Sleep apnea dental appliances, also known as oral appliance therapy (OAT), represent an effective treatment option for many people suffering from mild to moderate obstructive sleep apnea (OSA).
Although these devices have shown promising results, they are a relatively new therapy compared to traditional continuous positive airway pressure (CPAP) machines. Therefore, it’s natural to wonder if insurance will cover them.
Understanding insurance coverage for these devices helps patients make informed decisions about their treatment options while managing costs effectively.
Types of Insurance Coverage for OAT
Medical insurance typically provides primary coverage for sleep apnea treatment, while dental insurance may offer supplementary coverage due to the fact that sleep apnea is a medical condition [1]. The specific type of insurance and policy details significantly influence coverage levels. Fortunately, Medicare and many private insurers recognize oral appliance therapy as a valid treatment option for sleep apnea when certain criteria are met.
Requirements for Coverage
In order to qualify for coverage for sleep apnea treatment via oral appliance therapy, patients typically need to have:
- Documented sleep apnea diagnosis through sleep study
- Prescription from a licensed sleep physician
- Failed CPAP therapy or inability to use CPAP
- Specific severity levels of sleep apnea
- Pre-authorization from an insurance provider
- Treatment by a qualified dental provider
- Documentation of medical necessity
Coverage Variations
Coverage levels vary widely between insurance providers and specific plans [2]. For example, similar say to insurance coverage for chiropractic care, some policies cover the entire cost after deductible, while others require significant co-payments. Even with insurance coverage, patients may have out-of-pocket expenses, such as deductibles, co-payments, or costs for replacement devices. Many providers offer payment plans or financing options to help manage these expenses.
Maintenance and Replacement Coverage
Insurance policies often specify coverage terms for device maintenance, adjustments, and replacements when it comes to oral appliances for sleep apnea. Some policies limit the frequency of replacements or require documentation of wear and tear before they offer coverage for replacement. For example, some insurance plans, like those through Medicare, only cover replacements every five years, so this is important to take into account [3].
Ask Your Dental Practice About OAT Coverage
Dental offices experienced in sleep apnea treatment can assist with insurance verification and claims submission for OAT for sleep apnea. Contact your dentist and insurance provider to understand your specific coverage options for sleep apnea dental appliances. A thorough review of your benefits can help you make informed decisions and get the treatment you need to start getting a good night’s sleep.
Sources:
- https://aadsm.org/docs/FAQ_Reimbursement_3-19.pdf
- https://www.health.harvard.edu/blog/dental-appliances-for-sleep-apnea-do-they-work-2021042822476
- https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52512
