Insurance question - TMJ Disorder -TemporoMandibular Joint Message Board

Isew4work · 05-19-2003, 07:24 AM

Hi Everyone,
I received some paper work from the new Dr. that I want to see for tmj. It has a page full of prices for testing and even a few code that I am supposed to call my insurance about to find out for myself the type of coverage that I have for these things. I am concerned about calling my insurance with these questions. They have been decent in the past about covering things but I feel like the coding that was used was a bit tricky to get them to pay. Do I risk things by "letting the cat out of the bag" by asking them about tmj coverage? Anyone experience this? Thanks, I will wait to hear before I call my insurance.
Mary

PINKYPRISCILLA · 05-19-2003, 10:24 AM

I wouldn't do that because it is up to their "billing person" to find out that information. Did they treat any patients with you insurance?

Jill J · 05-19-2003, 11:03 AM

One more thing, check out your health insurance website, you can usually find what their TMJ coverage is before you call. I agree with Priscilla it is up to the doctor to call or he can play with the codes like use MPD or something of that nature to get it covered, don't use TMJ as a diagnosis.

Good Luck
Jill

princessmom1 · 05-20-2003, 06:37 AM

Hi Mary

I just wanted to let you know that my doctor does not submit claims with TMJ as the diagnosis, at least for my problems. They have paid for everything except the $10 office visit copay (I have a PPO)and that includes my splint. When I called my insurance company and read the billing codes some of them were just considered like any other xrays and an office visit.

Can you ask if you can bring in copies of your old xrays and etc. to see if they will accept them instead of doing all new ones?

Good Luck