Does Medical Insurance Cover a Sleep Apnea Oral Appliance?

If you've been told you need an oral appliance for sleep apnea, your first question is probably who pays for it. Sleep and airway care is a medical service, so at A-Z Sleep & Airway Center it runs through your medical insurance, even though a dentist makes the appliance. Below, we walk through what dental and medical plans cover, what you may still owe, and how we check your benefits before you decide on anything.

Does dental insurance cover an oral appliance for sleep apnea?

In our experience, no. Dr. Ashlee Goodman-Tabari puts it plainly: "dental doesn't cover anything with sleep." That includes every step of your care: "Not a sleep study, not an oral appliance, not a sleep evaluation, anything."

Obstructive sleep apnea is a medical condition. The muscles in the back of your throat relax during sleep and narrow or close your airway. Left untreated, sleep apnea is linked to problems such as high blood pressure and heart trouble, according to Mayo Clinic's overview of obstructive sleep apnea.

So your care belongs on your medical plan, and most of our sleep patients are thrilled to hear we bill it there.

Does medical insurance cover an oral appliance for sleep apnea?

It can. We bill your sleep care to your medical insurance, we accept all major medical insurances, and we handle the billing for you. What's covered depends on your specific plan, which is why we verify your benefits before treatment.

Medical billing reaches past the appliance itself. Dr. Goodman-Tabari is able to bill medical for your sleep visit, your consultations and your x-rays, too.

An oral appliance is a custom mouthpiece you wear at night. It moves your lower jaw forward to help keep your throat open while you sleep. A CPAP machine is a common treatment for obstructive sleep apnea, and Mayo Clinic's guide to sleep apnea treatment notes that an oral appliance can be an option for some people with mild or moderate sleep apnea. For plan details, see our page on insurance and coverage for oral appliances.

How much will I pay out of pocket for an oral appliance?

What you pay depends on your medical plan. Your deductible and your plan's other terms still come into play.

You'll see what to expect before treatment starts. Before your first visit, we gather your medical insurance information and send off a verification of benefits. At your consultation, we go over:

• Your sleep history, your symptoms and anything you've already tried
• Examples of our appliances, chosen to suit your teeth, including whether you have missing teeth or grind your teeth
• Your benefit breakdown and the cost you may incur

If you'd like to spread out what you owe, we offer financing through Cherry, which breaks your care into smaller, manageable payments. Our team is happy to help you apply during your visit.

If you don't have medical insurance, our new patient special makes your initial sleep and airway consultation $199.

Do I need a sleep study before insurance pays for an oral appliance?

Yes. Every appliance we make is backed by a real diagnosis, and a sleep study is always the first step. If you've had a sleep study within the last year, we can bill your insurance with it. If you haven't, we arrange a home sleep test, and a sleep physician meets with you by telemedicine to go over your results.

The process usually runs like this:

1. You complete our sleep questionnaire and new patient forms before you arrive.
2. At your consultation, we take a digital scan of your mouth and a 3D image. Dr. Goodman-Tabari does a head and neck exam and reviews everything with you on screen.
3. You take your sleep test in your own bed with a small wearable device, like a watch. Results come back to us the next day.
4. A sleep physician meets with you by telemedicine to review your results.
5. You come back in to be fitted for your oral appliance.
6. We retest to confirm you're getting enough oxygen and make adjustments until your treatment works.

If you've already been diagnosed and can't tolerate your CPAP, the process moves a lot quicker. As Dr. Goodman-Tabari says, "some treatment is always better than no treatment."

Why do Glen Allen patients choose A-Z Sleep & Airway Center for oral appliance therapy?

Dr. Goodman-Tabari treats her own sleep-disordered breathing with an oral appliance. She understands firsthand how much better life feels once your airway is supported at night, and she takes time to walk you through your options and make sure your treatment is optimized.

Dr. Goodman-Tabari and our whole team completed a mini residency on sleep together, and we handle your medical billing for you. Your screening, testing and treatment all happen under one roof, inside the Shops at Cross Ridge just off Staples Mill Road, with easy parking right outside.

We're a dedicated sleep practice, so sleep and airway care gets our full attention. Learn more about oral appliance therapy in Glen Allen, VA.

If you snore, wake up tired, or have been told you stop breathing at night, call us at (804)-767-2507 and we'll check your medical benefits before your first visit. You can also book your consultation online.

Published by A-Z Sleep & Airway Center.