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Seniors: New Medicare Rule Makes It Impossible For Oral Appliance For Sleep Apnea To Be Covered

Medicare started covering oral appliances for sleep apnea in January, 2011 if certain conditions were met. These conditions included a face-to-face meeting with a doctor who prescribed a sleep study, a Medicare approved oral appliance, etc.

I met the conditions in 2011, and my regular dentist made the device. I self-filed to Medicare, and, after 6 months, Medicare finally paid. A close relative of mine met the conditions in mid-2012, and his dentist made the appliance. He self-filed, and after many months, Medicare paid him.

We had to self-file, because dentists do not accept Medicare, and Medicare did not pay for dental procedures until it started covering for oral appliances.

My wife recently met all the conditions, but Medicare informed me that a rule had recently changed, and he was required to read the new rule to me. This new rule is what makes it impossible (or, almost so) for an oral appliance to be covered.

This is the new rule: Dentists must be the ones to file for payment. To do so, a dentist must apply to Medicare to be a "Medicare Durable Medical Equipment (DME) Supplier". The agent told me Medicare does not have a list of dentists who are DME suppliers, and I will have to call around. I had no luck after many calls, so I wrote to one of sites that supply expert answers for a fee. Below is the response from the expert what explains the reality of the situation:

Expert:  Mark Bornfeld, DDS replied 1 day ago.

Hello-- I'm Mark Bornfeld, DDS. Welcome, and thank you for putting your trust in me!

 "Your search for a dentist registered as a "Medicare Durable Medical Equipment (DME) Supplier" is almost certainly doomed to be futile. This is because registration as a Medicare supplier brings a dentist under the significant and onerous burden of compliance with a wide list of Federal regulations. Although it makes sense and seems self-evident that bringing dental service under the Medicare program is the right thing to do, dentists as a rule are grateful that we are not bound by Medicare regulations. And because the provision of oral sleep appliances is such a relatively small aspect of clinical dental care, there would be almost no incentive to assume the burden of Medicare regulation."


It is reasonable to conclude that Medicare knows this and has deliberately put up a blockade to keep Seniors from being covered in order to save money. Or, a scheme to force dentists to join. 


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Mindful that Medicare was going to cut benefits as a result of ObamaCare (and its associated costs), I started pursuing getting a dental device in the summer of 2013. My dentist is Barry Chase, DDS located in Long Island, New York with an office in New York City. (I've seen him at both locations.)

I now use a device and alternate between it and my APAP. The device is great for travel: it fits in my handbag!

I will notice a downside, however: I think the jaw advancement has had a slightly negative effect. I often feel enough pain near the ear area when I use my APAP that I have to switch back to the mouth device in the middle of the night. I suspect the ear pain has been caused by a misalignment of my jaw courtesy of the device.

A few notes about getting a device:

1.  I was evaluated by Steven Y. Park, M.D. for a device. Some do not have appropriate mouth and throat structures to benefit from the use of a MAD (Mandible Advancement Device) but, fortunately, I do. Dr. Park was able to assess this via examination.

2.  I suspect (and will return to the dentist to check on this) that use of the device has slightly altered my bite. (I already mentioned the pain problem that I believe may have been caused by a slight misalignment.) If I'm right on these two counts, this is Not Good.

Still, overall I am pleased with the MAD. This is the case even though I am very pleased with my APAP and have no problems using it. Indeed, I feel a certain comfort just from "strapping up" with my mask, chin strap, et cetera for the night. I think this is because I know I'll be rewarded with a good night of sleep!

I hope this helps.

need  to claim grandfather rights

and say this is not what i sign up for and challenge their decision

by claiming grandfather rights

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