Since obstructive sleep apnea is a medical disease, reimbursement falls under your Health Insurance Plan, not a dental plan. Common questions about insurance coverage for oral appliances are answered here.
Many healthcare plans do cover Oral Appliances for Obstructive Sleep Apnea (OSA) when they are custom-made oral appliances inserted by a qualified dentist and are FDA approved. There are over 100 FDA approved custom oral appliances available. Your Snoring Isn’t Sexy™ dentist is qualified to recommend the oral appliance that is right for you.
Almost all medical plans can be verified in advance for coverage of oral appliances. Medical plans do vary, so it’s a great idea to check with your Snoring Isn’t Sexy™ dentist for assistance in how to find out if your medical policy covers oral appliances.
The good news is that an insurance representative known as a “benefit estimator” ought to be able to determine coverage under your policy. Although the insurance representative may not be able to determine your exact reimbursement in advance, he/she can indicate if coverage is included in your plan.
Your deductible may differ from your usual insurance deductible since most carriers categorize oral appliances for obstructive sleep apnea as equipment known as Durable Medical Equipment. Equipment such as oral appliances or even CPAP often carry a separate deductible, so check your deductible for medical DME benefits. Something important to keep in mind!
Yes, under the ACA (also known as Obamacare), coverage for oral appliances or other types of devices have improved. Your variables will include deductibles or copayments, depending on your plan.
“Oral appliances are considered Durable Medical Equipment” writes Rose Nierman, CEO of Nierman Practice Management. “It’s good to know that coverage of Durable Medical Equipment is one of the Essential Health Benefits in the Affordable Care Act (ACA), commonly known as Obamacare. Most states have adopted some form of this insurance mandate.”
No. Medical insurance considers custom mouthpieces as the only type of oral appliances that are “medically necessary”. It’s important that your physician and dentist work together to manage sleep apnea in addition to the snoring. That snore could be something more! Even though snoring may stop, you or your bed partner still could be having sleep apnea episodes. For this reason, and to ensure that you receive the best possible care, medical insurance only covers custom mouthpieces fitted and inserted by a dentist.
Medicare’s policy states that certain oral appliances used to treat obstructive sleep apnea are covered when specific Medicare approved criteria are met. Medicare provides reimbursement for oral appliances under the Durable Medical Equipment (DME) benefit. This means that, in order to bill Medicare for these items, a dentist must enroll as a Medicare DME Supplier. Only a licensed dentist is permitted to bill for custom oral appliance therapy for a Medicare beneficiary.
This Insurance Guide for Oral Mouthpiece Coverage for Obstructive Sleep Apnea is a courtesy of Snoring Isn’t Sexy. This is not a guarantee of insurance benefits. Deductibles and copayments may apply.
Snoring Isn’t Sexy® is part of Nierman Practice Management which provides resources and training to dentists for medical billing of oral appliances. Dentists trained by Nierman Practice Management have helped more patients gain reimbursement for oral appliances than any other organization.
For more information about oral appliances, contact your Snoring Isn’t Sexy dentist.
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