TMJ Advice--Someone Stuck in a state that doesn't mandate insurance coverage - TMJ Disorder -TemporoMandibular Joint Message Board

TiredOTired · 08-20-2008, 01:45 PM

Hi, I live in AZ. We are not one of the few states that has passed legislation that requires insurers to cover TMJ as they cover any other joint in the body. I am a single mom BARELY keeping a roof over our heads. I am on the state's insurance plan due to low wages and they do not cover tmj.

Here are my symptoms: derangement upon opening mouth-swings to the left quite noticeably. I have had braces, splints, and an arthi, gosh forgot the name of the surgery where they basically rinse out "scar tissue." I grind my teeth at night, and can't use a splint due to me taking it out of my mouth in my sleep. (They never helped much anyway.) Years ago (I was first diagnosed with this as a teen and am now 37) I saw an X-ray of my joints and one is worse than the other. My right side is essentially missing the cartilage and is bone on bone. (Actually I can't recall if they both are-but my right side feels the worst.) I have an OBNOXIOUS large pop when I open my mouth. Sometimes it gets stuck in place and sometimes I have to manipulate it multiple times to get it back into place. (meaning popping it 3-4 diff times/ways to fit it back where it ought to be.)

I have terrible headaches that are LIFE ALTERING. I have tightness (SEVERE) in my neck muscles-basically all the muscles that attach to that joint. It is affecting both sides-right side more so. It is so bad now that I can barely turn my head all the way to the side due to extreme muscle tension. The muscle pain/tension actually goes all the way under my arms and can be felt in my chest muscles. I am on major pain meds and muscle relaxants-none really do a thing for this.

My opinion is that my joint is too far advanced for any minor treatments. How would one treat this and how would one get it paid for? Thanks!

luvtocamp · 08-20-2008, 02:29 PM

I am so sorry for your condition. Very few states as far as I know or medical insurance cover tmj splints and treatments with splints. It is really upsetting that they don't cover this joint like they would a knee , shoulder or hip, as in my opinion this is more life threatening, if a person can't eat without pain they become malnourished. I guess I can see them not covering splints but when you actually have an obvious joint problem it should be covered. I would get your doctors involved to write letters saying how this is affecting your life so and bring them to the state or whereever you get ins. and maybe get a free attorney help to try to get some treatment covered. I don't know if it will do any good.

In my opinion this is not a dental problem but a medical problem. Will they at the least pay for some physical therapy or chiropractor which may help your neck.
Maybe also call around some oral surgeons and see if someone cant help you or is there a dental school around.

I feel for you and all of us with this codition, its so expensive to get treated and its affecting our health in terrible ways. Wish I could be of more help, maybe someone else will have some suggestions.

Thelma-Louise · 08-20-2008, 04:01 PM

I was going to suggest the same thing - tmj tends to have a dental connotation to it - but some treatments (Like accupunture, physical therapy, cranial sacral therapy, chiropractoic treatments, ultra sound, Tens Unit, etc) used to help with the pain and some symptoms of tmj are also used to treat myofacial pain syndrome, orofacial pain syndrome and cranial-cervical disorders all of which are valid medical conditions - so maybe check if your state insurance covers those.

While it may be true (and sad) that your insurance may not cover splints and any surgery you may need (many medical insurance don't even if the state recognizes tmj as health condition - they then limit coverage to surgery only despite it being the riskiest teatment) - if you go to a surgeon or tmj specialist that can plead your case with the state (showing how this is affecting your overall health) you may be able to file an appeal.

Its not recognized in NY either - its been pending for a number of years unless it was recently approved - I am not sure - I doubt it would matter anyway.

TiredOTired · 08-21-2008, 06:12 PM

Not sure if you both noticed or not, but I already have done splints and braces and physical therapy and chiropractic and had one minor surgery. The only reason I had any of those treatments was because I had a car accident and that insurance had to pay for it. (Not medpay-it was someone else's fault.) This to me is NOT a dental issue. As a matter of fact, I think it nearly most of the time isn't. (just my opinion.)

I liked some of the terms used in one of your replies as I haven't heard of one or two of them and it might help to use them. I need surgery at this point done by someone who knows what they are doing. I am not sure what kind, but I think it was last described to me that I need to have my condyl sewn in place as it is not in the location it belongs. I am planning on seeing a dr. that deals with back bones, forgot what he is called to start the process of dealing with my neck. It is covered by my insurance, and we'll see what he says.

Thanks for your replies. I think all states need to mandate coverage and that we all need to get together and lobby Washington to make insurance companies treat this joint as any other in the body. There should NEVER be an exclusion of medical coverage based on what part of the body an issue develops. THAT IS THE HEIGHT OF LAMENESS!

Thanks for hearing me out.

Thelma-Louise · 08-21-2008, 08:19 PM

I don't mean to be nosy - but can you sue for future damages resulting from your accident - if they conceded fault to begin with and paid for previous treatment such as surgery - why aren't they liable for this as well?

have you thought about finding lawyer and suing your state provided insurer - I found several lawsuits on line where patients sued their insurance provider to get not only treatment and surgery but one petitioner who won was also reimbursed for the dental work he had to have done as well.