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Does Insurance Cover Sleep Apnea Oral Appliance

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Do You Have Sleep Apnea Would You Prefer An Oral Appliance Instead Of A Cpap Find Out If Its Covered Here

Are ORAL APPLIANCE DEVICES for snoring and sleep apnea COVERED by MEDICAL insurance?

In many cases, health insurance will cover all or part of the costs of getting an oral appliance for sleep apnea treatment.

This can vary from one insurance plan to another, or from state to state. Insurance coverage for mandibular advancement devices and other oral appliances may differ from that of CPAP machines.

Some insurers may cover the full cost, while others may cover part of the cost. Some insurers might not cover any of the cost.

If your current insurance provider doesnt cover the sleep apnea treatment thats best for your needs, you may want to consider signing up with a different provider during Open Enrollment each year.

What Is Oral Appliance Therapy For Sleep Apnea

An oral appliance is worn only during sleep and fits somewhat like an orthodontic retainer. The appliance helps keep the jaw in a forward position, so the upper airway remains open. This can be effective for treating snoring and obstructive sleep apnea. After an evaluation and diagnosis of sleep apnea, Dr. Bogrow will discuss your options and prescribe a custom-made oral appliance.

Benefits Of Oral Appliance Therapy

Many patients prefer oral appliance therapy as a solution for living with sleep apnea. It provides them much improved sleep and offers the following benefits:

  • Comfort

    It can be hard to sleep with a CPAP machine and bulky mask. Patients often like oral appliances because they are comfortable and easier to wear, especially for those who change positions during sleep or snuggle their bed partner.

  • Quiet

    A CPAP machine may silence the snoring, but its constantly running motor might not help you or your bed partner sleep more soundly. Oral appliance therapy is a silent option that can minimize the symptoms of sleep apnea, such as loud snoring, without making a peep of its own.

  • Easy Travel

    It can be difficult to travel with a bulky CPAP machine. A compact, lightweight oral appliance can help lessen your load.

  • Low Maintenance

    It is super easy to care for an oral appliance. Just a toothbrush cleaning with mild soap will keep your appliance germ-free.

  • Effective Treatment

    Research shows that oral appliance therapy is an effective alternative to CPAP. When patients consistently wear their oral appliance, they wake up each morning feeling refreshed.

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What Can I Do For Sleep Apnea Besides Cpap

CPAP therapy is not the only treatment option for sleep apnea. Oral appliance therapy repositions the tongue and lower jaw to keep the airway open, preventing pauses in breathing. Other patients may be candidates for a surgical procedure that either removes or stiffens the tissue that blocks the airway.

How Do I Order An Oral Appliance For Obstructive Sleep Apnea

Using Code D5999 for Billing Sleep Apnea Device

If you and your doctor decide that an oral device is a good option, you will need a referral to an appropriate dentist to have an evaluation. The dentist will decide if you are a candidate for this treatment and make an impression of your teeth. The dentist will make the device and call you back for a fitting. You will also be given a morning repositioner to realign your bite after the appliance is removed. He or she will also give you instructions on how to use and clean the appliance. You might also have to go back to the dentist for further custom adjustments to optimize care. Once care is completed, it is recommended that have another sleep test to see how the appliance is working for you. Further adjustments may be necessary.

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Dental Appliances For Sleep Apnea: Do They Work

Keeping your partner or yourself up at night with loud snoring? This might be more than a nuisance. About 25% of men and nearly 10% of women have obstructive sleep apnea , a serious sleep disorder characterized by explosive snores, grunts, and gasps. Tissue at the back of the throat temporarily obstructs the airway, leading to breathing pauses throughout the night. Not only does OSA leave people tired and groggy, but it also puts them at risk for a host of health problems, including high blood pressure, depression, and heart disease.

The most effective and best-studied treatment is positive airway pressure , a small bedside machine that blows air through a mask to prevent your airway from collapsing. But people with mild or moderate OSA sometimes find PAP challenging to use, and often wonder about alternatives. Dental devices are an option for some people. But do your homework before going this route, cautions Sogol Javaheri, MD, MPH, MA, a sleep specialist at Harvard-affiliated Brigham and Womens Hospital.

Can We Bill Follow

Yes, you can bill commercial carriers, using a medical office visit code, for the adjustments to the oral appliance. Most carriers bundle the first 90 days of adjustments into the code for the custom appliance .

With the right tools to navigate medical insurance billing, you can help more of your patients receive the care they need saving lives and relationships. Your patients will thank you!

Rose Nierman, RDH, is the Founder and CEO of Nierman Practice Management, an educational and software company for Medical Billing for Dentists, TMD and Dental Sleep Medicine advanced treatment, and co-founder of the SCOPE Institute, a non-profit educational organization dedicated to the advancement of sleep apnea, craniofacial pain treatment, and medical billing within dentistry. Rose and her team of clinical and medical billing experts can be reached at or at 1-800-879-6468

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Getting An Oral Device For Sleep Apnea

The first step to getting any sleep apnea treatment is talking to your doctor. You may be a candidate for certain sleep therapies while others may be excluded because of your medical history or anatomy. Discuss your symptoms with your healthcare professional. You may be asked to undergo a sleep study and if you are diagnosed with sleep apnea, you and your doctor can discuss treatment options.

With the increase in supply of manufacturers and qualified dentists, oral devices for sleep apnea have become a popular treatment for sleep-disordered breathing and snoring. If a dental device is indicated, you will be referred to a dentist who specializes in the treatment of sleep apnea. The dentist usually takes an impression of your teeth bite called a bite registration. A reproduction of your teeth is then made of plaster. Your sleep apnea mouthpiece will be designed using this model so that it fits your teeth and mouth perfectly.

You should only seek oral devices for sleep apnea that are FDA cleared. Although there are businesses that sell sleep apnea mouthpieces on the internet, it is important that your sleep physician, primary care doctor, and/or dentist approve the appliance. Many of the over-the-internet boil and bite sleep apnea mouthguards are not effective.

I Think I Might Have Sleep Apnea But I Am Not Sure What Should I Do

Insurance Coverage for Sleep Apnea Patients and the Referral Process, With Dr Larry Pribyl, of the

Its certainly difficult to determine whether or not you have sleep apnea by the symptoms alone. Thats why a sleep study needs to be performed to diagnose the disorder first. You can talk to Dr. Chenet or your primary care physician about the steps you need to take to have a sleep study performed. Remember, the vast majority of sleep apnea cases go undiagnosed, so its important to be proactive about having sleep apnea treated even if youre not completely sure.

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Can We Get Reimbursed For Our Sleep Screening Exam We Would Also Like To Bill For A Panorex And Possibly A Cephalometric Radiographic View

Most commercial carriers reimburse for an OSA screening exam with the submission of evaluation and management codes. There are also cross-codes from dental to medical for the radiographs. When billing for exams, its important to keep detailed clinical notes showing your medical history and clinical exam so that you can use a medical office visit code. The good news is that there is no frequency on the exam and x-ray codes with medical insurance like there is for dental so if a patient had an exam three months ago and you need to do another, the insurance typically will reimburse for both.

Dental Appliances For Obstructive Sleep Apnea

Before getting too far ahead, its important to understand that in most cases, health insurance companies are not going to cover an appliance that is used for the sole purpose of controlling snoring.

That being said, most health insurance companies will cover a portion or in some cases all of the cost of an oral appliance if it has been determined to be a medical necessity. Appliances that are custom made by the dentist for the purpose of controlling obstructive sleep apnea are considered a medical necessity and are often covered by private insurance as well as Medicare, Medicaid, and obamacare when certain conditions are met.

Which insurance is responsible for covering this expense? Despite the fact that these devices fit inside of the mouth, they are covered under your health insurance, not dental insurance because they are used to treat a medical condition such as sleep apnea.

Unfortunately, with so many insurance companies out there, its impossible to make a blanket statement concerning all insurance coverage. Since the insurance companies do not publish the amount that they will cover, not even your doctor can give you an exact out of pocket amount until several weeks after getting the insurance process rolling.

How about a rough estimate?

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What Is Obstructive Sleep Apnea

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing many times during sleep, sometimes hundreds of times during the night.

There are three types of sleep apnea: obstructive, central and mixed. Obstructive sleep apnea is the more common of the three. Obstructive sleep apnea occurs when the upper airway is blocked either partly or completely during sleep. During an apnea episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm problems.

In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system and not treated by oral appliance therapy.

Mixed sleep apnea is a combination of both obstructive and central sleep apnea.

How Can I Predetermine If Medical Insurance Covers An Oral Appliance

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Start by making a call to the eligibility & benefits department using the contact numbers from the patients medical insurance card. Its important to have sleep study information before the benefits verification call because the severity of OSA must be known before the benefits can be determined. Most health insurance plans categorize oral appliances for OSA as medical equipment, so reimbursement is typically under the coverage for Durable Medical Equipment . DME is the benefit category for medical equipment such as electrical stimulators for pain, wheelchairs & walkers. The information to receive during the benefit verification:

  • Deductible amount
  • How much of the yearly deductible has been met
  • Copayment amounts or percentages
  • Preauthorization requirements
  • Is a Medicare-approved oral appliance necessary ?
  • Is a GAP exception allowed for out of network providers ?

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Costs Of Sleep Studies

Chances are, youâll need a sleep study to diagnose your sleep apnea. The results of this test can also help you qualify for treatment coverage from your insurance company.

These overnight exams can cost $600 to $5,000 or more each night.

At-home sleep apnea tests are also available and typically run between $150 and $500.

Your insurance may cover all or part of the expense.

Cost Of A Sleep Study

The first step in treatment for sleep apnea is to schedule a formal exam. During your appointment, it will be determined if you need a sleep study and which type of study is most appropriate. Sleep studies are required to properly diagnose you with a sleeping disorder and identify which type of condition youre living with

There are typically two types of sleep apnea studies that experts use: overnight clinical sleep studies which are performed in a medical lab and take-home sleep studies which you administer on your own

Overnight clinical sleep studies cost more than at-home sleep studies. Especially if you dont have insurance coverage. The price difference can be hundredsbut more likely thousandsof dollars. Take-home sleep studies are relatively inexpensive compared to the conventional tests you hear about at a sleep lab.

But do take-home sleep study tests work? Absolutely. When used as directed, theyre effective at detecting and screening for chronic snoring, obstructive sleep apnea, and similar sleeping disorders. The bedside machine records your breathing, pulse, oxygen levels, and sleep patterns. A small device sticks to your chest and is worn on your hand. All you have to do is lay back and sleep! Fort people who worry about not being able to sleep anywhere except their own bed, or having someone be able to see them sleeping, home sleep studies are an excellentnot to mention a more affordablealternative.

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How Much Do Sleep Apnea Mouthpieces Cost

The average cost for a sleep apnea mouth guard is estimated at $1800 $2000. This includes the actual sleep apnea mouthpiece, dentist visits, adjustments, follow-ups, and modifications to the dental device. Most health insurance companies and Medicare cover oral devices for sleep apnea.

For more details on sleep apnea mouthpieces and prices, take a look at our review page here.

To arrange for a sleep apnea mouthpiece, contact your local dentist or primary care provider.

Have You Already Had Your Sleep Study

Dental Insurance Billing for Sleep Apnea, Dr. Don Wilcox Glendale Arizona

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How Does Oral Appliance Therapy Work To Treat Obstructive Sleep Apnea

For patients with mild to moderate obstructive sleep apnea, dental appliances or oral mandibular advancement devices that prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A sleep specialist and dentist with expertise in oral appliances for this purpose should jointly determine if this treatment is best for you.

Does Medical Insurance Cover Snoring Mouth Guards Found On The Internet

No, and for good reason. That snore could be something more! Even though snoring may be eliminated by an over-the-counter oral appliance, the patient could still be having sleep apnea episodes known as silent apnea. For this reason, and to ensure that appliances are medically necessary, medical insurance restricts coverage to custom mouthpieces inserted by a qualified dentists. Follow up sleep studies are frequently covered by medical plans to confirm the efficacy of the custom-made device.

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Where Can I Get An Oral Appliance For Sleep Apnea

If you suffer from obstructive sleep apnea and are looking for relief other than a CPAP machine, contactDr. Jeffrey W. Cross, D.D.S., F.A.G.D. Dr. Cross has been using oral appliance therapy and mouthpieces to treat sleep apnea since 2005. He is a member of the American Academy of Dental Sleep Medicine as well as the Academy of Clinical Sleep Disorders Disciplines. Dr. Cross has completed hundreds of hours of continuing education and is highly experienced in his field.

Contact Dr. Crosstoday at for a better nights sleep to learn more about treating your sleep apnea with a mouthpiece.

What Are The Effects Of Obstructive Sleep Apnea

Will Health Insurance Cover Oral Appliance for Sleep Apnea?

If left untreated, obstructive sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy , congestive heart failure, diabetes, and heart attacks. In addition, untreated sleep apnea may be responsible for job impairment, work-related accidents, and motor vehicle crashes as well as academic underachievement in children and adolescents.

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If You Have Medical Or Dental Insurance

In a typical situation, medical insurance pays for general health expenses, while dental insurance only pays for things related to your teeth and gums. Sleep dentistry and oral appliance therapy is a grey area that spans both medical and dental. As such, you can often tap into one or both insurance plans to help cover the cost of your sleep device.

The key to getting your medical coverage to pay for an oral sleep appliance is to first locate a trained sleep dentist and then to make sure they process medical insurance benefits. Not all dentists do, as its quite a complicated process to switch between dental and medical claim systems. But if you have a sleep dentist who accepts medical insurance, youre in for a treat! Their care coordinators can get a breakdown of benefits between both your medical and dental plans, to help you minimize your total out-of-pocket costs related to treating sleep apnea.

But lets consider one more thing: maybe you dont have medical or dental insurance. What then? The most cost-effective solution is to pay for an at-home sleep study and consider an oral appliance instead of the cost of a CPAP machine. You could be saving thousands and thousands of dollars, not to mention your health.

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