Why Is TMJ Not Covered By Insurance?

Is TMJ Covered by Insurance?

TMJ disorders are extremely painful and irritating medical illnesses. These conditions impair our ability to utilize our jaw properly and cause us pain that can interfere with activities as basic as eating and drinking. Unfortunately, there are many people who suffer from TMJ difficulties who are uninformed of their illness and are afraid of whether or not their health insurance will cover the necessary treatment to feel normal once again. Fortunately, there are techniques to alleviate the discomfort and even the fundamental reasons for TMJ.

TMJ is a jaw disorder that may be incapacitating. Although it might start off being very moderate, if addressed, it can worsen and cause severe discomfort or even jaw paralysis. Except in the eyes of insurance, it is actually similar to other joint issues from some perspectives.

insurance documents

Unfortunately, most insurance companies will not pay for temporomandibular joint diseases unless the state mandates coverage since they are viewed by insurance as being entirely distinct from other forms of joint ailments. Sadly, Colorado is not one of the states that require health insurance to pay for TMJ therapy.

However, this merely indicates that it is likely that your insurance will not cover TMJ therapy.

What is TMJ?

The temporomandibular joint is known as TMJ. The temporomandibular joint, despite its lengthy name, is simply the joint that joins your jaw to your skull. You can open your mouth to talk, eat, or drink since your jaw is a separate bone from your skull, of course. But the unique joint that allows for all of this is fragile, and it can develop a number of illnesses that are together known as TMJ diseases, also known as temporomandibular disorders (TMDs). Conditions affecting the TMJ can produce discomfort in and around the joint as well as in the muscles that move the joint itself.

It’s understandable if that seems a little hazy; according to doctors, it can be challenging to pinpoint the underlying reason for a TMJ disorder. The diseases themselves may show similar symptoms, with pain being the most noticeable, but they can be brought on by anything from nighttime teeth grinding to facial and jaw traumas that cause the joint to stop functioning normally.

Treating TMJ

The treatment of TMJ disorders is not as challenging as the illnesses’ enigmatic etiology might imply. Physical treatment techniques that focus on building the muscles that control the TMJ may be beneficial. Home exercises can help you feel better, but you should always consult a doctor before trying to “heal” yourself in your spare time.

Another option for treatment is TMJ splints. A biting splint is a specially designed item worn in the mouth by patients to place their jaw in a more cozy and natural position. Experts can prevent patients from developing TMJ pain by determining where the jaw should rest and making sure that it truly lands there. In many circumstances, the treatment can even completely heal the problem as well as short-term pain relief.

Is TMJ covered by insurance?

Everyone wants to be healthy, but few of us have the financial means to completely ignore the costs of medical treatment. Is TMJ covered by insurance? This is a reasonable question to ask if you’re thinking about receiving treatment for a TMJ disorder.

What TMJ Insurance Covers

If you’re lucky enough to have insurance that covers TMJ treatment, here’s what would typically be covered:

  • Bite splints and oral appliances are usually covered for 6 months (long-term treatment is considered “investigational”), but usually only for jaw pain and related problems, not headaches
  • Physical therapy
  • Cognitive therapy, relaxation therapy, and biofeedback
  • Acupuncture
  • Manipulation for reduction of fracture or dislocation
  • Non-opiate painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
  • Some surgical procedures, including:
  • Arthroplasty
  • Joint replacement
  • Cartilage and other tissue grafts
  • Arthrocentesis
  • Arthroscopy
  • Meniscus or disc repositioning

If you’re unclear about your situation, talk to your doctor or dentist as well as your health and dental insurance providers to learn more about your alternatives.

Beyond insurance: justice in medical care

Injury is one of the many reasons why TMJ disorders develop. You could develop a TMJ disorder if you sustain a jaw injury in an accident. That’s especially unjust if someone else’s negligence led to the accident in question, but workplace injury lawyers in Brisbane suggest that you may be able to find another means to pay for your medical care as a result. You may be entitled to compensation for any accidents or injuries sustained at work that was the result of someone else’s carelessness.

What TMJ Insurance Covers

What would ordinarily be covered, if you’re fortunate enough to have insurance that covers TMJ therapy, is as follows:

  • In general, bite splints and dental appliances are covered for six months (long-term treatment is regarded as “investigational”), although usually just for headaches that are caused by jaw pain and related issues.
  • Physical exercise
  • Biofeedback, cognitive therapy, and relaxation therapy
  • Acupuncture
  • reduction of fracture or dislocation with manipulation
  • Non-steroidal anti-inflammatory medications (NSAIDs) and non-opioid painkillers (NSAIDs)
  • Several surgical techniques, such as:
  • Arthroplasty
  • Replaces joints
  • Grafts of cartilage and other tissues
  • Arthrocentesis
  • Arthroscopy
  • Repositioning of the meniscus or disc
  • Speak with an attorney right immediately if you’re having trouble paying your medical bills after an accident that you think caused your TMJ disease.

TMJ Disorders Are Covered by Medical Insurance (TMD)

There is a consensus that TMJ issues ought to be covered by insurance. Many people wonder if it is covered by their dental or medical insurance and where the boundary is that separates the two types of coverage.

The main form of insurance for TMJ issues is often medical insurance. The reason for this is that a joint, along with muscles, tendons, and ligaments, can be found any place in the body. Physical therapy coverage is typically simple, but coverage conflicts can arise when orthotics, appliances, or splints are manufactured.

Sky Cross TENS is frequently labeled as experimental by Blue Shield when used to treat TMJ patients, however, it is still covered for other types of treatment.

It’s noteworthy to note that insurance companies and individuals typically save money when TMJ issues are covered.

Shimshak et al. conducted investigations that were published in Cranio and found that TMD patients used healthcare at rates that were 200–300% higher than those of non–TMJ patients.

My first opportunity to help insurance companies cut costs was with Chicago HMO in the 1980s. I had a patient who really required care, but her plan didn’t cover it. I pushed for coverage and eventually met Dr. Mitchell Trubitt, the medical director of Chicago HMO Ltd.


Leave a Reply

Your email address will not be published. Required fields are marked *