It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



TMJ Disorder -TemporoMandibular Joint Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 04-25-2005, 07:43 AM   #1
Junior Member
(female)
 
Join Date: Apr 2005
Location: Northern Ca
Posts: 10
CaKatie HB User
Question Insurance problems

How many of you have problems with your insurance paying for TMJ related stuff? How many of you have no problems? I haven't called my ins company yet, as I was just diagnosed last thurs. Thanks!

 
Old 04-25-2005, 09:41 AM   #2
Veteran
(female)
 
Join Date: Nov 2004
Posts: 497
rubato HB User
Re: Insurance problems

I had my first tmj surgery 11 years ago, and it wasn't covered by my insurance at all. I had my second surgery 2 months ago, and 90% of it was covered. A lot of the insurance companies don't cover this. Some are starting to come around. I don't think any of them cover the orthodontics associated with tmj, but I could be wrong. Mine doesn't. I really feel for the people dealing with tmj who can't get it covered by insurance. Just paying my 10% this time around has almost broken the bank. The problem with tmj is that the solution isn't easy. You can end up trying so many treatments and have none of them work for you. And, it's never ending. Dentists, orthodontists, physical therapists, surgeons. (Okay, now I'm sounding very negative!) I wish you luck with your insurance. Hopefully, you'll be one of the lucky ones.
Tandy

 
Sponsors Lightbulb
   
Old 04-25-2005, 09:51 AM   #3
Veteran
(female)
 
Join Date: Nov 2004
Posts: 497
rubato HB User
Re: Insurance problems

p.s. What type of tmj were you diagnosed with?

Last edited by rubato; 04-25-2005 at 09:54 AM. Reason: wrong post

 
Old 04-25-2005, 11:21 AM   #4
Senior Member
(female)
 
Join Date: Jun 2004
Location: The Sunshine State
Posts: 223
meditation HB User
Re: Insurance problems

I can say that, as with most of us, I am having that same problem, again.

When I first went through this as a teen, my ins. company considered tmj treatment, includiing surgery, experimental....they did not want to cover it at all...keep in mind in those days...you had Major Medicals.

Today, I am in need of a total joint replacement, thanks to a screw

The hospital I am considering is a provider. Great, Huh? Nope....the doctor isn't a provider. The hospital bill will not eclipse the doctor..His fee could triple or quadruple that of the hospital.


Insurance companies tend to look at TMJD as either dental or experimental....AH !!!

I think most of us are discouraged by the hoops we have to jump thru for them to cover it.

What did your doctor say about your TMJ?

Last edited by meditation; 04-25-2005 at 11:21 AM.

 
Old 04-25-2005, 12:22 PM   #5
Junior Member
(female)
 
Join Date: Apr 2005
Location: Northern Ca
Posts: 10
CaKatie HB User
Re: Insurance problems

The doc actually didn't diagnose me with "TMJ" or "TMD". He just said that my ear problems are being caused by my TMJ. And I don't think he deals with TMJ problems. I haven't gone to see another doc yet. But I have done tons of research online since he told me this and I defenetely have TMD.

 
Old 04-25-2005, 02:11 PM   #6
Junior Member
(female)
 
Join Date: Apr 2005
Location: Northern Ca
Posts: 10
CaKatie HB User
Re: Insurance problems

Ok, this is just great. I just got off the phone with the ear doc, dentist, and ins companies and none of my TMJ related stuuf is going to be covered. My ear doc said that I needed a splint (night gaurd) from my dentist and the dentist said that it would $250. So I called my ins co and they said that nothing TMJ related will be covered, even with a letter from my ear doc or dentist saying that this is medically neccesary. I guess I'm just screwed. We have no money to spend on my TMJ care. I feel so depressed right now. Actually caught myself thinking about running into a redwood tree on the way home earlier. Had a friend suggest going to a dental school for the splint; anyone ever heard of doing this and anyone know of any in Northern Ca?

 
Old 04-25-2005, 04:39 PM   #7
Senior Member
(female)
 
Join Date: Jun 2004
Location: The Sunshine State
Posts: 223
meditation HB User
Re: Insurance problems

It's good to do research. It makes you more prepared. My only advice is to go to a dentist or oral surgeon, who specializes in TMJD. It will save you time and $$$$.

 
Old 05-08-2005, 07:16 PM   #8
Junior Member
(male)
 
Join Date: Jan 2004
Location: new york
Posts: 12
tattoony22 HB User
Re: Insurance problems

Hi, I havent been on here for while but I can tell you my experiance with my tmjd and insurance company was quite interesting, my oral surgoen just keeps charging for other things so that he will be payed, instead of tmj treatment, I also found an online company that makes splints for real cheap, I paid $79.00 for one, they send you the impression stuff then you send it back, they mail you the splint and I have my guy adjust it. its the same exact thing they were charging me $850.00 for. insurance sucks when it comes to tmj, they dont consider it a "medical nessecity" according to ghi, I have gotten great releif from my chiro though,hope that help's. do some research, the splints can get crazy expensive, trust me,im on #9, and just now having my teeth reshaped and braces put on to keep them straight and allow my jaw to rest, I get very dizzy too, botox has helped me too with the muscle spasms in my ear, I have actually met people through my doc that have been really bad off and now are doing really good, dont give up, it gets better ,mike

 
Old 05-09-2005, 09:50 AM   #9
Senior Veteran
(female)
 
Join Date: Aug 2001
Location: Mt. Pleasant, MI, USA
Posts: 1,291
Katie G HB UserKatie G HB User
Smile Re: Insurance problems

Hi all - I have a form of BC/BS that requires your PCP to refer you to specialists for services like TMD. I have racked up bills of $5,400 for 14 months of bite splints, adjustments, and monthly follow-up appointments related to my TMD. The insurance so far has paid about $4,500 of that. I now have a 3 year bill of $10,000 for braces, but since my ortho's office bills it as "intra-oral fixation device" for continuation of my TMD treatment, I've been getting some reimbursement (SLOWLY !!!).

I've found that as long as I jump through all the insurance hoops, I can get some reimbursement. I have to pay for my ortho services up front (and yes, I've maxed out my credit card twice) by paying a percentage of the bill at the time of first service and then making monthly payments while the ortho's office submits claims for me to get reimbursed. The ortho's office is great about re-submitting claims under a different code if a claim gets denied.

This is all medical insurance - my dental wiill pay ZIP, NADA, ZERO toward my TMD treatment. They state TMD is a medical, not dental problem.

It's all a big game to the insurance carriers, and I'm sick of playing it.

Katie G

 
Old 05-12-2005, 11:28 PM   #10
Senior Member
(female)
 
Join Date: Apr 2004
Posts: 240
papergoods HB User
Re: Insurance problems

Hi All

I got TMJd with disk displacement 3 years ago and since have spent out-of-pocket $20,000. No kidding, including 3 arthrocentisis surgeries, tomograms, 2 MRI's, cat scans of my ears, 4 splints, injections out the wazoo, drugs, a therabite, a tens machiene ice packs, heating pads etc..on top of that I have about 6,000 still owed.

It is a big game, and it is Bad Faith Insurance. If you have it in you contact a lawyer who does bad faith in your city or ask on this board maybe someone knows one. There are some court cases proving that TMJ is medical and should be covered. (I have contacted a lawyer then of course i got scared and dropped it.) But am considering it agian because they just won't cover ANY form of treatment, so they can't use the excuse that every treatment is not proven to work, because even if that was the case they have to give you at least one treatment option, be it splint, surgery, PT whatever.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
How to get your health insurance to pay for breast reduction Gjazh06 Health Insurance Issues 2 06-19-2008 09:03 PM
Insurance Problems Figured Out april1848 Multiple Sclerosis 4 02-20-2008 06:01 PM
No Insurance -- Should I Get Diagnosed? What Should I Do? Dawning3 Multiple Sclerosis 5 08-16-2007 05:23 PM
Need help regarding symptoms. No insurance.No doctor. Please help!! kaia28 Bowel Disorders 11 08-02-2005 06:14 AM
Problems with Insurance and Meds Bilbo Pain Management 4 07-19-2005 09:52 AM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 06:10 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!