If you’ve been diagnosed with obstructive sleep apnea, you know there are several treatment options available. From CPAP therapy to oral appliances to advanced procedures like Inspire® therapy, every patient’s journey looks a little different.
What many patients don’t realize is that insurance providers often require specific steps before approving Inspire® surgery. One of the most common prerequisites is trying Oral Appliance Therapy (OAT).
Insurance carriers prefer patients to begin with conservative, non-surgical treatments before moving on to advanced procedures. Oral Appliance Therapy is:
Because of these advantages, most insurers require documentation that OAT was attempted, and that it either failed to provide relief or wasn’t well tolerated, before Inspire® therapy can be considered.
If you’re exploring Inspire® therapy, your insurance company will typically want proof that you:
Tried CPAP therapy but could not tolerate it or did not benefit from it.
Tried Oral Appliance Therapy and had similar difficulties.
Once these steps are properly documented, most carriers will review your case for Inspire® candidacy.
Navigating insurance requirements can feel overwhelming, but you don’t have to do it alone. At GoTo Sleep Center, we help you every step of the way:
We’re dedicated to helping patients achieve lasting relief from sleep apnea and ensuring they can access the treatment that fits their needs best.
Insurance requirements can feel confusing, and many patients have similar questions about the approval process for Inspire® therapy. To help you understand what to expect, we’ve answered some of the most common questions about Oral Appliance Therapy, insurance documentation, and how GoTo Sleep Center supports you along the way.
In most cases, yes. Insurance companies generally require patients to try non-surgical treatments like CPAP and Oral Appliance Therapy first. If these options aren’t effective, your doctor can document this to support your Inspire® eligibility.
Insurance carriers want patients to begin with the least invasive, most cost-effective treatments. Because many people respond well to Oral Appliance Therapy, insurers typically ask for this trial before approving surgical procedures like Inspire®.
If you’ve given Oral Appliance Therapy a fair trial and it hasn’t improved your sleep apnea; your doctor can document these results. That documentation becomes an important part of the Inspire® approval process.
The length of the trial varies by insurance provider. Some require just a few weeks, while others may ask for a couple of months. Our team will guide you through your plan’s requirements and ensure all steps are properly recorded.
Yes. We specialize in supporting patients through each stage, from fitting an oral appliance to collecting documentation and submitting the necessary paperwork to your insurance company.
If you’re considering Inspire® therapy, GoTo Sleep Center will ensure all the right steps are taken to meet insurance requirements while keeping your comfort and health the top priority. Schedule a consultation today and begin your personalized treatment journey.
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