New on board. Been reading some of your posts about splint therapy and braces (very informative, thanks posters!), but can't figure out from the posts whether the splints are normally covered by insurance.
A bit of background...
Last year I went for a consult with an oral medicine specialist about the clicking in my left jaw, which I've had for about 6 years now. There's no pain (except when I've been grinding), but the loud clicking that seems to be getting worse. The specialist did not recommend any ortho or surgery, I think because last year I had fairly normal jaw movements despite the clicking.
I got a bruxism splint last year to wear at night for the grinding and what I hope is slowing down the increasing of the clicking (I hope it's not making it worse!). My teeth are fairly straight but the bite is off.
I guess my jaw movements have gotten tighter and more restricted in the past year. The new dentist I've recently seen for my regular dental checkup has recommended that I consider orthodontics to correct my bite because the bite could cause teeth problems and more jaw problems later on, and that it is possible it might help with the clicking but no guarantees and even if it did help it probably won't eliminate it. He said that the orthodontist would probably put me in a splint for a while before braces, I think to try and align the jaws.
So my questions are:
I had put in a dental claim last year for the consult with the specialist (so the insurance co is aware that I might have TMJ), but my dental insurance does not cover anything to do with correction of TMJ. The ortho coverage only covers corrections of malocclusions. The health coverage doesn't include TMJ.
If I decide to do the ortho thing, would the insurance company consider the splints to be TMJ-related, especially since I've consulted with a specialist?
Is splint therapy normally considered TMJ treatment? Even when done by an orthodontist? Does it make a difference whether or not it is followed by braces? If the splints are considered to be for TMJ, would the braces also be considered TMJ-related?
Or would the use of splints be considered part of normal malocclusion correction?
Based on your experiences, would the splints and braces cause more harm than good? I don't want to do anything that will worsen my TM joints.
Just curious? Was your bite off before you started wearing the bruxism splint or after you starting wearing it? Because when I wear a splint it seems to throw off my bite in the mornings and then it returns back to normal. I am reluctant to wear it now because of this.
Have you seen your regular physician about the clicking or anything to do with the possible TMJ? If not, that would be my first step...my physician told me I did the right thing by seeing him, because technically it is a "joint" problem, not dental. In that instance, health insurance will cover it, since it is joint, not dental.
On the other hand, dental won't cover most, if any of it...they might cover the bite plate, but I doubt anything else..they're pretty particular with that stuff.
The Following User Says Thank You to dairycowz For This Useful Post: Petertayyy (10-30-2012)
Karies-
I've had very similair issue with the ins. co. We found an underlying cause that either was from the TMJ or caused it, oseoarthritis, degeneritive wear and tear of the joint. So my Dr is very good about not submitting any paperwork with TMJ anywhere on it b/c it would not be covered by health or dental, a problem most of us face. Try investigating alternate diagnosis' for the "reasons" for various treatments. I've had great success treating the symptons to cure the problems. This includes multiple MRI's, x-rays, Rx, and visits to Maxo-Oral surgeons and nuerologists. keep us posted and Good luck.
Unfortunately I wore it for over a year and during that time I didn't pay attention to my bite. I think it might have contributed to throwing off my bite because I don't recall ever noticing my jaw being this much out of alignment before.
Hi:
Splint therapy is definitely considered TMJ treatment and insurance companies will do anything in their power to get around paying for TMJ treatment but if your health care provider is good about using an alternate diagnosis code such as MPD often times insurance companies are better about paying for the treatment. Overall insurance companies are nothing but blood suckers and will always do anything they can to get out of paying for care for any condition. Many on this board though have got their insurance company to pay because their care provider used the code MPD. And since the dentist said he thinks you should have braces due to your teeth being lined up incorrectly perhaps the care provider could get insurance to pay. A word of warning however, if you do have TMJ you should not go into braces until your TMJ symptoms have subsided because braces can make your problems worse unless you've treated the TMJ first.
Tiffany
Dairycowz is correct. If it is TMJ then medical will cover it, but only if it is causing pain. They told me to take ibuprofen, avoid gum, try not to touch my teeth together at all. After trying those and my jaw is hurting on a regular basis she will send me to a jaw or TMJ specialist to figure it out. My dentist was the first one to tell me I had TMJ and right away they told me to see a doctor. If you dentist is not telling you that then he is trying to make the money himself. Yes medical should cover it if it is affecting you everyday life and your in pain.
tmj, ortho and insurance? 
