Is Myofunctional Therapy Covered By Insurance?

Is Myofunctional Therapy Covered By Insurance: Patients often ask, ” is myofunctional therapy covered by insurance?” In some cases, they also ask, “What is myofunctional therapy?”

These questions often arise after a dentist, speech therapist, or related medical professional recommends myofunctional therapy for them or a family member. In many cases, a parent learns that their child may benefit from seeing a myofunctional therapist. These options can be overwhelming, even without health insurance in mind.

The answer varies by insurance. However, myofunctional therapy is an advanced and emerging treatment. Not all insurance companies have started to cover it or fully understand it.

This article is not a substitute for individual medical, dental or financial advice from professionals. We simply provide it as a starting point as you explore the best options for your health and your family’s well-being.

Our first advice is to contact your insurance company and ask if they cover myofunctional therapy.

Most importantly, when it comes to wellness, we encourage all our patients to prioritize treatments that best suit their individual and family needs.

Many different wellness practices can significantly improve your health and your child’s quality of life that are not covered by health insurance plans. For example, yoga, massage, eating organic foods, support groups, and even some physical therapy that is rarely covered by medical or dental insurance significantly improve a person’s well-being and health. When people think about how much they already invest in wellness, they often realize that investing in myofunctional therapy isn’t much different.

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What is Myofunctional Therapy?

We often compare myofunctional therapy with physiotherapy and occupational therapy.

It is a treatment strategy based on exercises targeting the muscles of the tongue, mouth, and face. The exercises are designed to train the muscles for proper breathing, better speech, and more efficient chewing and swallowing.

Myofunctional therapy treats orofacial myofunctional disorders (OMD). These are several conditions that affect the muscles of the face and mouth and how they work. OME can directly or indirectly affect facial skeletal growth, a baby’s ability to breastfeed, facial development, chewing, swallowing, speech, oral hygiene, and more. Some also use the therapy to help relieve sleep apnea or mouth breathing.

The idea is to train the muscles to perform their function better. The patient may be able to develop healthier habits and more optimal function. Some issues addressed include tongue tie, mouth breathing during sleep, sleep apnea, impaired breathing, habits such as an unhealthy oral resting position, and more.

Therapists may also use other treatment strategies, such as gently covering the mouth to help correct specific breathing problems.

Some OMDs are the result of genetics, while others are the result of habit, conditioning, or the environment. Treatment plans are individually tailored based on the problems, possible negative effects, and the cause. For example, chronic thumb sucking and tongue thrusting sometimes exacerbate OME. A treatment plan can address any imbalances or habits to help achieve the ideal function.

As a multidisciplinary field, myofunctional therapy is sometimes combined with other treatments, including surgery, dental care, speech therapy, and more. Allied therapies are often reimbursed by health insurance.

The value of myofunctional therapy

The Academy of Orofacial Myofunctional Therapy describes its goal as helping people “recover the pleasure of eating, speaking, breathing and even healthier sleep.” Just imagine the value of any treatment that will help a child or adult speak with confidence, breathe better, sleep well or enjoy food!

The value for a person depends on the specific OME and its severity. For a child who is having trouble swallowing and learning to speak, effective myofunctional therapy can be “invaluable” in helping him on the path to healthier development and a better life. Exercises that correct habitual mouth breathing can prevent developmental problems, as sometimes excessive mouth breathing can alter facial features and even facial skeletal development.

For someone else with a small, barely noticeable problem, it might not feel as crucial. Every individual is unique and every treatment plan is just as unique.

How much does myofunctional therapy cost?

Extended Exam $225
All therapy options — breathing sleep disturbances, tongue tie, tongue thrusts, or often a combination of each — depending on your needs and the information gathered in your comprehensive exam. The average cost of treatment plans ranges from $1,700 to $2,400.
A discount is given for family therapy.
Payment plans are available (2 payments for individuals and 3 payments for families).

Pay for myofunctional therapy if insurance doesn’t cover it

It can be frustrating when insurance doesn’t cover the myofunctional therapy that you think is a good option for you or your child’s needs. The good news is that there are options to fit your household budget.

Talk to your provider about charges and payment schedules. Sometimes people find treatment surprisingly affordable, especially when compared to other health and personal development expenditures. If you have an HSA, find out if the therapy can be reimbursed.

More importantly, talk to your therapist about the best way to ensure you get value for money from treatment. For example, if your child is receiving myofunctional therapy, make sure he exercises as often as the therapist recommends. Following the treatment plan as recommended results in greater success and less chance of needing additional therapy sessions outside of the plan.