Will My Health Insurance Cover Oral Appliances for Snoring and Sleep Apnea?
When it comes to mandibular advancement devices, many patients ask “Will my insurance company cover this expense?” There are numerous factors that determine if and how much health insurance companies are willing to cover.
Dental Appliances for Obstructive Sleep Apnea
It’s important to keep in mind that most health insurance companies are not likely to cover an appliance used to control snoring alone. On the other hand, many companies will cover a portion (or sometimes all) of the bill for an oral appliance deemed medically necessary. Generally, this is for appliances custom-made to manage obstructive sleep apnea. For such devices, many private insurance firms, Medicare, Medicaid, and Obamacare often will provide partial to full coverage.
Insurance Responsibilities
Although these devices fit in the mouth, coverage typically comes from health insurance, rather than dental insurance. This is due to the fact that they are used to treat sleep apnea and other medical conditions. Because so many insurance companies are available, it’s difficult to predict exact amounts they will pick up. Even though the doctor can’t give an estimate, the process for coverage generally takes 6-8 weeks.
Submit the Proper Documentation
In order to apply for coverage, the patient must provide an affidavit of intolerance to CPAP (explaining CPAP’s ineffectiveness at treating sleep apnea); a sleep study is also usually required. Insurance companies evaluate the entire package and offer an estimated coverage amount — exact figures can’t be provided until after the treatment is finished.
Estimated Cost
It’s advisable to not count on health insurance to cover the entire cost of the oral appliance. Some companies are more generous than others — better insurers may cover the entire cost of the appliance, while others will only pick up about half the tab. Further, the cost of the appliance is influenced by the chosen brand (ranging from $2000 – $3000) as well as fees for the initial consultation, fitting, adjustments, and follow ups.
Considering the fees and insurance coverage, most patients can anticipate an out-of-pocket fee of $1500 or more for the appliance.
Oral Appliances for Snoring
For those who require oral appliances to control snoring that is not related to sleep apnea, insurance coverage is unlikely. Fortunately, cheaper alternatives exist that range from $200 – $500. However, patients should be aware that these products may not be as effective as those that are custom-made.
Consult Your Primary Care Physician or Dentist
When it comes to health expenses, individuals should always consult with their primary care physician or dentist before deciding on a course of action. Depending on the particulars of the health insurance policy in addition to the severity of the sleep apnea, there is a chance that the insurance company will pick up a huge portion of the cost. Determining what the insurance covers requires submitting the appropriate documentation.
Ready to Seek Treatment?
If you think you could benefit from an oral appliance, there are a few steps you should take as you pursue treatment and ask for insurance coverage. Talking with a sleep specialist is the best way to get the process rolling, and a copy of the sleep study will be necessary to get coverage. Furthermore, an affidavit of CPAP intolerance may be required.
Ultimately, it is important to remember that there is a great deal of variation in the coverage offered by health insurance companies. You may end up paying $1500 or more out-of-pocket, so be sure to make the best decision for you.
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