I am a dentist working in dental sleep medicine. I have had very mixed success in securing medical insurance coverage for oral sleep apnea appliances. I would agree with your sleep doctor that, as a practical matter, the insurance companies tend not to deal in good faith when covering these appliances. Firstly, you usually have to pre-certify the procedure and if you don't do it, you are a dead duck. Secondly, your documentation has to be comprehensive and you have to dot all the I's and cross all the T's. Thirdly, since most dentists are out of network for medical coverage, there tends to be a very high deductible and a lower out-of-network payment percentage. The bottom line is that you often do end up getting skunked on the coverage. Nevertheless, a few lucky patients with truly first rate medical coverage do end up getting significant coverage. I would put the percentage at about 20% in my practice. So it isn't hopeless for everybody. You have to take it case by case. I really like the Tap appliance and have used it for the majority of my patients. However. if you are breaking them that frequently, you may have an unusually severe bruxing problem. I have had success with another appliance called the Luco Hybrid for my bruxers. It is made out of metal and suppresses bruxing. See: www.lucohybridosa.com. I hope that this helps you. A.B. Luisi, Jr.D.M.D.. The Naplers Center For Dental Sleep Medicine.
Let me add one thing. Patients need to understand that they get the skimpy "out of network" reimbursements for oral appliances because most medical insurance companies WILL NOT ALLOW dentists to join the plans in network. I, for one, would be willing to join medical insurance networks for these devices. They just won't let me in. So don't blame the dentists. Blame the medical insurance companies. The only exception to this rule is that a FEW oral surgeons are allowed to go in network. Dr. Luisi
Given the reality of the costs of all apnea machines, we can say at once that buying this machine will solve all problems. But if not, you can use Medicare Supplement Plans in Michigan, which also covers the cost of such temporary machines you need. I understand that not everyone can afford to buy them, but if they break down, the insurance company will provide full replacement. Don't count on miracles and trust insurance agents, they don't readily pay out money
It can be frustrating when insurance coverage is unclear, but I hope you are able to find a solution that works for you. Have you considered reaching out to Thefinity Group (thefinitygroup.com) for assistance with navigating insurance and coverage for your device? They have a lot of experience in this area and may be able to help. Best of luck to you!
Almost 5 years with a TAP device. No insurance coverage all out of pocket to pay for devices. 6 months ago I started using a CPAP and haven’t looked back. The. Devices were changing my bite, that was the final straw. I felt better with the devices, but the CPAP has dramatically increased my quality of life. I no longer need blood pressure medication which I find amazing. Best of all, insurance covers the machine , supplies and I pay a very small amount of money compared to the TAP devices.