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 treated 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.
Does insurance pay for TMJ treatment?
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.
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.
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.
Can Botox for TMJ be covered by insurance?
Currently, medical insurance policies do not cover the use of BOTOX for TMJ issues. Because TMJ disorders are primarily a dental condition, it’s possible that insurance companies will eventually pay BOTOX injections as a way to prevent gum and tooth damage caused by excessive jaw grinding. Despite the fact that insurance companies have yet to cover this treatment, it is gaining popularity among patients, doctors, and dentists.
What happens if TMJ is left untreated?
TMJ dysfunction might eventually lead to tinnitus or possibly irreversible hearing loss. Balance issues and persistent dizziness can also be caused by inner ear abnormalities. In the same way, untreated TMJ issues can impair vision. TMJ can potentially result in major jaw issues.
Do ENT doctors treat TMJ?
Only ear, nose, and throat doctors are qualified to diagnose and treat TMJ/TMD.
TMJ therapy options include prescription, over-the-counter, and non-medicinal methods, according to ENT doctors.
Medicinal Treatments
When it comes to prescription and over-the-counter medications, some people respond better to anti-inflammatories like steroids or NSAIDs, while others respond better to neurotransmitter-targeting treatments like tricyclic antidepressants.
Non-Medicinal Treatments
In order to provide temporary relief from ear pain caused by TMJ, an ENT doctor may recommend a few things for a patient to do and avoid, as well as exercises.
To relieve TMJ-related pain, ear, nose, and throat doctors may recommend that a patient attempt the following practices:
What can be mistaken for TMJ?
You have two trigeminal nerves that govern your jaw, just like you have two temporomandibular joints on each side of your face. It’s simple to see why TMJ problem is frequently misdiagnosed as nerve dysfunction. Irritation of the trigeminal nerves causes intense pain in the face, teeth, and around the ear, as well as numbness or tingling on one side of the face. Trigeminal neuralgia pain, unlike TMJ discomfort, is characterized by a sensation of electric shock.
What type of doctor treats jaw issues?
Tooth decay, sinus difficulties, arthritis, and gum disease are just a few of the illnesses that create comparable symptoms. The dentist will ask about your medical history and perform a physical check to determine what is affecting yours.
They’ll listen for clicks, pops, or grating sounds as you move your jaw joints, looking for pain or tenderness. They’ll also check to see if your jaw is working properly and doesn’t lock when you open or close your mouth. They’ll also assess your bite and look for issues with your face muscles.
To rule out other concerns, your dentist may take full-face X-rays to see your jaws, temporomandibular joints, and teeth. Other tests, such as magnetic resonance imaging (MRI) or computer tomography, may be required (CT). When your jaw moves, the MRI can show if the TMJ disc is in the appropriate position. The bone detail of the joint can be seen on a CT scan.
For additional care and treatment, you may be sent to an oral surgeon (also known as an oral and maxillofacial surgeon). This surgeon specializes in procedures involving the entire face, mouth, and jaw. You could also visit an orthodontist to confirm that your teeth, muscles, and joints are functioning properly.
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.