Medical Billing

Dr. Nugent will utilize your medical insurance for the 3D xray, Radiologist interpretation, Home Sleep Study and Oral Appliance.

Pasadena Texas Sleep Apnea Doctor

Does my insurance cover oral appliances?

Obstructive sleep apnea (OSA) is a medical disease, reimbursement falls under your Health Insurance Plan, not a dental plan. In fact, there is no dental insurance codes for treating OSA.

Frequently asked questions about insurance coverage for oral appliances are answered below.

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Will Health Insurance Cover My Sleep Study?

Coverage of sleep apnea treatments can vary widely from one medical insurance provider to another. However, coverage of sleep studies is often more constant. Generally, most insurance companies will cover a sleep study if it is indicated as necessary for diagnosis and treatment of a disease. The only way to diagnosis a sleep disorder is with a sleep study. Therefore, sleep studies to identify a problem with sleep apnea generally meet these criteria.

 

Does Health Insurance Cover My Sleep Apnea Treatment?

Coverage of sleep apnea treatments can vary. Plus, it is dependent on your individual plan. In some cases, your insurance may dictate that you attempt one type of treatment before a different treatment is covered. For example, you may be forced to by your insurance to try treatment with a CPAP machine before insurance will cover an oral appliance. If you have already tried CPAP and simply could not wear it, you may be eligible for an oral appliance. Usually, a signed letter of CPAP intolerance is needed to send to your insurance company.

Pasadena Texas Sleep ApneaWhat oral appliances are covered by my medical insurance?

When the sleep apnea oral device is custom made, delivered by a qualified dentist and FDA approved most insurances will pay. There are numerous oral devices and our Sleep Dentists will choose the most appropriate device for you.

Does my insurance policy cover oral appliances?

Almost all medical insurance plans can be verified in advance for coverage of oral appliances.  Medical plans are extremely complex. Our office uses multiple benefit verification companies to check on your individual plan. Just bring your medical insurance card to our office so we can take down all the pertinent information.

Will my medical insurance tell me how much they cover for a mouthpiece or appliance?

Usually an insurance representative should be able to determine coverage under your policy. Although the insurance representative may not be able to tell you the exact reimbursement in advance, they can indicate if coverage is included in your plan. That is the annoying part of working with Medical Insurance. They are the one providing coverage, they know what they plan will pay but they usually will not tell us/you the exact coverage amount.

What are my deductibles?

Your deductible is specific to your plan. The deductible you have to pay may be different from your usual insurance deductible since most carriers categorize oral appliances for obstructive sleep apnea as equipment known as Durable Medical Equipment.  Equipment such as oral appliances can carry a separate deductible.

sleep apnea complications

Does medical insurance cover snoring appliances?

Unfortunately, the answer is no. Although our office can make you dental devices to help eliminate snoring, it is vital to verify that you do not have a more serious medical condition.  One of the hallmark signs of obstructive sleep apnea (OSA)is snoring. Therefore, it is imperative that we rule our OSA before fabricating a sleep appliance. The only way to test for OSA is with a sleep test.

I’m a senior and have Medicare. Does Medicare pay for sleep apnea oral appliances?

Medicare’s policy states that certain oral appliances used to treat obstructive sleep apnea are covered when specific Medicare approved criteria are met. However, our office does not accept or participate in Medicare.

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