Is Sleep Apnea Treatment Covered by Insurance?

After talking to your doctor and having a sleep test performed, you’ve found out that you actually have obstructive sleep apnea. This is both good and bad news because your sleep has been a problem for a while now, and you’re just happy to know why, even if it means that you have a serious disorder. Now comes the matter of treatment, or more specifically, paying for it. You have insurance, but you don’t actually know if they cover sleep apnea treatment or not. Dealing with insurance companies can be a confusing process, so today, we’re going to answer a few basic questions to make it easier for you to afford the treatment you need.

Is sleep apnea treatment covered by insurance?

Yes it is. Sleep apnea therapy, whether involving a CPAP machine or oral appliance therapy, is usually covered by medical insurance plans. This can sometimes be confusing because in the case of oral appliance therapy, the treatment is administered by a dentist, which leads many people to believe that it will be covered by their dental insurance. This is not the case.

How can I use my medical insurance to cover my sleep apnea treatment?

This is where things can get tricky. Different medical insurance plans have different criteria that have to be met before they’ll cover sleep apnea therapy. Assuming that a patient has already met their deductible or co-insurance payments for the year, some plans require that a patient submit a variety of paperwork to prove the necessity of treatment. This may include a note from the doctor who diagnosed you with sleep apnea along with test results, etc.

Oral appliance therapy is quickly becoming the preferred treatment option for patients because it is simpler to use than a CPAP machine, and this can further complicate things because some plans require that a patient prove they are CPAP intolerant before oral appliance therapy will be covered.

How can I get my insurance to cover oral appliance therapy?

There is no one-size-fits-all approach to this, but the best way to handle it is to call your insurance provider and let them know about your situation. From there, they should be able to walk you through the process.

A key thing to remember is that if they tell you that oral appliance therapy isn’t covered, be persistent and ask for the specific exception in your plan where this is outlined. In insurance coding, oral appliance therapy actually falls under “durable medical equipment,” which is the same code used for both wheelchairs and a CPAP, so this can sometimes lead to confusion on their end.

 Will Medicare cover my treatment?

Traditional Medicare will, but Medicare Advantage (HMO) may not. Once again, the best thing to do here is to be your own advocate and talk to your insurance company.

Navigating medical insurance is never fun, but when it comes to getting sleep apnea treatment, it will all be worth it in the end. To figure out if your plan covers sleep apnea therapy, simply call your insurance company and ask about your policy. If you need more help, simply reach out to a local sleep doctor or sleep dentist in your area, and they’ll likely be able to provide further assistance.

About the Author

Dr. Kenneth Mogell is a sleep dentist based in Jupiter, FL. He and his team have become insurance experts over the years, and they have helped thousands of patients get coverage for their oral appliance therapy. He currently practices at Florida Dental Sleep Disorders, and he can be reached through his website or by phone at (561) 744-4478.