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 TMJ a medical or dental problem?
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 jaw surgery for TMJ worth it?
Severe joint discomfort may necessitate more invasive procedures, such as corticosteroid injections into the TMJ. Surgery should only be used as a last resort. Surgical procedures for TMJ issues are not safe or effective, according to scientific research.
Is TMJ a permanent condition?
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.
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.
Can TMJ happen suddenly?
Did you clench your teeth last night while sleeping? That could have been the first thing that strained your TMJ. But, hey, you didn’t wake up with a sore jaw, so keep going.
This morning, did you brush and floss your teeth? Is mouthwash an option? When brushing their teeth, some people swish around mouthwash like a washing machine on the heavy cycle, get extra close to the mirror when flossing, and swish around mouthwash like a washing machine on the heavy cycle.
Jaw pain can be caused by any of these factors. But, because you’re being careful with your dental hygiene (which is a good thing), let’s continue.
What did you have for breakfast this morning? Bacon that’s chewy, fruit that’s hard, or a sausage biscuit? Excessive chewing and huge bites might put a strain on your jaw joint. However, let’s assume you were in a hurry this morning and skipped the most crucial meal of the day, so let’s continue.
Have you have a cigarette today? To smoke a cigarette, you must purse your lips and take a deep breath. This motion necessitates a modest forward movement of your jaw. When you smoke, you’re moving your jawbone and inhaling through the muscles near your jaw.
You already know we’re going to tell you to stop funding the cigarette industry to slowly kill you… Let’s keep going for those of you who don’t smoke.
Is today a good day or a bad day? Your TMJ is stressed as a result of stress. Mouth muscles and joints are strained when you clench your jaw, bite your tongue, or yell.
Because it usually occurs after you have found time to rest, stress is the leading cause of SUDDEN TMJ pain. Let’s keep going even if your day was absolutely stress-free (excellent for you!).
What’s the state of your posture today? When you text and check notifications, do you hold your phone up to your face or do you angle your head and neck down to look at it? Are you sitting at your computer desk with great posture or are you sitting comfortably? Do you suffer from scoliosis? Is today one of those days when it’s difficult to keep your head up high?
Poor posture strains your neck muscles, and depending on how often you gaze down or have your upper back inclined downward, poor posture could be the reason your jaw is only now complaining about pain! Let’s keep going even if your posture is great because you’ve read our articles on posture correction exercises and text neck/forward head posture.
Did you work out today? Physical activity, particularly weightlifting, can put your jaw under a lot of strain. Running forces you to utilize your jaw muscles to keep your lips from flapping open and closed with each step, while lifting big weights causes your neck and facial muscles to tense up. Your TMJ takes time to start feeling face pain and letting you know about it, just like you’ll “feel it” tomorrow.
Who qualifies for jaw surgery?
The following are some examples of situations that necessitate corrective jaw surgery: Your chin is retreating. You’ve had a face injury or have birth abnormalities that have caused your jaw to misalign. You have an elongated jaw.
Can TMJ damage be reversed?
The goal of temporomandibular disorders (TMD) treatment is to alleviate jaw pain and restore normal jaw movement and function. A variety of therapeutic options are successful. Because they are simple and temporary, the early therapies for TMDs are referred to as conservative. They aren’t invasive or long-lasting. They can be reversed or stopped. Over-the-counter pain relievers and self-care that can be done at home are among them.
Simple home therapy procedures can often ease jaw discomfort effectively. Only about one in ten persons has jaw disorders or pain that necessitates medical or dental attention.
How do you know when you need jaw surgery?
If you’re health-conscious, you’re aware of the benefits of a balanced diet, regular exercise, and monitoring your cholesterol levels. You stand tall, understanding that proper spinal alignment is beneficial to your back health. But what about jaw alignment? Most likely, you haven’t given it any thought.
It may come as a shock to find that a bad bite caused by misaligned teeth and/or jaws can harm your health as well as your appearance. Here are a dozen warning signals that you could need jaw surgery:
- Snoring is a symptom of obstructive sleep apnea, which is characterized by breathing issues while sleeping.
- When the mouth is closed (called a “open bite”), there is space between the top and lower teeth.
Does my insurance cover TMJ?
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.