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TMJ Disorder -TemporoMandibular Joint Message Board

coverage by pacificare ca for tmj?

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Old 09-05-2005, 08:42 AM   #1
Join Date: Sep 2005
Posts: 1
hkuehner HB User
coverage by pacificare ca for tmj?

Just wondering if anyone has fought the pacificare hmo in california and won coverage for an occlusal splint. my pcp gave me a referral for my neuromuscular dentist, but i'm starting the process to get the hmo to actually pay for it.
any input would help. thanks!

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Old 09-06-2005, 10:38 PM   #2
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Join Date: Apr 2004
Posts: 240
papergoods HB User
Re: coverage by pacificare ca for tmj?


you are going to a neuromuscular dentist? It is a real uphill battle to get it covered, I started 2 years ago and its cost me a ton. Insurance comes up with all these little things they say are "not medically necessary" with neuromuscular. I did get about 50% of mine covered, finally after getting a lawyer. I have one in LA if you need me to give you the name and you can look it up.

Old 09-09-2005, 04:03 PM   #3
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Join Date: Jan 2003
Posts: 1,179
TiffanyAnn HB User
Re: coverage by pacificare ca for tmj?

Some people have had luck with getting their TMJ treatment covered by insurance by having their dentist list their diagnosis as MPD rather than TMJ. I don't know if this will help you or not but I thought I'd suggest it just in case. I wish you the best of luck. Fighting with insurance companies is so frustrating. They are nothing but BLOOD SUCKERS

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