FREQUENTLY ASKED QUESTIONS ABOUT INSURANCE COVERAGE FOR TMJ DISORDERS

Is TMJ treatment covered under my Dental or Medical policy?

There are two phases of TMJ treatment. The first is the Active phase which includes the treatment modalities described on the Diagnosis & Treatment page, and these services, including surgery, of course, are generally covered under the patient's medical plan. This is because it is generally accepted that TM Joint disorders are Orthopaedic in nature. However, it is always a good idea to first check with your insurance company.

The second phase of treatment is designed to stabilize the jaw more permanently in its corrected position which was achieved during the Active phase. These services may include fabrication of new full and or partial dentures, crowning of teeth, orthodontics, fabrication of cast overlay Stabilizing appliances, etc, and they are Dental in nature.

Do all insurance companies cover TM Joint treatment?

NO! Be very careful! Call your insurance company and ask these questions:

• Do you cover diagnostic services for TM Joint disorders? If so what services are covered?
• Do You cover TMJ treatment? If so, does that coverage include the "Treatment Orthotic"?
• If you cover some services, but not others, which services ARE covered, and which are NOT covered?
• Is there a Benefit Limit? If so, what is the limit?

TIP: Always ask for the name of the person you are speaking with, and make a note of it, along with a note of the date and time of day of your conversation. If you are not satisfied with the answers you are getting, do not be afraid to ask to speak to a Claims Supervisor.

I have a friend whose employer is different from mine, but her insurance company is the same one that I have coverage with. Her TMJ treatment was covered by her insurance, and mine is not. Why?

There are several explanations, and I don't know which one applies. Firstly, insurance companies offer several different plan options, and the employer chooses which to offer employees. Second, insurance companies not only offer their own plans, they also contract with self insured employers to administer the employer's health plan. The consequence is that although you and your friend are both insured by the same company, you have different plans.

Here again, the best bet is call your insurance company before you proceed with diagnostic or treatment services, and find out what YOUR plan covers.