Does Medicare Cover Oral Devices for Sleep Apnea?

Question of the Week – Does Medicare Cover Oral Devices for Sleep Apnea?

Does Medicare cover oral devices for sleep apnea? The answer is YES! Watch and listen as Dr. Lydia Sosenko answers the complicated question. She also explains the importance of working with an office that is experienced in working with Medicare. Call our office today at (630) 369-5508 to schedule your appointment.

Dental Sleep and TMD Center of Illinois is a premiere snoring and sleep apnea treatment center in Naperville. We have been providing the CPAP alternative treatment of Oral Appliance Therapy successfully for over 15 years. We are extremely passionate in helping individuals that have been struggling with CPAP therapy in Naperville, Lisle, Aurora, Bolingbrook and surrounding Chicago suburbs.

Can I Get Snoring Treated and Paid For With Medical Insurance?

Can you get snoring treated and paid for with medical insurance? The quick answer – it depends.

get snoring treated and paid for

You have options to get snoring treated and paid for

Snoring is often a sign of a more serious condition called obstructive sleep apnea (OSA).  During obstructive sleep apnea, pauses or stoppages in breathing during sleep lead to oxygen starvation to vital organs. Treatments for OSA are most often covered under medical insurance guideline for reimbursements.  Some insurances may have a “minimum” amount of severity that they will begin coverage.

We have also seen (although far less common) some medical carriers have benefit coverage for upper airway resistance syndrome (UARS) or primary snoring depending on the severity of symptoms. These symptoms may include excessive daytime sleepiness (EDS). UARS and primary snoring are conditions that during a sleep evaluation patients did not “score” enough to reach the mild diagnosis range.  These patients may still in fact have apnea events (stoppages or pauses in breathing), just not enough to reach that number which classifies them as “mild” OSA.

Our practice has over 17 years of experience in workup with snoring and apnea patients.  We would be more than happy to screen your oral cavity, discuss possible treatment options and refer you to appropriate medical providers as needed to get your snoring resolved.

Dental Sleep and TMD Center of Illinois, a premiere snoring and apnea treatment center in Naperville, has been providing the CPAP alternative treatment of oral appliance therapy for over 17 years successfully.  We are extremely passionate in helping individuals that have been struggling with CPAP therapy in Naperville, Lisle, Aurora, Bolingbrook and surrounding Chicago suburbs.  For more information on this physician-recommended treatment option. visit www.TiredOfSnoring.com or call us at (630) 369-5508.

Does Medical Insurance Cover Oral Appliance Therapy?

Please watch this important sleep apnea video on helpful questions on medical coverage for oral appliance therapy, the most frequently prescribed CPAP alternative for apnea treatment.  It also covers what criteria is needed for medical insurance coverage that your doctor’s office will need for filing your claim.

Contact us directly for further details – 630/369-5508

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Is Oral Appliance Therapy Covered by My Insurance?

Oral appliance therapy for obstructive sleep apnea is covered by most medical insurance companies and government payers which includes Medicare.

Like CPAP therapy, there are required records that the dentist must include in order to acquire coverage including a written prescription from the patient’s physician or sleep doctor.

Most insurance companies do NOT require a trial CPAP failure or CPAP therapy in order to cover oral appliance therapy.

  • Very few dentists are contracted with medical insurance companies.  It is extremely difficult task to communicate with insurance companies.  We do everything we can to help our patients receive out of network benefits.
  • There are many varieties of oral appliances available and a great variability of lab costs associated with these appliances.  Most dentists offer several appliances, much like a DME company offering different CPAP machines and masks.  The fee for the appliance will depend on which appliance will be most effective and comfortable for the patient.
  • Most dentists ask for partial payment the same days the records and impressions are taken for oral appliance therapy.  The medical insurance is filed the same date as records.  The oral appliances are custom and returning the appliance is not an option.
  • A dentist must be an approved DME provider to bill to Medicare.
  • Medicare will cover oral appliance therapy based on the same criteria as CPAP therapy.
  • Medicare coverage for oral appliance therapy does vary state to state.
  • Military insurance does cover oral appliance therapy.

If you are interested in oral appliance therapy and your primary doctor or sleep doctor believes that an oral appliance is a good option for you, then there are several things your referring doctor can do to help you receive the maximum benefit allowed by your insurance.

  • A written prescription is needed for oral appliance therapy
  • Provide a copy of your diagnostic sleep study
  • Chart or record notes from your physician
  • If CPAP was tried and failed, those notes may be helpful in describing those facts.

Be kind to the dental office that is filing your medical insurance for you.  This process takes time, and the office does try to make this as easy as possible.

If you think oral appliance therapy is a good option for you, or if you have tried and failed or cannot tolerate CPAP, please talk to your doctor.  Untreated apnea is dangerous and will negatively affect your quality of life.

Dental Sleep and TMD Center of Illinois, a premiere snoring and apnea treatment center in Naperville has been providing the CPAP alternative treatment of oral appliance therapy for over 15 years successfully. We are extremely passionate in helping individuals that have been struggling with CPAP therapy in Naperville, Wheaton, Aurora, Bolingbrook and surrounding Chicago suburbs. For more information on this physician recommended treatment option, visit www.TiredOfSnoring.com or call us at (630)369-5508.

Do I have to try using a CPAP machine before getting an oral device to treat my apnea?

This is a great question that I get asked quite often. And the answer is not a simple yes or no.

Oral appliance therapy (OAT) is widely recommended by physicians as a treatment choice for obstructive sleep apnea (OSA). Most current standard of care guidelines include that OAT is a suitable choice of treatment for mild to moderate OSA, for severe who cannot tolerate or failed CPAP treatment, or for those who prefer to have an oral appliance. However, in many cases patients are automatically sent through the path of CPAP.

What we have found over the years working with oral appliance therapy for the treatment of obstructive sleep apnea is that there are several factors regarding insurance reimbursement for OAT that need be considered.

Whether oral appliance therapy gets covered without attempting CPAP therapy may depend on the following:

  • Specific plan of the policy
  • Severity of the diagnosis of OSA
  • The presence of other symptoms like excessive daytime sleepiness
  • Occupation restrictions or necessity of treatment usage monitors
  • How recent the sleep testing diagnosis occurred
  • Medical notes on factors that may contribute to poor CPAP tolerance

For many, CPAP does not need be attempted for medical insurance reimbursement of OAT for the treatment of OSA.

To find out if your medical insurance guidelines dictate CPAP failure prior to OAT, call us at (630) 369-5508 and we can review your particular situation after a general screening is performed.

Dental Sleep and TMD Center of Illinois, a premiere snoring and apnea treatment center in Naperville, has been providing the CPAP alternative treatment of oral appliance therapy for over 15 years successfully. We are extremely passionate in helping individuals that have been struggling with CPAP therapy in Naperville, Lisle, Aurora, Bolingbrook and surrounding Chicago suburbs. For more information on this physician recommended treatment option, visit www.TiredOfSnoring.com or call us at (630) 369-5508.

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DENTAL SLEEP AND TMD CENTER OF ILLINOIS

1100 SHERMAN AVE., SUITE 103 | NAPERVILLE, IL | PHONE: 630.369.5508