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TMJ Disorder -TemporoMandibular Joint Message Board

does medical insurance cover TMJ

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Old 10-04-2007, 12:25 PM   #1
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does medical insurance cover TMJ

does medical insurance cover TMJ

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Old 10-04-2007, 03:00 PM   #2
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: does medical insurance cover TMJ

Each plan varies so some do and some do not or those that do, only cover certain aspects of it like therapies used to treat the symptoms of it - chiro, accupuncture, PT, tens unit, trigger point injections, pain meds and muscle relaxers, etc. Some go as far as to cover certain orthotic devices and surgery. Some have caps or limits as to what they will pay or how many treatments allowed, etc. For those that don't cover tmj, they may cover myofacial or cranio facial pain syndrome (or other similar conditions) which is similar to tmj in both symptoms and treatment. Most plans will not cover phase II treatments such as braces or restorative dental procedures like crowns even though they may be necessary to ensure the tmj problem which was treated remains in check or is stabiized.

A really good tmj dental staff will be familiar with the diagnosis and procedure codes that are accepted by most health insurance cos and will call your insurance co to find out what they do cover -even if they require you to pay up front and do not accept insurance payments. Or you can call yourself to find out what they do cover, but I have found unless you are familiar with the various diagnosis codes they will not offer alternatives that they do cover unless specifically asked about each.

Hope that helps some - unfortunately tmj falls into one of those grey categories for most health insurance cos primarily b/c it is still often thought of as being "dental" related since it has to do with the mouth (jaws, teeth, joints, condyles, etc).

Old 10-04-2007, 04:11 PM   #3
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marinerseric HB User
Re: does medical insurance cover TMJ

Most do not apprently.

Old 10-05-2007, 04:33 AM   #4
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Beppie1 HB User
Re: does medical insurance cover TMJ

The TMJ clinic asked my referring doctor to put it down as "treat and evaluate for MFD", instead of TMJ which apparently many polcies do not insure. MPD is mao fascial pain disorder, although I doubt I spelled it right.

Old 10-23-2007, 07:54 PM   #5
Join Date: Oct 2007
Location: Keller TX USA
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SanDee53 HB User
Re: does medical insurance cover TMJ

I talked to my medical insurance company and they said they would cover it 100% if the problem is Medical and not Dental. I assume then if it were dental that my Dental insurance would cover but not sure. Seems my TMJ is medical. All insurance cos are different.

Old 10-24-2007, 01:35 AM   #6
Join Date: Jun 2005
Posts: 303
legallyblondied HB User
Re: does medical insurance cover TMJ

Actually. ThelmaLousie is right and some insurances will pick
up under medical and others under dental or both if they will
work together, and believe it or not, since it such a grey area, they often do. TMJ as far as i am concerned, unless it has been caused by a traumatic injury to the jaw, or a tumor, or
avacular necrosis or osteonecrosis or osteo or inflammatory
arthritis, is caused by the bite being off or malocclusion, which translates into jaw pain and painful muslces that are doing the work of muscles that are doing have muscle fatique and more pain becaue of overworked mucsles.the pain can be in the jaw or radiate into the face and head , neck and shoulders and arms...The person that is trying to cope with this pain usually has a forward head postion and their posture is off. TMj muscles can become
so tight that they put pressure on the cheek bone,am
not sure of the correct spelling of that partiular bone and
am too tired to look it up! but this inturns irritates the
sinus passages and causes pain. It is not do to a sinus infection or fluid just presssure from muscles working that
should not be in order to keep that jaw in line to try to
stablize the bite. people often experience blocked eustachian tubes and tinnitus which are all caused by tmj
so if you go to a dentist find one that bills himself as a neuromuscular dentisit with post grad training and they
will be able to help you. Karen

Old 10-24-2007, 12:23 PM   #7
Join Date: May 2007
Location: Des Moines, Iowa
Posts: 59
alorcoy HB User
Re: does medical insurance cover TMJ

Just a note on financing. I used CareCredit, run by GM, to finance my $5,000 neuromuscular splint. I had to pay the dentist for service, then Aetna paid half. The CareCredit offered 12 or 18 months interest free. If I hadn't been able to pay it off in that time. I would have moved the balance to a 0 percent card. I just hate to think of anyone staying in pain when there are 0 percent financing options out there. It sucks to have to pay so much, but even a little relief can be so worth it.

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