I would like to know if anyone has had success getting coverage for TMJ. It is of interest to know the state and company, or intials of company if the board rules do not allow.
I personally live in NY and have so far had great difficulty getting anywhere with my MVP insurance company. They say it is dental. The dental insurance says it is medical, but they cover an intial consult.
Also, apparently in NY the laws are such that lawsuits against insurance companies can not include coverage payment of legal services or punitive damages, so the insurance companies have free reign. Even if you would win a lawsuit, you would be out the legal fees, time, and suffering.
I would like to know if other states are different, and if TMJ coverage is mandatory and normal.
I'd love to hear any stories in which coverage was granted.
I have b.c. insurance via my company who is based out of Seattle Washington and they do not cover TMJ but i have secondary insurance with the same company under my husband and that is via Minnesota and they cover it for the most part. In the state of Minnesota there is some law that insurance has to cover TMJ but Washington does not have this
Hi. I have insurance through Mailhandlers in Kansas and it's covered here. I am out of pocket all orthodontics including splints, but everything else is covered on my ppo plan. Luckily, my really great tmj doctor is on the plan. When I had my first tmj surgery 11 years ago, tmj wasn't covered and fell in the crack between medical and dental. So, they've come around.
Good luck.
Tandy
I just started a new job so my health insurance won't kick in for another two weeks, however I will be having United Healthcare and it seems that in this plan TMJ is covered in all aspects from diagnosis to splint therapy to surgery. I am in Atlanta.
When i got my surgery about 4 years ago for TMJ dislocation, they said they'd cover some of it not bvery much and then an hour before my surgery they called the surgery center and said they wouldnt cover it. and that insurance company PHP Physicians health plan. I live in indiana. So you can imagine how terrible that was for my parents. that surgery was like 6 thousand dollars. Dont go through PHP they are expensive and they dont cover TMJ at all.
