What type of insurance cover TMJ jaw problems?

Answer 1

Health policies: Each state has laws requiring the coverage of certain services, known as "mandated benefits." Call your state insurance commissioner's office and ask about your state's laws; if you work in another state, call that state's insurance commissioner's office, also.

Many states require coverage for TMJ, but only after demonstrable damage to the joint has occured. In other words, if there's only pain, there's no coverage; but when the joint becomes deteriorated, such as bone spicules or meniscus damage, the insurance will cover it. Such is the case in my state.

In the absence of a mandate, insurers are permitted to exclude coverage of certain diagnoses. If coverage for TMJ syndrome and/or its side effects are excluded in a policy, there's no coverage.

Dental policies: The vast majority of dental insurance policies define a "dental service" as any service that treats the teeth or its supporting structures. In the presence of this definition, there will be no coverage for TMJ problems, even if the pain is caused by malocclusion (misaligned teeth). This is because the temporomandibular joint is not a "supporting structure" of the teeth. There may be coverage for a dental appliance that prevents the teeth from grinding during sleep (bruxism) and alleviates the pain of the TMJ, however. In order for this type of dental appliance to be covered, it must listed within the "Covered Services" section of the policy.

I hope this helps.

Answer 2

Normally a jaw misalignment is a health issue, not a dental issue, so it's usually health insurance.

But if the TMJ is caused by misaligned teeth, then it's an orthodontic problem, and covered by dental insurance.

Answer 3

Some dental insurance companies still offer it as an option to their plans. However there aren't too many left due to the cost and the complexity of the disorder.

However, your medical coverage should still pick it up. If you are lucky enough to have dental that will cover some, then submit the balance and a copy of the dental EOB to your medical carrier. Sometimes they will pick up the balance.

Answer 4

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RE :What type of insurance cover TMJ jaw problems?
Follow 7 answers

Answer 5

You can visit your regular doctor, but they have to bill it as ear pain because EVERY insurance plan tries to shove it off to dental coverage.

Therefore, if you have dental coverage, see the dentist.

Answer 6

i think this would be covered by dental insurance

Answer 7

Not sure.. my boyfriend had that and it stopped him from kissing me a lot.. ha it was horrible. i hope you find what youre lookin for.. feel for ya:-p