Insurance Coverage For Obstructive Sleep Apnea

January 26, 2017 в 2:48 pm  |   |

Obstructive Sleep Apnea (OSA) is a medical disease that falls under your medical health insurance plan, not dental. Below you will find answers to common questions about insurance coverage for oral appliances used to treat OSA.

What type of oral appliances are covered by medical insurance?

Many healthcare plans cover oral appliances for OSA only when the devices are FDA approved, custom-made, and inserted and monitored by a qualified dentist. 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.

How do I know if my insurance covers oral appliances and will they tell me how much they cover the devices for?

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” should 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.

How does the Affordable Care Act (ACA) affect my insurance coverage for oral appliances?

Under the ACA (also known as Obamacare), coverage for oral appliances or other types of devices have improved.  “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.”

What about Medicare?

Only a licensed dentist is permitted to bill for custom Oral Appliance Therapy for a Medicare beneficiary. 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.

Does medical insurance cover mouthpieces for just snoring?

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.

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.

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