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DDS vs DMD? Insurance? Oxford? Newbie needs help.

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Old 06-23-2009, 09:33 AM   #1
Join Date: Jun 2009
Posts: 4
2silverwings HB User
DDS vs DMD? Insurance? Oxford? Newbie needs help.

Hi all,

I am not a newbie when it comes to TMJ - I have suffered to varying degrees for 10 years. But I am a newbie when it comes to trying to get treatment beyond night guards (which I promptly cracked or chewed through, and didn't seem to help), massage therapy (sometimes very helpful), acupuncture and self-massage. And soft foods / heat application. These treatments aren't cutting it now.

I woke up yesterday morning unable to close one side of my teeth - The teeth were firmly touching on one side but on the other they barely touched. It was so bizarre. I had trouble chewing and lots of pain in the joint. Couldn't open wide. It felt like the left side of my jaw was literally dislocated. Muscle relaxants before bed resulted in my waking up 90% better. But still, the clicking, clacking, grinding, popping, locking that I've experienced for the last 10 years... It's just become too much for me to deal with and I need some help. X-rays many years ago (not panoramic) showed bone loss, but I couldn't afford the stuff that specialist wanted me to do - THey didn't accept any insurance. So that's all the info that I have about what my condition is.

I have migraines, neck pain, pain in the muscles that travel from your jaw down your neck into your shoulders, shoulder pain, occiptal ridge pain, some facial pain and numbness/tingling on my face occasionally. I do have myofascial pain syndrome, a repetitive strain injury, and fibromyalgia, as well - These developed after the TMJ did, however.

I am trying to figure out whether I should go to a DDS who specializes in TMJ or a DMD. My dental insurance is crappy, but my medical is fine - The only problem is I know most medical insurance I've had specifically excludes TMJ. I am calling my insurance in a minute to find out. My understanding is a DMD could be covered by my regular medical insurance, but a DDS won't? Is it possible to go to a DDS and have them bill your regular medical for some of the treatment, or will they view it as dental and kick it back to your dental insurance? I'm basically trying to figure out a way to have as much of my visits/treatment covered by MEDICAL instead of dental as possible. Any suggestions? Experiences dealing with Oxford PPO for TMJ?

Thanks in advance!

BTW, I live in Bergen County, NJ.

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Old 06-23-2009, 07:59 PM   #2
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Join Date: Apr 2004
Location: Rockland County, NY
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: DDS vs DMD? Insurance? Oxford? Newbie needs help.

I don't have all the answers you are looking for but in response to whether a regular dentist can submit claims to a medical insurance provider - yes they can - some tmj dentists have the necessary billing softward to print and submit claims - some will just give you a statement and have you submit it on your own - most want payment upfront either way so any reimbursement would go directly to you and not the dr - so make sure your ins provider knows the bill has already been paid by you - this is done by completeing the claim form correctly and showing no balance is due to the dr on the lower right hand side of the claim form. They may not accept all the charges by your dr - but orthotics (splints), tens unit, trigger point injectsions, drugs, and most alternative forms of therapy - PT, chiro, cranial sacral, acupuncture, osteopath - this can be covered as well as tmograms, MRIs, CTscans, etc. If they don't cover tmj per se ask about cranial mandibular cervical disorder or myofacial pain syndrome or cranio facial pain syndrome.

Last edited by Thelma-Louise; 06-23-2009 at 08:01 PM.

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