Medical Insurance Coverage for Oral Appliance Therapy
Understanding Coverage for Sleep Apnea Treatment
Is Oral Appliance Therapy Covered by Insurance?
In many cases, oral appliance therapy for sleep apnea is covered by medical insurance, not dental insurance.
Because sleep apnea is a medical condition, treatment with a custom oral appliance is considered a medical service when certain requirements are met. Understanding insurance coverage can feel overwhelming, but our team helps guide patients through the process step by step.
What Types of Insurance May Provide Coverage?
Many major medical insurance plans may provide coverage, including:
Employer-sponsored commercial plans
Medicare (when criteria are met)
Medicare Advantage plans
Some secondary or supplemental plans
Coverage varies by plan, and benefits depend on individual policy details.
What If You Cannot Tolerate CPAP?
Many insurance plans recognize that CPAP is not tolerated by all patients.
Coverage for oral appliance therapy may be available if:
CPAP was attempted but not tolerated
CPAP use is medically contraindicated
The patient prefers an alternative supported by clinical guidelines
Documentation from your medical provider is often required.
Medical Insurance vs Dental Insurance
Although oral appliances are made by a dentist, treatment for sleep apnea is billed through medical insurance.
Key points:
Sleep apnea is a medical diagnosis
Coverage is based on medical necessity
Dental insurance typically does not cover sleep apnea appliances
Medical insurance often provides significantly better coverage
This distinction is one of the most common sources of confusion for patients.
What Is Required for Insurance Coverage?
How We Help With Insurance
Our team assists patients by:
Verifying insurance benefits
Reviewing sleep study requirements
Coordinating required documentation
Communicating with medical providers
Guiding patients through authorization steps
We aim to make the insurance process as clear and stress-free as possible.
Most medical insurance plans require the following:
A diagnosis of obstructive sleep apnea
A sleep study (home or in-lab)
A prescription or referral from a medical provider
Documentation of medical necessity
Treatment provided by a qualified dental sleep medicine provider
Meeting these requirements allows insurance companies to evaluate coverage eligibility.
What Out-of-Pocket Costs Should I Expect?
Out-of-pocket costs vary depending on:
Your specific insurance plan
Deductibles and co-insurance
Annual out-of-pocket maximums
Whether prior authorization is required
Many patients are surprised to learn that insurance often covers a significant portion of treatment.
We review benefits and help patients understand potential costs before treatment begins.
What If Insurance Does Not Cover Treatment?
If insurance coverage is limited or unavailable:
Self-pay options may be available
Flexible payment arrangements can be discussed
We help patients understand all available options
Our goal is to help patients make informed decisions that fit both their health needs and financial situation.
Dr. Ola is In-Network and participates with most major medical insurance carriers including:
Blue Cross Blue Shield, Blue Care Network, Priority Health, Medicare, ASR Health Benefits, Tricare, United Healthcare
Ready to Learn What Your Insurance Covers?
If you’ve been diagnosed with sleep apnea, or suspect you may have it , a consultation can help determine:
Whether oral appliance therapy is appropriate
What documentation is needed
How insurance may apply to your care
