Does Insurance Cover Mouth Guards and Other Dental Appliances

Insurance coverage for mouth guards and other dental appliances can be a bit confusing, but don't worry, I've got you covered. Many insurance plans cover mouth guards for athletes or individuals with a high risk of dental injury, such as those who participate in contact sports.

Some insurance plans may require a doctor's prescription for a mouth guard, while others may not. It's essential to check your policy to see what's covered and what's not.

Many insurance plans also cover other dental appliances, such as night guards for teeth grinding or sleep apnea devices. However, the level of coverage and the specific types of appliances that are covered can vary widely.

It's always a good idea to review your policy and ask questions before purchasing a dental appliance to ensure you understand what's covered and what's not.

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Most dental insurance companies do not cover oral appliances that treat sleep apnea, so you'll need to contact your medical insurance provider to confirm coverage.

You'll need to have a sleep study prior to contacting your medical insurance carrier to determine the severity of your OSA, which is necessary for benefit verification.

To determine if your medical insurance covers your oral appliance, you can call the eligibility & benefits department using the contact numbers on your medical insurance card.

The insurance representative will want to know the diagnosis code for OSA, which is G47.33, and the procedure/equipment billing code for the custom sleep appliance, which is E0486.

Most health insurance plans categorize oral appliances for OSA as medical equipment or devices, so reimbursement is typically under the coverage for Durable Medical Equipment (DME).

You may need preauthorization for treatment, so be sure to ask your insurance carrier about preauthorization or precertification rules.

Medicare does provide coverage for custom oral appliances for OSA, and for a patient to receive reimbursement, the treating dentist must be enrolled as a Medicare DME Supplier.

Even if your snoring sounds stop with the placement of an oral appliance, you may still be experiencing sleep apnea episodes, so it's essential to have a follow-up sleep study.

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If your plan does cover oral appliances, your dental practice will need information from your medical insurance card and a copy of your sleep study to communicate with your medical insurance carrier.

You can help facilitate the reimbursement process by providing the necessary documentation and following up with your insurance carrier once the claim is filed.

Sleep apnea is a serious problem that affects many people, and it's characterized by pauses in breathing or shallow breaths during sleep, which can last for up to 10 seconds or even longer.

Most people don't know they have sleep apnea until their sleeping partner tells them or their doctor or dentist tells them they might have it.

Sleep apnea can be treated with an oral appliance, a custom-made device that fits comfortably in your mouth and can decrease snoring and help with obstructive sleep apnea (OSA).

Oral appliances are not typically covered by dental insurance, but most medical insurance carriers do cover them.

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To determine if your medical insurance covers your oral appliance, you'll need to contact your medical insurance provider and confirm that the sleep appliance you're interested in will be covered 100% or a certain amount.

Most health insurance plans categorize oral appliances for OSA as medical equipment or devices, so reimbursement is typically under the coverage for Durable Medical Equipment (DME).

You'll need to have a sleep study prior to the benefit verification call to determine the severity of your OSA, as this information is required for benefits to be determined.

To receive preapproval, the insurance will also want to know the procedure/equipment billing code for the custom sleep appliance, which is E0486 – ORAL DEVICE/APPLIANCE — USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY.

Medicare does provide coverage for custom oral appliances for OSA, but the treating dentist must be enrolled as a Medicare DME Supplier.

Even with Medicare coverage, you'll still need to have a sleep study following delivery of an oral appliance to make sure it's doing its job.

If your plan does have coverage for oral appliances, the dental practice will need your medical insurance card and a copy of your sleep study to communicate with your medical insurance carrier.

It's essential to follow up with your insurance carrier once the claim is filed, as you have the most clout to get things done and receive access to potentially life-changing treatment.

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Insurance plans can typically be verified in advance for coverage once you have a sleep test verifying obstructive sleep apnea. You can look for your policy's Summary of Benefits and Coverage letter, or reach out to your insurance company to find out if your sleep study and oral appliance therapy are covered.

Most insurance plans treat a sleep oral appliance as Durable Medical Equipment (DME), which may have a separate deductible and copayment amounts. This can vary from one medical insurance carrier to another, so it's best to refer to your policy for details on how it covers DME.

You can expect to pay a copayment or percentage of coinsurance for the oral appliance, and you may need to meet a deductible before coverage kicks in. It's essential to have a sleep study prior to the benefit verification call to determine the severity of your OSA, as this will affect your insurance coverage.

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Here are some key points to consider when it comes to insurance coverage for oral appliances:

Most dental insurance companies do not cover oral appliances that treat sleep apnea, and only medical insurance carriers cover them. To confirm coverage, contact your medical insurance provider to see if the sleep appliance you're interested in will be covered 100% or only a certain amount.

You can typically determine if your medical insurance covers your oral appliance by contacting the eligibility & benefits department using the contact numbers on your medical insurance card. They'll want to know the severity of your OSA, which is usually determined by a sleep study.

Most health insurance plans categorize oral appliances for OSA as medical equipment or devices, so reimbursement is typically under the coverage for Durable Medical Equipment (DME). This is the same benefit category as medical equipment like electrical stimulator units for chronic pain, wheelchairs, and walkers.

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To receive preapproval, your insurance will want to know the procedure/equipment billing code for the custom sleep appliance, which is E0486. They may also require preauthorization in advance, so be sure to have the office inquire about preauthorization or precertification rules.

If your plan does cover oral appliances, you'll typically need to provide your medical insurance card, a copy of your sleep study, and clinical notes from your first visit to the dental practice. Your physician and the dental practice team can assist with reimbursement by providing the necessary documentation.

It's essential to follow up with your insurance carrier once the claim is filed, as you have the most clout as the member or "owner" of the insurance plan.

Finding out your insurance doesn't cover night guards can be a major bummer. If this is your situation, you have two major options that won't cost you an arm and a leg.

One option is to try over-the-counter mouth guards. These can be a more affordable alternative to custom-fit night guards.

You can find over-the-counter mouth guards at most pharmacies or online. They come in various sizes and materials, so you can choose the one that works best for you.

Another option is to consider custom-fit night guards. While they may be more expensive than over-the-counter options, they can provide more relief and protection for your teeth.

Custom-fit night guards can be made by a dentist or a specialized lab. They're designed to fit your teeth perfectly, reducing the risk of discomfort or injury.

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