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.
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 12:21 PM.
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.
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?
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
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.
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.