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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 11-28-2005, 09:04 PM   #1
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Tmansdc HB User
What insurance plans cover tmj?

I want to know because my insurance doesn't and I want to get a temporary insurance plan to cover tmj because I can't afford the payment for surgery/fitting/mouthguard/etc.



I live in Las Vegas, Nevada by the way.

Last edited by Tmansdc; 11-28-2005 at 09:05 PM.

 
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Old 11-28-2005, 11:19 PM   #2
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Tmansdc HB User
Re: What insurance plans cover tmj?

I really need to know.

 
Old 11-29-2005, 07:28 AM   #3
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Re: What insurance plans cover tmj?

This is not an easy question to answer. My two cents on it are first to see if your state has a TMJ coverage mandate. Each state is different.

Once you do this, then I would ask questions in writing to an insurance company. See what they cover, and to what extent. You might get a response, not sure.

I had an HMO plan at the time of seeking TMJ coverage. They gave me the biggest runaround of my life. Not a fun ride. I did get approval, out of network, for a surgeon of my choosing, but only after going through a big ordeal. Then I learned more about TMJ and decided to postpone surgery.

This is my opinion of TMJ medicine and insurance: you will likely spend some time going from doctor to doctor looking for someone who is helpful. Then if and when you find them, there will likely still be a mystery to the whole thing, and you will wonder if you are getting the care you seek. That's largely why all of us here are working together to be informed.

Even if this isn't the case in your situation, be prepared for it with insurance.

Not sure if this is answering your question, but I tried. I only have my experience to go from.

There are past postings on insurance. Use the search function of the site to study up.

 
Old 11-29-2005, 10:22 PM   #4
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Tmansdc HB User
Re: What insurance plans cover tmj?

Any second opinions? any sites to look up dental or medical insurances? (not sure which would cover tmj.)

 
Old 11-30-2005, 12:23 AM   #5
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Michelle W HB User
Re: What insurance plans cover tmj?

I have been working on this problem for six months. It isn't a one day question. I had to find insurance companies such as Blue Cross/Blue Shield, Aetna, Healthfirst, Principal, and ask them for a coverage booklet to see if they would cover it. It might take me a week to get a person. Then it would take a week to get them to fax me the booklet/policy. You have to look at the exclusions on the policy.

Also, most insurance people are sales people. They are not medical people or nurses and most could not even pronounce tempromandibular joint disorder. They were like huh? What? Sure it is covered and then I would look at the policy to only find it was not. They are sales people wanting to sale you a policy. They don't care if it is covered.

Also, if you do not currently have coverage it will be considered pre-existing and not be covered. You can only get it covered if you go from one group policy to another group policy and have a HIPPA certificate. You can not be uninsured and then go out and buy a private policy. I tried that and it is considered pre-existing.

Just because Aetna covers TMJ in Nebraska does not mean it will cover it in Missouri. Nebraska may be a state in which TMJ is mandated that it be covered where in Missouri it is not mandated that it be covered. Call you State Insurance Commissoner in Nevada and ask if TMJ is covered.

Also, we can't post website links unless they are approved by the moderators. It is against the rules.

 
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