Oral Appliance Therapy and your Insurance

Bye Bye CPAP at Comprehensive Sleep Care Center (CSCC) is the only sleep center in the Washington, D.C. metropolitan area with on-site sleep medicine physicians and dentists to provide ApneaGuard with SomnoMed oral appliance therapy for the treatment of mild to moderate sleep apnea.

Why choose Bye Bye CPAP over a dental office offering oral appliance therapy?

Convenience! Our board-certified sleep medicine physicians work together to coordinate your care. Oral appliance therapy requires a prescription from a Sleep Medicine Physician for insurance purposes.

You don’t have to travel to multiple offices. All your services can be coordinated under one umbrella of care at CSCC.

Cost! You will save time and money. Many dentists charge their fees at the time of service. Most dentists can’t bill for medical services and are unwilling to wait for insurance reimbursement. This is partly due to the lab fees that are incurred by the dentist prior to the patient being fit with the appliance. Your fees at the time of service with a dentist may be up to $2,000 or $3,000 for an oral appliance for sleep apnea.

CSCC will bill your medical (not dental) insurance directly and our billing specialists will do all the behind the scenes work required for determination of your benefits and getting authorization of the oral appliance treatment by your insurer.

We accept most insurances. Medicare contracts with a national provider for all durable medical equipment (DME) related services including oral appliances for sleep apnea, so unfortunately, we cannot bill Medicare for DME related services or equipment.

Most dentist offices do not take medical insurance, only dental insurance, since they are not medical doctors. If you want to file a claim for an oral appliance from a dental office it will probably be considered an out-of-network claim. This kind of claim can require an additional deductible be met and typically only covers 30-50% of the cost for the oral appliance.

Facts about Insurance coverage for ApneaGuard℠ services

  • Oral appliance therapy is virtually always covered by medical insurance (after your deductible is met) and Tricare using the same criteria that is used for coverage of continuous positive airway pressure (CPAP) therapy
  • Just like CPAP therapy, there are several required records that the dentist must have to acquire coverage, including a written prescription for the appliance from a physician (the family physician or sleep doctor) to treat sleep apnea
  • Most insurance companies do not require a trial of CPAP or failure of CPAP therapy to cover oral appliance therapy

How do I find out how much my health insurance company will cover?

Please give us a call and we will be happy to assist you by answering your questions and setting up a consultation with one of our sleep medicine physicians to ensure you’re a candidate for our ApneaGuard℠ services.

Just like CPAP therapy, there are several required records that we must have in order to acquire coverage. Medical insurance companies do not cover treatment for snoring only.

  • In order for a physician to prescribe therapy to treat sleep apnea, a sleep study is required in order to diagnose the patient with sleep apnea. Many payers (insurance companies) require this as well
  • Most insurance companies do NOT require a trial of CPAP or failure of CPAP therapy in order to cover oral appliance therapy. Rarely, oral appliance therapy is covered under a dental plan. The VAST majority of the time it is covered under major medical or under the medical insurance DME coverage
  • If there are providers within the network, what is my coverage if I see an out-of-network provider?

Have you already had your sleep study?

If you have trouble tolerating Continuous Positive Airway Pressure (CPAP) and need an effective alternative for living with sleep apnea contact us today 703-679-0598!