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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 08-04-2008, 09:40 AM   #1
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trisha322 HB User
Question Getting my splint covered by insurance.

I have never had this problem before so I am not sure how to handle it. I haven't had any serious problems with my TMJ since '98. Now, I have been diagnosed with Degenerative Joint disease. My splint that I was wearing at night was a cheaper one made by my dentist. My custom splint made in '98 is broken. My current doctor recommends some joint injections to help ease my pain but I need a new splint to start the treament. My insurance doesn't cover appliances. Is there any way around it since it is for a serious issue? I don't have $850.00 to pay for another splint. Any help is appreciated...

 
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Old 08-04-2008, 12:20 PM   #2
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Re: Getting my splint covered by insurance.

I am assuming you mean getting the splints covered by medical health insurance and not dental correct? Some good tmj drs have an office staff that know how to handle this - even if the dr does not accept insurance payments - his office staff may submit the claims on your behalf using the proper diagnosis and procedure codes. Most time they will call your insurance co and find out what condtions are covered if tmj is not - often myofacial pain or orofacial pain syndromes or cranio facial disorders - or in your case degenerative joint diseases, may be covered and the office staff will submit the claims using those diagnosis codes - they will also ask the insurance co what treatments or procedures are then covered for those conditions and submit the claim accordingly or based on what is covered and what treatment the dr does provide. The insurance co may ask the dr to submit xrays or films supporting his diagnosis as well. Some tmj dentists on the other hand leave this up to the patient and unfortunately at that point you need to do the calling and asking and submitting the claim and any supporting documentation - its doable but time consuming. But if you pay premiums for health insurance then its worth it in the long run.

Probably the best thing to do is talk to your drs office mgr and see if there is anything they can do - some know the "system" quite well and do what they can to help patients receive whatever reimbursements they can. If none of this works the other option might be to consider asking the dr for a payment plan you can pay over time or if your credit is OK applying for a health care credit card with 0% financing over 12 mos - most drs have applications in their offices.

 
Old 08-04-2008, 01:34 PM   #3
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Re: Getting my splint covered by insurance.

Thanks for your quick response. I think, unfortunately, I will take the route of fighting the battle myself. I have put off treatment for months now because our company sold and we were changing health insurance. I didn't think about paying it out. I will check in to that and hopefully get it resolved with the insurance company in the mean time. It has been a long road for me...going on 14 years now with TMJ. This site has been a wealth of information for me. Wish I'd have found it sooner...

 
Old 08-04-2008, 02:18 PM   #4
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hessie28 HB Userhessie28 HB User
Re: Getting my splint covered by insurance.

I don't know if it is the same as the dental device I use for Sleep Apnea or not. It was not covered under my dental. It was covered under my health insurance under Durable Medical Equipment. They covered 90 percent. Actually only paid 70 percent and I had to fight an won the extra 20 percent. So double check your policy for Durable Med Equipment. I had to have it preapproved. The orthodontist did it all for me.

 
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