jarjarbinks
11-17-2005, 10:47 AM
Hi,
two days ago, i was fitted with a lower splint for my jaw to relieve symptoms of my TMJ disorder (a couple times in the past month, i have woken up with a locked jaw due to a TMJ disc displacement. the last time it happened -- last week -- i could barely open my mouth, for four days). anyway, my in-network dentist referred me to an out-of-network dentist (it was an emergency, so i didn't complain, although thinking about it now, i should have) who has charged me ridiculous rates (and she doesn't co-operate with any insurance companies, so i must do all the claims legwork) such as $265 for 60 min consultation, $287 for left tomogram x-ray, $287 for right, etc etc etc. And that was only my first visit! she then said i should wear a splint, so i obliged. that costed another $1050. anyway, to make a short story even shorter, i am of the understanding that the splint must be adjusted quite often. anyway, my question is: how much, in your experience, does each adjustment cost (please say less than $100.. please please please), and how many adjustments have you needed per month? i really feel like i was suckered into the out-of-network dentist (who can charge insane prices because of it -- i mean, what insurance company would pay $287 for an xray?!). i still haven't filed the insurance claims... does anyone know if splints and corresponding xrays and adjustments are covered by insurance? if it helps, my insurance provider is MAMSI, who told me that all TMJ problems should be ruled dental problems.
also, does anyone know if many dentists are able to adjust splints? i say this because i would like to switch to an in-network dentist ASAP (just so it's easier to deal w/ the insurance company). i am hoping some dentists in my area help me out w/ insurance, rather than hanging me out to dry, as my current dentist does.
thank you very much!!
two days ago, i was fitted with a lower splint for my jaw to relieve symptoms of my TMJ disorder (a couple times in the past month, i have woken up with a locked jaw due to a TMJ disc displacement. the last time it happened -- last week -- i could barely open my mouth, for four days). anyway, my in-network dentist referred me to an out-of-network dentist (it was an emergency, so i didn't complain, although thinking about it now, i should have) who has charged me ridiculous rates (and she doesn't co-operate with any insurance companies, so i must do all the claims legwork) such as $265 for 60 min consultation, $287 for left tomogram x-ray, $287 for right, etc etc etc. And that was only my first visit! she then said i should wear a splint, so i obliged. that costed another $1050. anyway, to make a short story even shorter, i am of the understanding that the splint must be adjusted quite often. anyway, my question is: how much, in your experience, does each adjustment cost (please say less than $100.. please please please), and how many adjustments have you needed per month? i really feel like i was suckered into the out-of-network dentist (who can charge insane prices because of it -- i mean, what insurance company would pay $287 for an xray?!). i still haven't filed the insurance claims... does anyone know if splints and corresponding xrays and adjustments are covered by insurance? if it helps, my insurance provider is MAMSI, who told me that all TMJ problems should be ruled dental problems.
also, does anyone know if many dentists are able to adjust splints? i say this because i would like to switch to an in-network dentist ASAP (just so it's easier to deal w/ the insurance company). i am hoping some dentists in my area help me out w/ insurance, rather than hanging me out to dry, as my current dentist does.
thank you very much!!
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newjerseyguy
11-17-2005, 12:39 PM
Jarjar, please try not to feel bad. What you are going through is similar to what so many of us have been through. You feel that you are in pain, and you place your trust in certain individuals, and you don't know where to turn. It seems to me that the person you are going to is not someone you feel good about. As far as the costs, there is no way to really compare. When dealing with TMJ treatments, insurance coverage, medical vs. dental, it get so complicated and varies so much. May I make a suggestion? REad through as many posts on here as you can. There is so much helpful info that you pick up here and there. Also, if you have access to the internet, do reserach one day or night, type in your city and then TMJ, like "New Jersey TMJ Dentists" for example. Then, drill down, get some names and the look to see who participates in your plan. To be honest, when delaing with TMJ, it sometimes doesn't matter because in or out of network, none of it is usually covered. When I first had my bouts with this condition, I finally had a dentist who submitted some of the xrays and treatment through medical and coded it medically. Some of it was covered, but none of the actaul splint costs. Good luck to you, keep posting, and take the time to educate yourself.
jarjarbinks
11-17-2005, 07:46 PM
thanks for the reply.
i've done quite a bit of research since i was first diagnosed w/ TMJ a couple months ago. i just learned that MAMSI will not cover the cost of the splint therapy. that said, what do you normally pay for splint adjustment? i'm trying to get a rough idea, since i probably will not be able to afford a long treatment plan.
p.s. i'm not in any physical pain; my TMJ disc slips out from time to time, and my jaw ends up locking. my dentist claims that the splint will help with the inflammation in the TMJ.
i've done quite a bit of research since i was first diagnosed w/ TMJ a couple months ago. i just learned that MAMSI will not cover the cost of the splint therapy. that said, what do you normally pay for splint adjustment? i'm trying to get a rough idea, since i probably will not be able to afford a long treatment plan.
p.s. i'm not in any physical pain; my TMJ disc slips out from time to time, and my jaw ends up locking. my dentist claims that the splint will help with the inflammation in the TMJ.
une_fille
11-17-2005, 08:57 PM
Jarjar- Your situation sounds very similar to mine in terms of the disc slipping out of place and you waking up with a locked jaw. This started happening to me exactly one year ago. I have been a nighttime bruxer since I was a child and wore whatever splints the dentists made me for about 10 years. I didn't know anything about TMJ and I really just thought the splints I had were to prevent my teeth from wearing away. Anyway, little did I know the splints I had were all wrong for me. So last year I would awake with locked-jaw every so often, but it always popped back within a matter of a few hours. In July, however, it locked for good. My disc is now permanently displaced. Please do what you can to prevent this from happening. You are lucky that after 4 days your disc slipped back into place. I second what newjerseyguy said in that if you do not feel comfortable with this doctor, find another one. Yes, the costs are mortifying, but if you can get this treated now, even if out-of-pocket, you will save yourself so much money in the future. Do not just look for a doctor/dentist solely because they are in your network, look for the best one.
The costs you have had so far are very similar to mine. My doctor does not take insurance so I have to submit all the claims and pay out-of-network expenses. I am able to file these under my health insurance rather than dental insurance. I am not familiar with MAMSI's plans, but once you find a doctor you like see if they will work with you on the codes to be able to submit under health and not dental insurance. It's been my personal experience that dental insurance does not cover as much as health for TMJ, but of course, every plan is different. Yes, submitting the claims are a pain, but it's such a small hassle in the grand scheme of TMJ problems, especially if you only have to do it for a little while.
Sorry, I went off on a tangent, back to your questions about cost. I had the splint made in July (same cost as yours) and I was told I would have to have it adjusted about twice a year at $75 a visit. However, I've had to have it adjusted 3 times already but my doctor didn't charge me for those visits. So, it all really just depends on your coarse of treatment and how you are progressing in terms of how often you will need it adjusted.
Do you know if you are grinding your teeth at night and that is why you sometimes wake up with a limited opening? If so, the splint will not prevent you from grinding your teeth...it will only help to relieve pressure off your joint. And it won't necessarily prevent your disc from slipping in the future. That is why you need to find someone who can address these issues.
Keep us posted!
The costs you have had so far are very similar to mine. My doctor does not take insurance so I have to submit all the claims and pay out-of-network expenses. I am able to file these under my health insurance rather than dental insurance. I am not familiar with MAMSI's plans, but once you find a doctor you like see if they will work with you on the codes to be able to submit under health and not dental insurance. It's been my personal experience that dental insurance does not cover as much as health for TMJ, but of course, every plan is different. Yes, submitting the claims are a pain, but it's such a small hassle in the grand scheme of TMJ problems, especially if you only have to do it for a little while.
Sorry, I went off on a tangent, back to your questions about cost. I had the splint made in July (same cost as yours) and I was told I would have to have it adjusted about twice a year at $75 a visit. However, I've had to have it adjusted 3 times already but my doctor didn't charge me for those visits. So, it all really just depends on your coarse of treatment and how you are progressing in terms of how often you will need it adjusted.
Do you know if you are grinding your teeth at night and that is why you sometimes wake up with a limited opening? If so, the splint will not prevent you from grinding your teeth...it will only help to relieve pressure off your joint. And it won't necessarily prevent your disc from slipping in the future. That is why you need to find someone who can address these issues.
Keep us posted!