Insurance
Is Oral Appliance Therapy Billed to Medical or Dental Insurance?
Oral appliance therapy for sleep apnea is billed to medical insurance, not dental insurance. That’s because sleep apnea (obstructive sleep apnea) is a diagnosed medical condition, not a dental problem, so it’s treated and covered the way other medical care is.
Here’s the typical path patients follow:
- Physician referral or diagnosis. A doctor identifies signs of sleep apnea and refers the patient for evaluation.
- Sleep study. A physician orders a sleep study to formally diagnose obstructive sleep apnea. This diagnosis is usually what triggers insurance coverage.
- Prescription. Once diagnosed, the patient receives a prescription for oral appliance therapy as a treatment option.
- Oral appliance therapy. The appliance is billed as durable medical equipment under the patient’s medical plan, the same medical insurance card and plan used for other doctor visits, not a separate dental plan.
Because it’s billed to medical insurance, oral appliance therapy is not available under dental insurance. If you’re unsure what your specific plan covers, our team can help you check your medical benefits before your appointment.
Does Insurance Cover Oral Appliance Therapy?
If you’re someone struggling with sleep apnea, you know how much sleep affects your overall health. However, getting the right equipment to deal with sleep apnea effectively can be overwhelming, particularly if you’re unsure whether your health insurance plan covers the treatment.
Most health insurance plans will cover oral appliance therapy to treat sleep apnea. This therapy is not available under dental care. In addition, some health insurance plans will cover the total cost of sleep apnea treatment, while others may pay a small portion.
Your level of coverage and discount plans under your health insurance may differ according to their policies and procedures. We accept the following types of insurance:
Remember that you do not have to have medical insurance to benefit from our services. Instead, you may opt to purchase our custom-fitted oral therapy devices and at-home sleep test outright using one of our flexible sleep apnea payment options.
Remember that you do not have to have medical insurance to benefit from our services. Instead, you may opt to purchase our custom-fitted oral therapy devices and at-home sleep test outright using one of our flexible sleep apnea payment options.
How do I know if my insurance covers oral appliances?
Most health care plans view oral appliances as a treatment for a medical issue rather than an oral health treatment and cover the treatment and required equipment. However, you should check with your insurance provider to verify this before seeking treatment. When you schedule your consultation with our providers at Healthy Sleep Midwest, we can assist you with contacting insurance and validating your access to benefits.
Does insurance cover the sleep study?
Although insurance coverage for oral appliances can be tricky, coverage for sleep studies is typically consistent. If your doctor requests a sleep study to diagnose or treat a disease, your insurance will cover it. Sleep studies help medical practitioners diagnose and prevent health complications like many diagnostic tools. Insurance companies are more inclined to cover these studies.
What information will my insurance require to cover oral appliances?
If your insurance covers oral appliances, they will use the same criteria for continuous Positive Airway Pressure (CPAP) therapy, including a written prescription from your doctor. However, unlike the CPAP device, insurance will not require you to undergo a trial period to obtain coverage.