thisstarr
01-15-2003, 05:51 AM
Hi Everyone,
I am going to be getting insurance soon and was wondering what was better for the coverages of TMJ. Is a HMO better? Or a PPO?
Thanks,
Starr
I am going to be getting insurance soon and was wondering what was better for the coverages of TMJ. Is a HMO better? Or a PPO?
Thanks,
Starr
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Elaine
01-15-2003, 04:33 PM
Star,
I would get a copy of their benefit booklet to see what they cover. All insurance companies are different and don't all cover the same thing. Mine is a PPO and it covered $3000. I know Sherri's is a HMO and she is in the state of California and is covered but believe me she had a real fight on her hands as she was denied to begin with. I wish she was still on here as she could guide you with California laws better than me. She is not doing too well, bad headaches still, despite surgery. Main thing is don't mention TMJD, get their booklet and see what they cover. Definitely don't want to be denied because of pre-existing conditions, they have a hayday with that.
Elaine
I would get a copy of their benefit booklet to see what they cover. All insurance companies are different and don't all cover the same thing. Mine is a PPO and it covered $3000. I know Sherri's is a HMO and she is in the state of California and is covered but believe me she had a real fight on her hands as she was denied to begin with. I wish she was still on here as she could guide you with California laws better than me. She is not doing too well, bad headaches still, despite surgery. Main thing is don't mention TMJD, get their booklet and see what they cover. Definitely don't want to be denied because of pre-existing conditions, they have a hayday with that.
Elaine
thisstarr
01-15-2003, 09:40 PM
Hi Elaine,
I am having a blonde moment.. :D can you help me out on this one...lol.. Do they send the benfits book when you get an application sent to you I didnt see anything that had anything to do with tmj in it. It is from blue cross. DO you actually have to ask for it?
Thanks,
Starr
I am having a blonde moment.. :D can you help me out on this one...lol.. Do they send the benfits book when you get an application sent to you I didnt see anything that had anything to do with tmj in it. It is from blue cross. DO you actually have to ask for it?
Thanks,
Starr
Elaine
01-16-2003, 07:58 PM
Star,
It should be listed in the benefit booklet if it is covered. It should either exclude it or include it.
Call them and don't tell them who you are, that you are looking for a policy that covers TMJ. Do they cover it or could they refer you to someone. I guess at least that way you would know for sure.
Sorry I am not of much help.
Elaine
It should be listed in the benefit booklet if it is covered. It should either exclude it or include it.
Call them and don't tell them who you are, that you are looking for a policy that covers TMJ. Do they cover it or could they refer you to someone. I guess at least that way you would know for sure.
Sorry I am not of much help.
Elaine
autumn83175
01-18-2003, 02:10 AM
Starr,
I have Blue Cross and it is covering my TMJ, but I am in a different state and some states now mandate coverage. If you purchased your plan through an employer, there is a contract between the employer & insurance complany that spells out exactly what is covered. You do not receive a copy of that contract. You need to ask the employer to see it and copy the applicable page. Your benefit booklet is probably very vague. When I first approached the insurance company they said it was not covered. I faxed them the proper page from the employers contract and they had to cover the TMJ. Most people don't know the contract exists and therefore when the insurance company says no, people don't fight it and the insurance companys saves lots of money. If you purchased it individually you probably received it directly. If not ask them to mail you a copy of the contract not a new member booklet. Hope this helps, I've been through this one a twice now!
I have Blue Cross and it is covering my TMJ, but I am in a different state and some states now mandate coverage. If you purchased your plan through an employer, there is a contract between the employer & insurance complany that spells out exactly what is covered. You do not receive a copy of that contract. You need to ask the employer to see it and copy the applicable page. Your benefit booklet is probably very vague. When I first approached the insurance company they said it was not covered. I faxed them the proper page from the employers contract and they had to cover the TMJ. Most people don't know the contract exists and therefore when the insurance company says no, people don't fight it and the insurance companys saves lots of money. If you purchased it individually you probably received it directly. If not ask them to mail you a copy of the contract not a new member booklet. Hope this helps, I've been through this one a twice now!
thisstarr
01-19-2003, 04:35 AM
Hi Autumn,
Thanks for replying to me, wow that would be go great if they cover it, and I will keep that in mind about fighting them if they say they dont cover it I will put up a fight! And keep all papers.... Do you have an HMO or PPO you didnt say?
thanks,
Starr
[This message has been edited by thisstarr (edited 01-19-2003).]
Thanks for replying to me, wow that would be go great if they cover it, and I will keep that in mind about fighting them if they say they dont cover it I will put up a fight! And keep all papers.... Do you have an HMO or PPO you didnt say?
thanks,
Starr
[This message has been edited by thisstarr (edited 01-19-2003).]
autumn83175
01-22-2003, 12:59 AM
I have an HMO. I used to have a PPO through another insurer and they covered the splint (after a fight), exploratory surgery and physical therapy. They would not cover surgery. The HMO is covering surgery. I don't know what else they would have covered since all that was done through the other insurance. If you decide to change coverage, make sure that there is no lapse in the coverage dates, thats how they get you. You may also have to go to an oral & maxiofacial specialist instead of a dentist to get it covered, I'm not ure what their rules are. I suggest you call your insurance and ask what oral surgeons are on their list (don't tell them why). Then call a few of them and see if they have been successful in getting coverage from that insurance company. If they have you know you have a fairly good chance, if not you may have a long battle ahead, you may want to ask what insurance companies they have had luck with. Good luck!
thisstarr
01-22-2003, 02:44 AM
Hi,
I am so happy they will cover surgery for you if you have to get it :) I have heard so many people tell me there problems with the stupid insurance companys.
I have been engaged to my boyfriend for a longtime, we were thinking of getting married sooner so I can get on his health insurance plan but he has Kaiser pemanente. Have you heard if them? I really hope they have good coverage. Some coverage is better then none, I need treatment I cant take this pain much longer. I did see one guy that was a maxiofacial specialest but he didnt have a cule how to help me!
Take care & thanks again,
Starr
I am so happy they will cover surgery for you if you have to get it :) I have heard so many people tell me there problems with the stupid insurance companys.
I have been engaged to my boyfriend for a longtime, we were thinking of getting married sooner so I can get on his health insurance plan but he has Kaiser pemanente. Have you heard if them? I really hope they have good coverage. Some coverage is better then none, I need treatment I cant take this pain much longer. I did see one guy that was a maxiofacial specialest but he didnt have a cule how to help me!
Take care & thanks again,
Starr