exactly what to expect before your first visit. Here is how dental and medical insurance work at Toothpillow Breathing & Sleep Center, in plain language, with no surprises.
Six things to know
Out of network with all plans
We are out of network with every dental and medical insurance plan. That lets us plan treatment around your airway rather than around a plan's rules, and many patients still use their benefits.
Dental insurance: we can bill it
Depending on the procedure and your individual coverage, we can submit claims to your dental insurance for you. Our team will tell you ahead of time whether your treatment qualifies.
Medical insurance: we provide the paperwork
We do not bill medical insurance directly. If you'd like to submit a claim yourself, we'll give you the documentation you need, including the codes and records your insurer asks for.
HSA and FSA cards welcome
You can pay for your consultation and treatment with a health savings account or flexible spending account card.
Payment plans through Cherry
Monthly payment plans are available through Cherry, with quick approval and options for many credit profiles. See financing.
Coverage is never guaranteed
Coverage always depends on your plan and your benefits. We'll help you understand what we know, but only your insurer can confirm what they will pay.
If a sleep appliance is part of your plan
For applicable sleep appliance treatment, the code insurers most often look for is E0486, the medical billing code for a custom-made mandibular advancement appliance. We include it in your documentation so you can submit the claim to your medical insurance yourself.
A few things to know: medical plans typically ask for a sleep apnea diagnosis from a physician and a completed sleep study before they consider an oral appliance. Coverage is never guaranteed and ultimately depends on your individual plan and benefits, so we recommend calling your insurer before treatment and asking what they require.
Questions? Call (801) 893-0234 and our team will talk you through it.
How to use your insurance here, step by step
Bring your cards
Bring your dental and medical insurance cards to your first visit so we have your plan details on file.
Ask before treatment
Once Dr. Buxton recommends a plan, our team will tell you which procedures, if any, we can bill to your dental insurance.
Request your medical documentation
If you want to submit a medical claim, ask us for your documentation packet. It includes the records and codes your insurer typically asks for.
Submit and follow up
You send the claim to your medical insurer and they reimburse you directly, based on your plan. We're happy to answer questions along the way.
Care planned around you, not a fee schedule
Airway care looks at how you breathe, sleep, and grow, and the right plan is rarely the one an insurance table expects. Staying out of network lets Dr. Buxton recommend what your scans and exam actually call for, and lets you decide with full information.
We keep pricing clear up front: the airway consultation is $350 for kids and adults, and treatment fees are reviewed with you before anything begins. See financing and payment plans.
Book Your Airway Consultation
Insurance questions we hear most
Are you in network with my insurance?
No. We are out of network with all dental and medical insurance plans. Many plans still pay a portion of out-of-network care, so it's worth checking your out-of-network benefits.
Will you bill my dental insurance?
Depending on the procedure and your individual coverage, yes. Our team will let you know before treatment which procedures we can submit to your dental plan.
Do you bill medical insurance for sleep apnea appliances?
We don't bill medical insurance directly. We provide the documentation you need, including the E0486 code for a custom mandibular advancement appliance when it applies, so you can submit the claim yourself. Coverage depends on your plan and is never guaranteed.
Can I use my HSA or FSA?
Yes. HSA and FSA cards are welcome for consultations and treatment.
Will my dental insurance cover expansion or aligners?
It depends on your plan and the procedure. Some plans include orthodontic benefits and some don't, and limits vary. We'll check what we can before treatment and tell you what we find.
What does the airway consultation cost?
$350 for kids and adults. It includes a 3D CBCT airway scan, a digital intraoral scan, photos, and a review with Dr. Buxton. See financing and insurance for payment options.
Schedule Your Airway Consultation
Book online or call. Consultations for kids, teens, and adults at our Draper office.
14203 Minuteman Drive #101
Draper, UT 84020
Just off I-15, minutes from IKEA
Monday to Friday, 9 AM to 5 PM
"Great place! They are doing it differently. Well done!"
Request Your Airway Consultation
Tell us a little about what's going on. Our team will call you to find a time that works. No pressure, just answers.