How to Use Your Health Insurance to Cover Sleep Apnea Treatment with an Oral Appliance
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How to Use Your Health Insurance to Cover Sleep Apnea Treatment with an Oral Appliance

It’s good news when you’ve found a solution for a restful and healthy night’s sleep. It’s equally good when you discover that your oral sleep appliance can be covered by your health insurance.

To clarify, most dental plans will not reimburse you for sleep apnea treatment. But before you panic, medical insurance can provide a reimbursement.

The key is in the diagnosis

Your dentist can bill your medical coverage for the appliance. Billing changes and applying specific tips can assist with the process.

Again, it’s all about diagnosing your condition and applying the proper coding when billing. Here’s how this applies to us, as your dentist:

”According to the International Classification of Disease, the medical diagnosis of OSA should be coded as ICD 327.23. This ICD code applies to child or adult OSA when diagnosed by a laboratory or home overnight sleep study and interpreted by a sleep physician. A copy of the sleep study should be sent to the medical insurer with your office notes and a letter of medical necessity or written order from a physician. Medical histories should document high blood pressure, daytime sleepiness, cognitive or mood disorders, heart disease, and other consequences of sleep apnea.” [1]

Getting the most from your medical insurance

It’s common for medical policies to cover oral appliances. Medicare made this possible in 2011. And since then, medical plans have improved their coverage allowances for FDA approved oral devices.

To assure that coverage is available, begin by carefully checking your benefits. Do this by phone or request a pre-authorization.

And we’re happy to assist if you have any related questions.

Oral appliances are considered “durable medical equipment (DME).” This gives reason for them to be included under your medical coverage following a necessary diagnosis.

And if you qualify for Medicare…

Approved oral appliances for obstructive sleep apnea are covered. You must meet certain criteria such as:

  •               A visit to your physician prior to treatment using an oral appliance
  •               A reimbursement that requires your dentist be enrolled as a Durable Medical Equipment (DME) supplier
  •               Noting that a DME supplier cannot order a sleep test according to your Medicare benefits

What about sleep studies?

It’s also common for a comprehensive health insurance plan to cover a home or laboratory sleep study. Some insurance companies even require a home study rather than a lab study in order to receive a reimbursement.

This requirement reduces the insurance company’s costs if sleep apnea is possible as a diagnosis. Your co-payment will also be reduced if this applies to you.

Plus, you can expect a more comfortable experience by having a home sleep study. And a diagnosis can be more acceptable as well under those conditions.

Improve your sleep quality and eliminate your health risks

Your sleep study helps confirm the necessary diagnosis that allows for insurance coverage. It opens the door to alternative sleep therapy using an oral appliance instead of the traditional CPAP technology.

Sleep dentistry utilizing a custom-designed oral appliance is more comfortable and convenient.

  •               Experience uninterrupted breathing
  •               Reduce or eliminate the health risks associated with sleep apnea
  •               Sleep more restfully

Contact your St. Petersburg Cosmetic Dentistry Specialist, Dr. Roberto Macedo, DDS, MS, PhD. about your sleep related problems, including sleep apnea. Schedule your initial consultation to discuss sleep dentistry as a solution and how your treatment could be covered by your medical insurance.

[1]              https://www.dentaleconomics.com/articles/print/volume-104/issue-11/features/medical-billing-for-snoring-and-sleep-apnea-appliance-therapy.html

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