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tap device and insurance coverage.

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grinderfrank +0 points · 2 months ago Original Poster

Going on two years wearing a tap device. They have been effective in stopping my bruxism and pain. My question is has any one had success with insurance coverage? My insurance says they are covered, the sleep doctor says "they all say that and then do not cover them" . I have an appointment for a third device as they seem to only last year. thanks

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SleepDent +0 points · 2 months ago Sleep Commentator

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.

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grinderfrank +0 points · 2 months ago Original Poster

Oh, wow. ok thanks so much for the reply!

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SleepDent +0 points · 2 months ago Sleep Commentator

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

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