Can I Use my Medical Insurance for Snoring and Sleep Apnea Appliances?

Can I use my Medical Insurance for Snoring and Sleep Apnea Appliances

By Mina Levi, DDS, 12/23/2014

If you suffer from sleep apnea or you snore at night, your Dentist San Francisco may recommend that you have an appliance custom-made for you, as untreated sleep apnea and snoring can lead to a number of issues. However, many patients are concerned with the relatively high cost of sleep apnea and snoring appliances and have questions about how they can have their dental or medical insurance cover the cost of the appliance. In this week’s article, San Francisco Dentist Mina Levi, DDS discusses medical insurance billing for sleep apnea and snoring appliances.

First, check dental:

If you are being seen by a dentist and the dentist is going to be fabricating the device for you, the first thing that you should check is your dental insurance coverage of the specific appliance code that the dental office gives you. For example, an occlusal guard has the code D9940, and some plans cover these types of mouth guards at 50% of the insurance company’s contracted rate. When speaking with your dental insurance company, you should ask three things:

1) What is the contracted rate for this procedure code?

2) Is this procedure code a covered benefit on my plan?

3) What is the coverage percentage rate?

Next, check medical:

Many medical policies offer coverage for oral appliances. Check with your dentist to see if they will be billing to your medical policy or if you will be needing to submit your own claim. If you are submitting your own claim, there are some things you will need to gather from the dentist:

1) A copy of the medical claim form (latest revision as of April 2014)

2) Exam notes and patient history (including symptoms, past treatments, exam findings, and treatment plan)

3) Radiographs such as an FMX or panoramic x-ray, or if those are not available then 4 Bitewings may be sufficient

4) The medical code for the appliance (this will be different from the dental code)

5) Letter/narrative of medical necessity

Another treatment that is also covered by most medical insurance companies is a sleep study, in which physicians monitor your sleeping patterns and diagnose your sleep apnea. The records from the sleep study can be sent in to the insurance company to ensure coverage of a sleep apnea appliance.

If you have questions regarding sleep apnea and related appliances, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

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