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.

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.

DENTAL SLEEP AND TMD CENTER OF ILLINOIS

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