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TMJ covered by MEDICAL insurance?

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Old 10-19-2009, 12:15 PM   #1
Join Date: Oct 2009
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saralynnk HB User
TMJ covered by MEDICAL insurance?

My insurance company, anthem blue cross of colorado, is refusing to pay for TMD treatment, saying it is a dental issue and my plan doesn't cover dental. My symptoms are headache and neck pain - I do not have bite problems but I have scoliosis of the cervical spine which has caused my skull, jaw, etc... to be out of allignment. I believe this is a medical and not a dental issue. any ideas on how I can convince my insurance company of this?

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Old 10-19-2009, 05:54 PM   #2
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Thelma-Louise HB UserThelma-Louise HB UserThelma-Louise HB User
Re: TMJ covered by MEDICAL insurance?

It depends on what type of treatment you are trying to get them to cover and of course the diagnosis code the dr provides. All my chiro, PT, crianial sacral therapy and acupuncture were covered under the diagnosis codes for cranio-cervical disorder and myofacial pain syndromes - and the treatment codes included those for ultra sound, electro stimulation, deep tissue massage, chiropractic adjustments, cervical manipulations, etc. When I had UHG they covered many orthotics/splints under the treatment code of medical equipment but would not pay the dentist for his service, examination, bite adjustments or anything "dental" in nature. Luckily for me most of the practioners I have gone to have had their billing representative contact my insurance carrier to find out what I was covered for and then they would submit their bills accordingly - even if they made me pay up front - any remibursements would then go directly to me. So it was important they itemize their bill so charges that could be covered were specified on the service statement. If you are submitting bills on your own to the insurance company and are using a form its important you find out the diagnosis and treatment codes your carrier will accept or cover you for - so if you call them do not even mention tmj/tmd - mention migraines, cervical problem, scoliosis, etc - they will probably tell you to submit your claim and will contact the dr that provided the service to obtain the diagnosis and treatment codes - so you need to advise them as well not to mention tmj either.

Old 10-20-2009, 03:50 AM   #3
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Re: TMJ covered by MEDICAL insurance?

I have blue cross of NJ and had no luck either, I wound up not getting treatment. Even my medical doctor agreed that's it's a medical issue, not dental, but it doesn't do me any good.

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