Finding out if clinical GAP insurance coverage is available is one place for sleep dentists to start, reports Dental Economics.
A clinical GAP exception, otherwise referred to as an “in-network exception,” is when there isn’t a contracted provider within a certain mile radius on the patient’s medical insurance policy. It is usually set at 25 to 30 miles. Most insurance carriers understand that it is not the fault of the member (patient) that the insurance carrier doesn’t have a contracted provider close to the patient’s home. With this understanding, many policies allow a one-time exception for a patient to see an out-of-network provider and use the in-network benefit level (deductible and coinsurance).