How do you eat? - TMJ Disorder -TemporoMandibular Joint Message Board

Merrida · 01-14-2003, 07:44 AM

I cannot open my jaw wide enough to eat. My health insurance won't cover this saying it's a "dental" problem, so my dental insurance gets maxed out within 30 days the beginning of each year. It's like no one wants to take responsibility (insurance-wise) for what this is and how it affects us.

My doctor wrote a letter to help me appeal to my insurance company, stating that I am on an almost whole liquid diet because I cannot chew most solid foods, he lists the infections I get because I drool now (because of how my jaw comes together),...I cannot articulate well, and I speak for a living,...my inability to eat fibrous foods has affected my digestion and my health,...my husband cannot kiss me, I frequently jam my gums with the tooth brush because I cannot open my jaw wide enough to fit the toothbrush in,...

So my venture this year, is going to be trying to appeal to my health insurance to see that this is affecting my entire health.

Does anyone get any luck with this? I feel like health insurance tells me to bill dental insurance. Dental insurance runs its course within a month and I don't "qualify" for further care.

Where exactly do you go from here, when you've run out of money?

Do "the insurance companies" view this as a medical/physical condition, or purely as a "dental" related condition?

What gives?

Jill J · 01-14-2003, 10:27 AM

I have the same problem with eating. The only thing that works for me is to "squish" my food small enough to fit in my mouth. I was losing weight due to not eating, but starving all the time. Hope this helps you. Also in one of the other posts I read about brushing your teeth and hitting them with a toothbrush, I use a childs size toothbrush and it works great. Good Luck

Jill

Elaine · 01-14-2003, 01:14 PM

Merrida,
Insurance companies hate to even acknowledge TMJD.Most have a limited amount they will cover, if any. I had a $3000 lifetime maximum and it didn't go far. The three surgeries have basically been out of pocket. At times, I think it was the insurances way of trying to save me from a lifetime of hell, by not covering me. BUT!!! Like others, I found a way to come up with the money, thinking there would be pain relief. NOT!!! I should have saved my money.
As for eating...I have lost close to 30 pounds last year due to not being able to eat right. When you can't eat solid food, food tends to be disgusting and I am guilty of going without eating. I was in so much pain between the TMJD and the back, I just didn't care. Now I feel like maybe...I can get well again. If I get rid of the back pain, TMJD I will deal with although it sucks to be stuck with this condition. I have a hard time deciding which is worse, but the two together are intolerable.
My doctor wrote a letter to the insurance company stating medically neccessary as I couldn't chew anymore. Needless to say they are cold-heartless,
b------, as they denied me. My motto is expect the worst, because then you won't be disappointed when it doesn't happen. Insurance companies are definitely not on our side.
Take care,
Elaine

GenDen · 01-14-2003, 02:40 PM

My insurance will not pay for TMJ treatment. However, my medical and dental did pay for diagnosis. My dental paid for the dental diagnosis examination. The medical paid for an MRI for diagnosis. Neither insurance paid for a splint or dental treatment of the TMJ, but my insurance does pay for physical therapy because they bill/code it as myofacial pain. It works best if your provider has a good office person who knows the correct codes to bill. Every bit of coverage helps.

Merrida · 01-14-2003, 05:31 PM

Well my primary "concern" here starts off with my needing full mouth dental reconstruction. After a car accident and whiplash, spinal injury, broken bones in my face and various teeth broken off and/or fractured, - all the surgery and drugs and reconstruction (as it started) began,...so the struggles I've been facing have been related to my back, my neck, my face, my teeth, my nose, hips, legs, etc... and within the last 2-3 years I've had incredibly aggressive and overwhelming dental work (and now only have 2 of my own teeth left on my top jaw - they took the rest)... with little regard for my small mouth they've pryed me open, propped me open, and I've had many nasty dental experiences along the way to oral annihilation.

So while this started out being an issue of trying to reconstruct my teeth so I can chew solid food, and my trying to appeal to my health insurance for consideration because of how my "whole person" health has been affected, -- I'm realizing that several of the "symptoms" I thought were not even related, are evidently extremely related to my jaw situation.

I can feel it. I know what I feel. It angers me when it's implied or told directly that my complaints are not valid or not related. I can read all the posts here -- and unless we are all suffering from some bizzare form of mass hysteria because of watching our computer monitors, - I cannot possibly find any other links that would demonstrate how ALL OF US are sharing so many of these physical symptoms,....how much pain and discomfort we're in,... how much our lives are affected (including our private, personal lives),... how many commonalities we all seem to have,... and yet the insurance companies and the AMA are trying to deny that this even exists?? Or deny that it's a medical condition?? Or deny that there's any association between our TMJ and other bodily ailments?? Or deny coverage of benefits -- because -- because why? Just "who" do "they" think "IS" the responsible party then?

Is it considered a medical issue?

Is it considered a dental issue?

No one wants to lay claim to what TYPE of issue this is, as long as they can continue to pass the buck.