Insurances That Cover Oral Appliances

Do you struggle with obstructive sleep apnea (OSA) and wish for an alternative to continuous positive airway pressure (CPAP) that your insurance will cover? We may have the solution you’re looking for.

At Spark Sleep Solutions in San Ramon, we provide oral sleep appliances that can restore the restful sleep you need in a less intrusive manner than CPAP does. Our appliances require no unwieldy headgear, tubes, or parts to replace. They provide benefits such as:

  • Noise-free operation
  • The ability to sleep in any position
  • Letting you speak or drink while wearing them
  • Being easy to travel with

It’s likely that your health policy will cover your appliance since we accept most types of medical insurance and work with major insurers to help maximize your benefits to cover CPAP alternatives. We’re happy to coordinate everything with your insurance company to make your experience as convenient as possible. We work with HMOs, PPOs, Medicare, Kaiser Permanente, and other insurers to provide oral appliances for sleep apnea.

General Insurance Requirements for These Appliances

Since we offer sleep apnea appliances to treat a medically diagnosed condition, your dental insurance will not cover them. You must use your medical insurance.

Typically, insurance providers will require:

  • An approved sleep study leading to a diagnosis of obstructive sleep apnea
  • Reasons why CPAP treatment won’t work well for you
  • A written prescription from your sleep specialist stating that the appliance is medically necessary

These oral devices can typically help patients with mild, moderate, or severe OSA. However, some insurance companies ask patients with severe sleep apnea to try positive airway pressure (PAP) therapy before considering an appliance. If you’re approved for our sleep apnea device, insurance will usually allow for a new one every three to five years.

Health Maintenance Organizations (HMOs)

An HMO limits services to a local network of healthcare providers and facilities. To obtain your HMO’s coverage for an oral appliance to relieve your sleep apnea, you will need to consult a provider within your network.

Preferred Provider Organizations (PPOs)

A PPO generally offers more flexibility than an HMO when it comes to choosing your healthcare provider. In addition to the general criteria listed above, your PPO may require:

  • A failed CPAP trial
  • A qualified dentist’s confirmation that the appliance is suitable and correctly designed
  • Pre-authorization from your insurance company

Medicare

This federal insurance program helps to pay healthcare costs for people 65 and older as well as some younger people with certain disabilities. In addition to the usual Part A and Part B coverage, you may have a Part C or Medicare Advantage Plan that involves a private company.

Medicare typically requires that your sleep apnea appliance be PDAC-approved and FDA-approved. It must also meet Medicare’s “reasonable and necessary” standards.

Kaiser Permanente

The largest nonprofit health plan in the United States, Kaiser Permanente is unique. It’s an HMO that combines health insurance with the delivery of healthcare services through the hospitals and clinics it owns and the doctors it employs.

After you complete your sleep study and obtain a prescription for an oral appliance from your physician, Kaiser Permanente’s Durable Medical Equipment (DME) department will order the device.

Conclusion

If you have obstructive sleep apnea in San Ramon or any of our other Bay Area locations, many insurance plans cover the oral appliances we offer. Specific policies vary, so consult your insurance provider to go over the details of your individual coverage. Our team at Spark Sleep Solutions will be happy to check your insurance to help you estimate your coverage and anticipated out-of-pocket costs.