TMJ issues should be covered by insurance, according to most experts. Many people wonder whether it’s covered by medical or dental insurance, and where the boundary is that separates the two types of coverage.
Medical insurance is usually the primary source of coverage for TMJ issues. The reason for this is that a joint, like muscle, tendons, and ligaments, can be found everywhere in the body. Physical therapy coverage is normally straightforward, although coverage conflicts are common when orthotics, appliances, or splints are created.
Blue Cross and Red Crescent Societies When used to treat a TMJ patient, Blue Shield will generally classify TENS as experimental, but will pay treatment for other purposes.
It’s worth noting that treating TMJ issues saves both patients and insurance companies money.
TMD sufferers used healthcare at 200-300 percent higher rates than non-TMJ patients, according to Shimshak et al’s findings published in Cranio.
My personal experience with saving money for insurance companies dates back to the 1980s when I worked for Chicago HMO. I had a patient who really required treatment, but her insurance didn’t cover it. I struggled for coverage and eventually met with Dr Mitchell Trubitt, the Medical Director of Chicago HMO Ltd.
I described the treatment to him, and he agreed to the non-surgical treatment, which proved to be effective. We agreed to a trial period after I assured him I could save the insurance company money while also benefitting the patients. Six patients were sent to me by a Chicago HMO, all of whom were told they needed TMJ surgery.
I handled the first six patients, and after reviewing the records, Dr. Trubitt estimated that the non-surgical approach had saved the Chicago HMO over $250,000.
Dr. Trubitt then negotiated a preferred provider agreement with Chicago HMO, under which Chicago HMO would cover 100% of phase 1 TMJ treatment with no deductible. Because of the cost savings to the corporation, he also cut the physician’s referral fee to the same level as cancer and cardiac treatment, which was the lowest available.
The end product was fantastic. Almost all of the patients who were tentatively scheduled for TMJoint surgery were able to avoid it. It was less politically acceptable because many oral surgeons objected to their surgical patients being referred to a general dentist for non-surgical treatment. Dr. Bruce Douglas, who was a Board Certified in OMS and a prior editor of their magazine, and I developed a very good relationship since he was an amazing oral surgeon who did not like TMJ surgery.
This arrangement allowed me to work with Chicago HMO and Mitch Trubitt for many years until United Health Care purchased the company. I met with their medical director and Dr. Trubitt, but they informed me that they were not interested in continuing the program because they did not pay for surgery and would not see any savings.
The Shimshak study, which found a 300 percent increase in medical utilization among individuals with TMJ issues, had not yet been published. With the sale of Chicago HMO to United Health Care, a scheme that helped patients and physicians while also saving money came to an end.
The future of health care and coverage for TMD problems is still up in the air.
I am the current chair of the American Alliance of TMD Organizations, which works to represent the majority of dentists who treat TMJ issues in obtaining insurance coverage and protecting patients’ rights to receive adequate treatment.
Is treatment for TMJ covered by insurance?
TMJ is a potentially debilitating jaw disorder. Although it may appear to be minor at first, if left untreated, it can progress to severe pain or even full jaw paralysis. Except in the eyes of insurance, it’s actually no different than other joint disorders from some perspectives.
The temporomandibular joint and related diseases are treated differently by insurance companies than other forms of joint ailments, and most insurance companies refuse to cover them unless the state requires it. Unfortunately, Colorado is not one of the states that requires TMJ therapy to be covered.
That isn’t to say that your insurance won’t cover TMJ therapy; it just means that it probably won’t.
What kind of doctor do you need to see for TMJ?
You should see a dentist if you’re suffering from TMJ pain. Dentists are professionals who are trained in the anatomy of the jaw and the diagnosis of bite dysfunction. They don’t only fix your teeth.
How much does it cost to fix a TMJ?
The total cost of temporomandibular joint (TMJ) surgery varies greatly depending on the severity of the case and the source of your discomfort. Patients should anticipate to pay anything from $5,000 and $50,000 in total.
Factors Affecting The Cost Of TMJ Surgery
The reason of your pain, the sort of therapy you’ll receive, and your doctor’s skill are all factors that will influence the cost of your TMJ treatment.
- The reason of your TMJ pain will determine which treatment option is best for you. Stress, a poor bite, or bruxism can all cause TMJ pain (nightly grinding and clenching).
- Treatment for TMJ pain can range from a simple sleep guard, which costs between $200 and $600, to corrective jaw surgery, which can cost upwards of $50,000.
- Another important issue that will influence your treatment costs is your doctor’s training. Specialists are usually more expensive than general practitioners, and TMJ therapy is no exception.
Why does the cost of treatment vary so widely?
Non-invasive procedures are considerably less expensive than surgical treatments. Smaller cases of TMJ pain caused by stress and/or bruxism may be managed effectively with an occlusal guard and/or medicines. A low-dose antidepressant that relaxes the muscles in the jaw and aids sleep may also be beneficial to certain people.
In more extreme situations, corrective jaw surgery and full mouth reconstruction may be required. TMJ discomfort can be caused by anatomical issues such as a poor bite. This may necessitate jaw surgery or orthodontic treatment.
What payment options are available?
Every office has its unique financial policy, so it’s vital to talk about it with them before starting treatment. You may be able to take advantage of in-house financing, or they may employ a third-party financing firm like CareCredit.
It’s worth checking your medical and dental insurance policies to determine whether they’ll cover anything. If you need jaw surgery, medical insurance might come in helpful.
Treatment for TMJ is an excellent investment in your overall health and quality of life. You may find yourself compromising to avoid discomfort if you don’t get therapy. Patients who have TMJ pain, clicking or popping at the joint, headaches, or earaches can benefit from a TMJ evaluation with their dentist.
The expense of your treatment may seem prohibitive, but your doctor may be able to work out a payment plan that works for you. Do not go untreated; at the very least, consult with your doctor about your choices.
What will happen if TMJ is not treated?
TMJ Disorder (Temporomandibular Joint Disorder) is a disorder characterized by misalignment and/or tension of the joints, muscles, and teeth. This can cause pain in the joint itself, as well as in the facial muscles and teeth. TMJ problem can be caused by a variety of reasons, including a misaligned bite, tooth grinding or clenching, osteoarthritis, or trauma and injury. TMJ dysfunction, while not life threatening, can cause substantial discomfort and tension if left untreated. Chronic pain can even contribute to mental illnesses such as anxiety and despair.
Is TMJ considered a medical or dental condition?
Patients who experience clicking or popping in the temporomandibular joint may have TMJ disorder, which is a combination of jaw joint and facial muscle dysfunction. Patients who are feminine, suffer from stress or anxiety, or have other health issues that impact the muscles and joints may benefit from a consultation. Because TMJ might be caused by a medical issue, a dental issue, or a mix of the two, it’s important to figure out what’s causing the patient’s condition before developing a treatment strategy.
Is TMJ permanent?
A TMJ issue occurs when the two joints that link the jawbone to the skull ache as a result of trauma, dislocation, or damage. The temporomandibular joint, or TMJ, is the name for this joint. Patients with TMJ suffer from mild to severe pain in the joint and have difficulty opening their mouths or even eating. Teeth grinding and clenching are two of the most common causes of TMJ pain.
However, this is not an incurable problem, and with the right treatment, TMJ pain can be permanently cured. To begin, you must cease grinding or clenching your teeth, as well as anything else that exerts pressure on the joint. You should also begin eating a soft diet to avoid putting too much strain on your teeth while biting down on something, as this places direct pressure on the TMJ.
Can TMJ affect your brain?
TMD, or temporomandibular joint dysfunction, occurs when one or both of these joints become misaligned. TMD left untreated can cause memory loss because the misalignment of the jaw can cause persistent pain that affects various sections of the brain.
Do orthodontists treat TMJ?
When the mouth is opened or closed, Temporal Mandibular Joint Disorder is a common joint problem that causes pain and discomfort. Don’t allow your illness go untreated, whether it’s tiny and only makes a slight clicking sound or severe enough to cause intense agony. By realigning the mandibular bone, a few basic procedures can rapidly cure this issue.
What is TMJ Disorder?
Different diseases that affect the temporal mandibular joint, face nerves, and jaw muscles are referred to as temporomandibular dysfunction. TMJ pain can be caused by twisting the jaw, opening or closing the mouth, or moving the jaw side to side. The muscles and ligaments that hold the TMJ in place can get injured or strained over time, causing the lower jaw to move out of alignment. It can also happen all at once in the event of a catastrophic occurrence in which the jaw moves too far out of alignment, impairing eating and speaking capabilities.
What Are the Causes of TMJ?
Although little is known about the etiology of this illness, it is linked to a collection of behaviors. Teeth grinding is a primary cause of TMJ dysfunction because it exerts a lot of pressure on the joint, which can aggravate an already inflamed joint. Teeth clenching exacerbates the problem by causing the face and jaw muscles to tighten, putting greater pressure on the joint. The temporal mandibular joint can be affected by arthritis in addition to teeth clenching and grinding. Another cause that aggravates TMJ is stress, particularly if you engage in hard physical activity such as lifting heavy objects, as the jaw muscles are overworked as a result of teeth grinding or clenching.
What Are the Symptoms of TMJ?
The following symptoms are frequently reported by those suffering from TMJ disorder:
Women (particularly those in the childbearing age range) are two times more likely than men to suffer from TMJ.
Orthodontic treatment for TMJ
There are three non-invasive therapies for TMJ disorder: a night guard that keeps your teeth apart and prevents them from grinding against each other; a splint that must be worn at all times; and braces to correct the bite. A night guard helps to relieve pressure on the temporal mandibular joint by allowing the joint to slip back into place, reducing the joint’s impact. A splint, unlike a night guard, must be worn all of the time, but orthodontic braces are one of the greatest TMJ therapies. TMJ condition is caused by bite problems and can be addressed efficiently with orthodontic braces. If you’ve been suffering from jaw pain, teeth grinding, or jaw clenching, orthodontic braces should be your first line of defense. Braces are meant to straighten your teeth while also reducing TMJ pain and discomfort.
Does TMJ show up on xray?
To rule out other probable causes and assess whether you have a TMJ issue, they’ll utilize a series of easy tests and draw on years of experience testing for TMJ.
When your dentist does a TMJ condition screening, he or she will perform the following tests:
To test for tenderness and pain, your dentist will use their fingers to apply light pressure to the jaw and TMJ.
When you open and close your mouth, the dentist will listen for popping and clicking sounds.
Observation – your dentist will examine your mouth for evidence of teeth grinding, clenching, or misalignment. If they find indications of a TMJ condition, they’ll additionally use X-Rays.
Things You Can Look for on Your Own
How do you know when it’s time to see a dentist? What if the pain comes and goes, but not for long periods of time?
Here are some things to look for to see if you have TMJ condition and if you should see a dentist:
It’s a good idea to tell your dentist if you experience any of the following symptoms, even if it’s only once in a while.