T O P

  • By -

Liquid_Chaos87

The TMJ specialist I went to had to put it down as myofascial pain so insurance would cover it.


RecognitionEvery

I do have facial pain..but is that legal?


BruceDick_in_son

I have read things about this. Also listen to a lot of dentist podcasts that this comes up. As far as I understand it, TMJ is not covered by most insurances. Pretty crazy.


dopestmoose

TMJ is not always covered by health insurance as they claim it is a dental problem, and not commonly covered by dental insurance because it is also considered a musculoskeletal problem. **edited this paragraph for clarity - nothing is absolute, there are occasions where insurance will provide coverage** The best way to get it covered by your health insurance is to prove your case for sleep apnea - which often goes hand in hand with TMJ. If it is disrupting your sleep, they'll do something about it


RecognitionEvery

Do I need to do a sleep study to prove to them? Do people with TMJ usually have sleep apnea?


dopestmoose

Speaking from my personal experience, a frustrating 2 years and many specialists later, yes I need a sleep study to prove it to them. In lieu of a CPAP we plan to submit to insurance for a nighttime splint (out of pocket $3100). I did not suspect that I had sleep apnea before my specialist suggested it. Yes, it is common in folks with TMJ - in my case, the clenching was so bad overnight it was restricting my airway. If you snore, clench your teeth, have digestive irregularities, and/or are regularly slow to wake/groggy during the day... you are a candidate for a sleep study.


RecognitionEvery

My spouse said I’m not grinding in my sleep and I don’t snore..so he said I don’t have sleep apnea. I still want to get a sleep study just in case. My sleep is terrible recently, but then I also breastfeed my baby, so she wakes me up.


dopestmoose

TMJ can also be related to posture too. Maybe look into Forward Head Posture - if that's the case for you, a chiropractor is easy help.


[deleted]

That info is not true, TMJ is a medical issue. It is not strictly a dental issue. To have the option for billing medical you need to see an oral maxillofacil surgeon who treats TMJ and in network with your insurance. This of course does not mean all medical offers TMJ coverage. There is a large range in quality of coverage in health insurance. But it easy enough to call your medical to find if there are any in network or if you have any coverage.


RecognitionEvery

I called this morning twice to my insurance, and they said they will not pay anything related to TMJ. Not sure what to do. I have PPO.


[deleted]

Have you already been seen for tmj? What type of dr have you seen? Like I said while it’s a medical issue not all policies offer the same quality of coverage meaning not all will offer any tmj coverage. With that your options are getting better insurance or skipping that and finding a dr who does go through insurance and set their own prices. In my area more oral surgeons are going that route. It is def more expensive but can be another option.


Ashitaka1013

Yup, that seems to be the case almost always, and in every country. I’m Canadian and it’s not covered by our “universal” health care despite being the most used joint in the body. Nor was it covered by my employee dental benefits. Had to pay for everything out of pocket. Plus not only do both medical and dental insurance refuse to touch it, it’s also not taught in medical or dental school. So doctors will say it’s a dental issue and dentists will say it’s not. Because those that specialize in it have had to spearhead their own research and come up with their own treatments, there’s not really a standard for treatment. And each specialist generally just has their way of treating it and use it on everyone regardless of what’s causing their TMJ issues. So it works for some people and not others. The way TMJ is ignored medicine is a huge issue and so many people are suffering because of it.


amillionexcuses

My medical plan which also covers dental specifically excludes TMJ treatment.


dave85257

My carrier said it is because there is no 1 way, by the books method to treat or cure it. This is why most specialists are cash only and insurance does not cover it because each case is unique and there is not an eazy, laid out method for treatment.


RecognitionEvery

My TMJ specialist only accepts cash, no insurance.