HMO OR PPO? - TMJ Disorder -TemporoMandibular Joint Message Board

thisstarr · 01-15-2003, 02:51 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

Elaine · 01-15-2003, 01:33 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

thisstarr · 01-15-2003, 06:40 PM

Hi Elaine,

I am having a blonde moment..

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, 04:58 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

autumn83175 · 01-17-2003, 11:10 PM

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!