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tap device and insurance coverage.

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grinderfrank +0 points · about 4 years 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 · about 4 years 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 · about 4 years ago Original Poster

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

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SleepDent +0 points · about 4 years 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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GorimSgart +0 points · over 1 year ago

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

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Legiboka +0 points · about 1 year ago

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!

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grinderfrank +0 points · 11 months ago Original Poster

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.

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SleepDent +0 points · 11 months ago Sleep Commentator

I am a dentist working in dental sleep medicine. Tooth movement is a common side effect of oral appliance therapy. That should have been explained to you at the outset. Were you given a small pink appliance called an A.M. Aligner to use in the morning when you removed your Taps? This would largely eliminate the possibility of movement. I would be interested in your long term reaction to the change to CPAP. Sure, it feels good to get everything essentially for free. But how long are you going to like hauling the machine around every time you travel or leave the house. How are you going to feel when you have changed your mask, hoses, filters, etc. for the FOURTH time. And you have to keep the supply of distilled water on hand. Lastly, keeping a CPAP sanitary is REAL work. All parts of the machine must be kept scrupulously clean to avoid the chance of serious infection. You c;lean the Taps with toothbrush, tooth paste, and done. Will you be this happy two years from now? Time will tell. Please keep us posted. Dr. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.

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grinderfrank +0 points · 11 months ago Original Poster

It was not stressed to use the AM aligner by the dentist. I did use it however, not daily until it became an issue. My lower jaw became advanced so far that it would not comfortably fit back in the aligner. It would not go back where it belonged. 6 months on CPAP, the lower jaw has retracted.

Those TAP devices did not last more than 6 or 7 months and would need to be replaced, I was still grinding. I was given another TAP device to try, during the Pandemic, but it was not alleviating my debilitating headache, facial pain that was undiagnosed for almost 50 years. It did not allow any side to side movement. The dentist got a lab to make the old style TAP that was no officially offering. So yes that was my other concern, when are they going go run out of parts.

Yes cleaning the CPAP is something that most be done. Its a daily chore, but It’s not that big of a deal. I buy distilled water by the case. My motivation to use the CPAP is that I feel great. If I don’t, I know something is wrong, mask needs adjustment. I had days with the TAP devices I felt lousy, more frequent than CPAP, However. I had to keep a spare TAP device for times when they broke because of the lead time for a replacement, it was costly to do this. And I used a machinist’s rule to measure the advance as there was no indication on the TAP, just a hook and eye. If I started feeling crappy, I knew the device was starting to crack and come out of alignment.

It took a long time for me to used to the TAP device. Maybe the amount my airway needs to be opened pushed the limit on those devices and caused them to fail prematurely. All I know is that a feel really good for a change

I

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Sierra +1 point · 11 months ago Sleep Patron

"I buy distilled water by the case."

Another option if you can find it is to use 5 gallon refillable containers and fill them periodically with reverse osmosis water. We have this service in our area at hardware and grocery stores. They used to be $1 per 5 gallon fill, and now unfortunately has gone up to $3. Still cheaper than distilled water in 1 gallon jugs though. No plastic jugs to dispose of.

https://www.dyna-pro.com/ultra-puretrade-retail-dispensers1.html

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SleepDent +0 points · 11 months ago Sleep Commentator

Also forgot. You now have to find out which night guard has to be worn to replace the now missing Taps. Dr. Luisi

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SleepDent +0 points · 11 months ago Sleep Commentator

Well, you make a pretty compelling argument for the change to CPAP. Clearly, your dentist made a good faith effort to keep you going. What I would have done at the first sign that your jaw was not returning to baseline was to tell you to keep it out for a'few days at a time when that happens. When your bite gets that far off, it is difficult to recover. By what you say, I assume that your diagnosed AHI was relatively high and the'ability of the Taps to resolve it were marginal. Given this information, I believe that you did the right thing. Unfortunately, even though using the CPAP is much more work, you have to do what you have to do to stay healthy. Dr. Luisi

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