ISO guidance for navigating medically-necessary approved palate expansion Medicare Humana PPO

TL;DR how do I go about getting medically necessary orthodontic treatment for obstructive sleep apnea?

I was diagnosed with obstructive sleep apnea (diagnosis code) G47.33 and one of the approved treatments is oral palate expansion and the subsequent bite correction/alignment. I have been trying to get this taken care of since August. The orthodontist submitted, with subsequent denial—because they are a dental provider and used a dental code.

I had my PCP submit the same thing and it was a bit of a “riddle” getting through the clinical intake review. We basically had to guess what ICD10 codes they wanted. Humana claims the “equipment” be ordered via 3rd party durable medical equipment (dme) vendor. The orthodontist basically “reverse 3D prints” the expander [it’s called a “Hyrax” palate expander] so there isn’t any equipment to order.

To complicate matters further, a “case manager” is the person dealing with this on my doctors end. She doesn’t know much more than I do. She communicated to the orthodontist office Humana would “only be covering x,y,z” and it would equate to about $100. I figured that’s better than a denial… except now I can’t find any record of that. In fact, I can’t even find the claim for any medical submission on my Humana portal. I see the dental denial though.

Everyone I’ve heard from in the Facebook groups said they gave up and just paid out of pocket. I refuse to do that because I was told by several Humana reps it’s covered. And CMS also reflects this.

The final piece of complexity here is I have medicaid for workers with disabilities and they pick up whatever Medicare doesn’t. So, that’s also a party that needs to be involved. But they can’t do anything until humana approves and by the looks of things Humana doesn’t even reflect a submission from my pcp. Apparently this has become a “thing” in medicare world and I’ve heard from a different providers office that medicare likes to wait around forever to even acknowledge claims.