Insurance & Cost Guide

Most Patients Pay $0 – $200 Out of Pocket

Oral appliance therapy is a medical treatment billed through your medical insurance — not dental. We verify your coverage before treatment begins so there are no surprises.

Important: This Is Medical, Not Dental

Oral appliance therapy is prescribed by a physician for a medical condition (obstructive sleep apnea). Although the device is made by a dentist, it is classified as durable medical equipment (DME) and billed through your medical insurance. This typically means better coverage than dental insurance would provide.

We Handle Everything

You should never have to navigate insurance paperwork alone. Our team verifies your benefits, obtains pre-authorization, submits claims, and handles appeals if needed. You focus on getting better sleep — we take care of the rest.

Free insurance verification
Pre-authorization handled
Direct insurance billing
Appeal support if denied

Government Insurance Programs

We specialize in Medicare and TRICARE coverage for oral appliance therapy. Read our detailed guides to understand exactly how your plan covers treatment.

Insurance Plans We Accept

We are in-network or accept out-of-network benefits from most major medical insurance carriers. If your plan is not listed below, call us — we may still be able to work with your insurance.

Medicare

OAT covered under DME benefit

TRICARE

Covers active duty, veterans, and military families

Optum / UnitedHealth
Kaiser
Blue Shield of California
Anthem Blue Cross
Aetna
Cigna

Don't see your carrier? Call (619) 880-8774 — we work with many additional plans not listed here.

How Insurance Coverage Works

1

Free Insurance Verification

Before any treatment begins, we contact your insurance carrier to verify your benefits. We tell you exactly what is covered, what your out-of-pocket cost will be, and whether pre-authorization is required.

2

Pre-Authorization

If your plan requires pre-authorization, we handle the entire process. We submit your sleep study results, physician referral, and clinical documentation. Most authorizations are approved within 5-10 business days.

3

Treatment Begins

Once approved, we schedule your custom fitting. Your insurance is billed directly — we handle all the paperwork. You pay only your copay or coinsurance amount, if any.

4

Follow-Up Coverage

Follow-up visits, adjustments, and your verification sleep test are typically covered under the same authorization. Replacement appliances are usually covered every 3-5 years.

Treatment Cost Comparison

Understanding the total cost of sleep apnea treatment helps you make an informed decision. Here is how the most common treatments compare.

CPAP Machine

$800 – $3,000
Ongoing: $300-500/yr for masks, filters, tubing
Usually covered with copay
Best Value

Oral Appliance

$1,800 – $3,500
Adjustments included. Replace every 3-5 years.
Covered by most medical insurance
~90% compliance — patients use it

Inspire Surgery

$30K – $100K
Battery replacement every 11 years
Prior auth required; strict criteria

What Will I Pay Out of Pocket?

Your out-of-pocket cost depends on your insurance plan, deductible status, and copay structure. Here are the typical ranges:

$0 – $200

With Good PPO Coverage

Deductible met, standard copay

$200 – $500

With Typical Coverage

Standard coinsurance (80/20) after deductible

$1,800 – $3,500

Without Insurance

Self-pay. Payment plans available.

HSA & FSA eligible. Oral appliance therapy is an IRS-qualified medical expense. You can use pre-tax dollars from your Health Savings Account or Flexible Spending Account to cover copays, coinsurance, or the full cost — effectively reducing your out-of-pocket by 20-30%.

Why Treatment Pays for Itself

Treating sleep apnea is not just an investment in better sleep — it is an investment in your overall health that often reduces other medical costs over time.

Lower Healthcare Costs

Treated sleep apnea patients use fewer emergency services and have fewer hospitalizations. Studies show treated OSA patients have significantly lower healthcare utilization.

Better Productivity

Quality sleep restores daytime energy, focus, and cognitive performance. Many patients report improved work performance and fewer sick days within weeks of treatment.

Reduced Health Risks

Effective treatment lowers your risk for heart disease, stroke, type 2 diabetes, and other conditions associated with untreated sleep apnea — potentially reducing future medical expenses.

No Recurring Supply Costs

Unlike CPAP, which requires $300-500/year in replacement masks, filters, and tubing, oral appliances have no ongoing supply costs. Adjustments are typically included.

Free Insurance Verification

Call or text us and we will verify your coverage in 24-48 hours. No obligation, no cost. We will tell you exactly what your plan covers before any treatment begins.

Insurance & Cost FAQs

Yes. Oral appliance therapy is a medical treatment, not dental, so it is covered under your medical insurance — not your dental plan. Most major medical insurance carriers cover oral appliance therapy when prescribed by a physician for diagnosed obstructive sleep apnea.
Yes. Medicare Part B covers custom oral appliances for obstructive sleep apnea when ordered by a treating physician. You will need a sleep study (either home or in-lab) confirming your diagnosis, and the appliance must be provided by a Medicare-enrolled dentist. Our partner providers are Medicare-enrolled.
Yes. TRICARE covers oral appliance therapy for active duty service members, retirees, and their families when prescribed by a physician for diagnosed sleep apnea. Several of our partner locations are near military installations.
The cost of a custom oral appliance ranges from $1,800 to $3,500, depending on the specific device prescribed. This includes the initial consultation, custom fitting, follow-up adjustments, and a follow-up sleep test to verify effectiveness. Ask your provider about payment plans for patients without insurance coverage.
Your out-of-pocket cost depends on your specific plan, deductible, and copay structure. Many patients pay between $0 and $500 out of pocket. Our partner providers verify your benefits before treatment begins so there are no surprises. Call or text us at (619) 880-8774 for a free insurance verification.
While some insurance plans require a physician referral, many do not. We can help coordinate with your primary care doctor or sleep physician if a referral is needed. If you don't have a sleep apnea diagnosis yet, our partner providers can arrange a home sleep test to get started.
Oral appliance therapy is a medically prescribed treatment for a medical condition (obstructive sleep apnea). Although the device is made and fitted by a dentist, it is classified as durable medical equipment (DME) and billed through your medical insurance. This typically means better coverage than dental insurance would provide.
Yes. Oral appliance therapy is an IRS-qualified medical expense, so you can use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for copays, coinsurance, deductibles, or the full cost if you are self-pay. This allows you to use pre-tax dollars, effectively reducing your out-of-pocket cost by 20-30%.
Denials are uncommon when proper documentation is submitted, but they do happen. If your claim is denied, we help you file an appeal. Common denial reasons include missing sleep study data or incomplete physician referrals — both of which we can resolve. Our team has extensive experience navigating insurance appeals for oral appliance therapy.
We typically verify your insurance benefits within 24-48 hours of receiving your information. We will contact you with a clear breakdown of what your plan covers, what your estimated out-of-pocket cost will be, and whether pre-authorization is required. There is no cost or obligation for this verification.
Yes. Insurance carriers require a diagnosed sleep study (polysomnography or home sleep test) confirming obstructive sleep apnea before they will authorize an oral appliance. If you have not had a sleep study, our partner providers can arrange a convenient home sleep test — often covered by your insurance — so you can get tested in your own bed.

Questions About Your Coverage?

Call us for a free insurance verification. We will tell you exactly what your plan covers before any treatment begins.

Call or text (619) 880-8774 to schedule your free consultation

(619) 880-8774