In many cases, health insurance will cover all or part of the costs of getting an oral appliance for obstructive sleep apnea (OSA) treatment. This can vary from one insurance policy to another. Some insurers may refund/rebate different amounts depending on the level of cover.
How can I predetermine if my medical insurance covers an oral appliance? Patients should call their insurer’s benefits department using the contact number on the medical insurance card. It is important to have sleep study results and other medical information (if available) before the call to ensure medical eligibility and necessity and determine whether the policy’s criteria is met, to receive coverage. In many instances a diagnosis for OSA and the severity must be known before the benefits can be determined.
Oral appliances are typically covered for severe OSA if the patient cannot tolerate CPAP or in some cases if the patient refuses CPAP (however check with your medical insurer first).
What are the billing codes? The item code available for an oral appliance to treat OSA is 984 – Bimaxillary oral appliance for DX snoring and sleep apnea (adult). It is important for patients to check with their private health insurer as to whether their policy provides a rebate before they proceed with ordering an oral device.
Patients – check with your dental provider what item codes they will use before asking your insurer whether you qualify for any rebate. Examples of additional codes a dentist may claim include: 014 – consultation; 071 – diagnostic models (x 2). Also ask your insurer whether a sleep study or diagnosis for OSA is mandatory for any rebate for an oral device (Item 984).
Does insurance cover snoring devices? An oral appliance for snoring alone is not covered by medical insurance. However, snoring is a symptom of sleep apnea and if OSA is diagnosed, then most medical insurers will offer coverage for an oral appliance.