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TMJ Disorder -TemporoMandibular Joint Message Board

insurance problems

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Old 05-23-2003, 06:35 PM   #1
Join Date: May 2003
Location: Plainsboro, New Jersey, USA
Posts: 55
quinnma HB User
Post insurance problems

I am upgrading my Aetna dental insurance to a plan that claims to cover 50% of TMJ costs. However, the TMJ dentist I am going to for the first time next week has said Aetna doesn't pay, because the dentist uses a medical code, not a dental code. I hope I get a resolution to this Catch-22.

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Old 05-23-2003, 06:45 PM   #2
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Join Date: Apr 2003
Posts: 1,579
CherylL24 HB UserCherylL24 HB UserCherylL24 HB User

Hi There,

It's coded as Myofacial Pain Dysfunction, which is considered a medical condition. I think that's how most people get this paid for. Hope this helps!

[This message has been edited by CherylLynn24 (edited 10-31-2003).]

Old 05-23-2003, 08:44 PM   #3
Join Date: Sep 2001
Location: california
Posts: 68
Sharbear HB User

Yeah, your medical insurance should cover it. If you have a HMO go to your primary care Doctor and tell him of your symptoms and he/she will refer you to someone. Coverage for tmj is slowly starting to improve compared to 10-15 years ago. Once the referral is made and if they deny it, you will have to appeal, it takes a while but it is worth it. I had to fight for almost a year to get the treatment I needed. If the appeal is denied you can complain to the dept of managed heatlh care and they will help. That's what did it for me. Heck, once I sent them all my info my insurance company called and apologized to me and basically said I could have whatever I wanted, including the surgery which was well over one hundred gran.
I'll help if you need me,

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