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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 09-24-2003, 08:37 AM   #1
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Ouch-ear-pain HB User
Angry My dental insurance won't tell me what to do and that they don't cover none of It....

Please someone help me!!!,
I have been trying my hardest to find a dentists. My insurance told me well, "non-one covers it so just call around under othodontist and a Prosphodontist". I don't know how to do that if they don't take my insurance. I had to hang up-because I started crying!! Please someone help me through this, how do I get started????

I know that it is not covered but I can pay the money to get a splint made but the darn lady wouldn't tell me how. I asked her how and she replied, "just call around to the places that I gave you (ortho) and see if they do any TMJ and if they can do your treatment"! How in the world would I do that if nowhere took my insurance?? I am sooo confused someone please help me!!!

 
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Old 09-24-2003, 10:41 AM   #2
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Dear Ouch,
Dental insurance in general has excluded TMJ/TMD other than "bruxism." Try your medical doctor, ask for a dental referral for "cephalgia" (head pain). Tell the dentist they will have to file medical insurance and that will require a SOAP format as well as medical claim forms. You must get the referral first from the MD. Good luck.

QA11

 
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Old 09-24-2003, 01:56 PM   #3
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Not sure if this could help but when I claimed via insurance for my bite splint (nightguard) I said it was for facial, shoulder and neck pain, plus severe ear/hearing problesm, the ENT I saw wrote a note saying the TMJ is causing ear problems, and I had the splint adjusted by a maxillo facial surgeon who I went to for facial and head pain, so the insurance thankfully accepted it as a general medical expense and not a dental expense, and paid for it. Possibly sometimes wording can make all the difference. I wouldn't even mention TMJ maybe, just head pain, bad ear issues etc. Good luck.

Isobel

 
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Old 09-24-2003, 02:59 PM   #4
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Hello,
Thank you all so so much for helping me!! I am gonna do exactly what both of you said and hopefully I can get a splint! I can't thank you enough for how much you have all helped me!!!
Thanks sooo much, I deeply appreciate it!!

~*EAR*~

 
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Old 09-25-2003, 12:00 AM   #5
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while I have gotten some things partially (like 50% or so) covered under health, it does take a lot of work. I have to pay upfront, submit forms and then be paid a few months later. Mostly, no matter how honest they are, TMJ people know they have us between a rock and a hard place and they can do that where as with most doctors you'll just go to another doc. Also, they probably have it hard getting paid by the insurance cos so some if it maybe them forced to do things that way.
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m.s.

 
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Old 09-25-2003, 05:45 AM   #6
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ouch - my treatment hasnt been covered by my insurance either. instead, i've had to use the money i saved up for university to pay for all this stuff for my jaw. you really have to find money and pay... because you want to find a good dentist to help you.

are there family members that could give you money or give you a loan?

- saaraah.

 
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Old 09-25-2003, 07:02 AM   #7
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Ouch and board,
The key to this is a statement of "medical necessity" from the primary physician. This may be difficult to get. Plainly put, MD.s and Medical Insurors don't always consider Dentists part of Medicine. Also if you have a copy of the "exclusion" by dental insurance. Be careful about using TMJ or TMD, use facial pain or specific diagnoses instead.
Some policies offer benefits at a lesser level for "bruxism". Good luck.

QA11

 
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