Medical Insurance Covers Oral Appliances
Once you and your dentist have come up with a treatment that will suit you, the next thing to tackle is whether your medical coverage will cover the cost of the treatment. You will realize that oral appliance devices are necessary and will reduce your discomfort and even save relationships. Most dentists will offer their services in managing sleep apnea, as it helps the patient effectively.
Most medical insurance plans will cover custom-made dental appliances. Therefore, taking care of the necessary paperwork is crucial when deciding to have an oral appliance device fitted.
Documents that the Insurance Companies Require when Fitting Oral Appliances
You will realize that, depending on your insurance provider. Most documents will vary. Still, most will require a copy of your sleep questionnaire score, sleep study, clinical notes, screening appointment, and doctor’s prescription for the oral appliance. In addition, some insurance providers require that you provide your signed proof of delivery form.
How to Determine if Your Medical Plan Covers for Oral Appliance
The first step is to call your insurance provider and check if your plan will cover the cost of having an oral appliance fitted. Next, have your sleep study notes show your provider the severity of your condition. Once the situation has been determined, it will show the importance of a custom oral appliance.
You will realize that most medical insurance providers categorize oral appliances as medical equipment. Like medical equipment, an oral appliance falls under the durable medical equipment (DME) category. Your insurance provider should provide the following information while they are carrying out the verification process:
- The deductible amount available on your cover,
- Preauthorization requirements
- Co-payment percentages
- How much of your yearly deductible have you met?
The Types of Oral Appliances Covered by the Medical Plan
In the United States, over 100 FDA oral appliances are approved and readily available to dentists who make custom-made sleep appliances. Some medical insurance providers insist that your oral appliance be published on Medicare’s Product List. Therefore, ensure you comply with the terms and conditions set by your medical coverage providers.
Your insurance representative should be able to tell you if your plan covers an oral appliance, even if not the exact dollar amount, before you have the dental device custom-made. You should also be in a position to know if your deductibles will differ since oral appliances are treated as durable medical equipment. Since most medical equipment will carry a different deductible, knowing the benefits of your coverage is crucial.
Will medical insurance Cover for mouthpieces?
It is crucial to note that while most insurance providers cover oral appliances after you have been diagnosed with sleep apnea, snoring is usually not covered. For example, suppose your doctor prescribes a snoring mouthpiece to assist with your Obstructive Sleep Apnea (OSA). In that case, treating either mild or moderate sleep apnea can be considered a medical necessity. However, in most cases, oral appliances are covered to treat severe sleep apnea, where CPAP is not applicable.
Reimbursements for Sleep Screening Exams
Once you have submitted your sleep management codes and evaluation documents, most insurance providers will reimburse you for the screening exams. Some medical insurance providers will require cross-codes for your dental work and any radiographs you have taken. When you decide to bill for your exams, ensure that all your clinical notes are ready, showing your medical history and making using the medical office visit code easier.
Billing for a Follow-up Visit for Oral Appliance Adjustments
If your insurance provider will cover any follow-up visit to your dentist to adjust to the oral appliance, worry no more, as you can bill it using a medical office visit code. Most insurance providers usually put the first 90 days of the appliance adjustment into a code for the custom-made appliance. Your dentist or health provider will assist you in navigating the medical insurance billing process, asking for assistance to ensure you do not make a mess of it.