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Is Myofunctional Therapy Covered by Insurance

Is Myofunctional Therapy Covered by Insurance – Myofunctional therapy is a growing area of interest within the field of oral health. It involves exercises and techniques that aim to correct improper tongue, lip, and jaw movements that can lead to speech disorders, dental malocclusion, and other related problems. However, many patients wonder if their insurance plans cover this type of therapy. The answer to this question is not straightforward and can vary based on many factors. 

In this blog post, we will explore the topic of “Is Myofunctional Therapy Covered by Insurance“. We will discuss the types of insurance plans that may cover myofunctional therapy, as well as the common limitations and restrictions that can impact coverage. We will also provide tips for navigating insurance claims and appeals processes, and offer suggestions for finding affordable myofunctional therapy services if insurance coverage is not available. 

If you are considering myofunctional therapy for yourself or a loved one, it is important to understand your insurance options and potential costs.

What is Myofunctional Therapy?

Myofunctional Therapy is a type of treatment that focuses on correcting improper oral functions such as tongue thrusting, improper swallowing, and incorrect breathing habits. It involves specific exercises and techniques that help to strengthen the muscles in the mouth and face and improve overall oral function, leading to better oral health and overall well-being.

Benefits of Myofunctional Therapy

  1. Improved breathing: Myofunctional therapy can improve the way a person breathes by correcting issues such as mouth breathing and snoring.
  2. Better sleep: By improving breathing, myofunctional therapy can help individuals get a better night’s sleep, leading to increased energy and overall well-being.
  3. Improved oral health: Myofunctional therapy can help correct issues such as tongue thrusting and incorrect swallowing, leading to improved oral health and a reduced risk of dental problems.
  4. Improved speech: Myofunctional therapy can help improve speech impediments such as lisps and mispronunciation by correcting underlying muscle issues.
  5. Reduced headaches: Myofunctional therapy can help alleviate tension headaches caused by muscle tension.
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Improved Breathing

  • Myofunctional therapy can improve breathing by correcting muscle imbalances in the face and mouth.
  • By strengthening the muscles used in breathing and improving tongue positioning, myofunctional therapy can help individuals breathe more efficiently.
  • Improved breathing can lead to better sleep, reduced snoring, and decreased risk of sleep apnea.
  • Myofunctional therapy can also improve overall oral health and facial appearance.

Enhanced Speech and Swallowing

  • Myofunctional therapy can improve speech clarity and articulation.
  • It can help correct tongue and lip postures, which can affect speech production.
  • Myofunctional therapy can also improve swallowing function and prevent choking or aspiration.
  • It can strengthen the muscles involved in swallowing and improve coordination between them.
  • Myofunctional therapy can also address breathing issues, which can impact speech and swallowing.
  • It can help improve nasal breathing, reduce mouth breathing, and increase overall oxygen intake.
  • Myofunctional therapy can improve overall oral health by promoting proper tongue placement and preventing dental issues such as malocclusion and tooth decay.

Reduced Dental Issues

  • Improved breathing and airway function
  • Reduced risk of sleep apnea
  • Improved tongue posture and swallowing function
  • Correction of tongue thrusting habits
  • Improved speech clarity
  • Reduced risk of dental malocclusions and crooked teeth
  • Enhanced facial aesthetics and symmetry
  • Improved overall oral and facial muscle function and coordination.

Improved Facial Aesthetics

  • Myofunctional therapy can improve the alignment and symmetry of facial features.
  • It can help correct issues such as a receding chin or an overbite, which can improve the overall appearance of the face.
  • Myofunctional therapy can also help reduce the appearance of wrinkles and fine lines around the mouth and eyes, as it strengthens the facial muscles and improves blood flow.
  • Improved facial aesthetics can lead to increased confidence and self-esteem.
  • Myofunctional therapy can also help improve speech and swallowing function, which can enhance overall facial aesthetics and function.

Coverage of Myofunctional Therapy by Insurance Companies

The coverage of Myofunctional Therapy by insurance companies varies depending on the individual policy and the insurance company. Some insurance companies may cover Myofunctional Therapy as a part of their dental or medical coverage, but others may not. It is recommended to check with the insurance company and the specific policy to determine the coverage for Myofunctional Therapy.

Coverage Varies by Insurance Company

  1. The coverage of myofunctional therapy by insurance companies varies greatly.
  2. Some insurance companies may cover myofunctional therapy, while others may not.
  3. The amount of coverage may also vary, with some insurance plans covering only a portion of the cost.
  4. It is important to check with your specific insurance company to understand their coverage policies for myofunctional therapy.
  5. Some insurance companies may require pre-authorization or a referral from a healthcare provider before covering myofunctional therapy.
  6. Out-of-pocket costs for myofunctional therapy may be high if insurance coverage is limited or not available.
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Coverage Varies by Type of Insurance Plan

  • Myofunctional therapy may be covered by some insurance companies.
  • Coverage for myofunctional therapy may vary depending on the type of insurance plan.
  • Some insurance companies may require a referral or pre-authorization for myofunctional therapy.
  • Patients may need to meet certain criteria or have a specific diagnosis to qualify for coverage.
  • Out-of-pocket costs for myofunctional therapy may still apply even with insurance coverage.

Coverage Varies by State

  • Coverage of myofunctional therapy varies by state.
  • Some insurance companies may cover myofunctional therapy, while others may not.
  • The extent of coverage may also vary, depending on the insurance plan.
  • Patients should check with their insurance provider to determine their coverage for myofunctional therapy.
  • Out-of-pocket costs may be incurred if insurance does not cover myofunctional therapy.

How to Determine if Your Insurance Covers Myofunctional Therapy

To determine if your insurance covers myofunctional therapy, you should contact your insurance provider and ask if the therapy is covered under your plan. You can also ask about any specific requirements or limitations for coverage, such as the need for a referral from a doctor or a certain diagnosis. Additionally, it may be helpful to ask if any in-network providers for myofunctional therapy may be preferred by your insurance provider.

Review Your Insurance Policy

  1. Look for the specific terms and conditions of your insurance policy regarding coverage for myofunctional therapy.
  2. Check whether myofunctional therapy is listed as a covered benefit or if it falls under a category of covered services.
  3. Review the policy’s maximum benefit amount and any limitations or exclusions that may apply to myofunctional therapy.
  4. Contact your insurance provider or agent to confirm coverage and any pre-authorization requirements.
  5. Keep in mind that some insurance plans may require a referral from a primary care physician or specialist before approving coverage for myofunctional therapy.

Contact Your Insurance Provider

  1. Contact your insurance provider directly.
  2. Ask about coverage for myofunctional therapy.
  3. Provide them with the details of your specific plan.
  4. Ask about any limitations or restrictions on coverage.
  5. Inquire about any necessary pre-authorization or referrals.
  6. Ask about the amount of coverage and any out-of-pocket expenses.
  7. Obtain a clear understanding of the coverage and reimbursement process.
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Speak with Your Healthcare Provider

  1. Contact your health insurance provider to inquire about coverage for myofunctional therapy.
  2. Ask your healthcare provider if they accept your particular insurance plan for myofunctional therapy.
  3. Check if myofunctional therapy is considered an eligible service under your insurance plan.
  4. Determine if there are any out-of-pocket costs you will need to cover, such as co-pays or deductibles.
  5. Seek a referral from your healthcare provider to a myofunctional therapist who is covered by your insurance plan.
  6. Review your insurance plan’s policy and benefits booklet for more detailed information on coverage for myofunctional therapy.

What to Do If Your Insurance Does Not Cover Myofunctional Therapy

If your insurance does not cover myofunctional therapy, you may have a few options:

  1. Appeal: You can appeal the insurance company’s decision to not cover myofunctional therapy. This may involve submitting additional documentation or speaking with a representative.
  2. Look for alternative coverage: Some insurance plans may have alternative coverage options for myofunctional therapy, such as a flexible spending account or health savings account.
  3. Pay out of pocket: You may need to pay for myofunctional therapy out of pocket. It may be worth exploring payment plans or discounts offered by the provider.
  4. Seek lower-cost alternatives: There may be lower-cost alternatives to myofunctional therapy, such as online programs or self-help resources.

Consider Alternative Treatment Options

Consider the following alternatives if your insurance does not cover myofunctional therapy:

  1. Look for low-cost or free resources, such as online tutorials, YouTube videos, or community programs.
  2. Consider financing options, such as payment plans or medical credit cards.
  3. Seek out a myofunctional therapist who offers a sliding scale or discounted rates.
  4. Discuss alternative treatment options with your healthcare provider, such as speech therapy or orthodontic treatment.
  5. Consider self-help techniques, such as tongue exercises, breathing exercises, and posture correction.

Seek Financial Assistance Programs

If your insurance does not cover myofunctional therapy, you can seek financial assistance programs by:

  1. Researching nonprofit organizations that provide financial support for medical treatments, such as the Oral Cancer Foundation or the National Foundation of Swallowing Disorders.
  2. Checking with your myofunctional therapist to see if they offer a sliding fee scale or payment plans.
  3. Exploring healthcare credit cards, such as CareCredit, which offer financing options for medical expenses.
  4. Talking to your employer about a flexible spending account or health savings account, which can be used to cover medical expenses not covered by insurance.
  5. Contacting your state’s Medicaid program to see if myofunctional therapy is covered and if you qualify for assistance.


In conclusion, Is Myofunctional Therapy Covered by Insurance – while myofunctional therapy is an effective treatment for a variety of orofacial disorders, it is not always covered by insurance. However, it is important to do your research and contact your insurance provider directly to determine what benefits you are entitled to. Some plans may cover this type of therapy, while others may not. In the end, the benefits of myofunctional therapy are numerous, and it is worth exploring all options to receive the best care possible.

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