Coverage for TMD
People with temporomandibular disorder, or TMD, which “refers to a problem with the temporomandibular joint, or the TMJ,” can receive coverage for treating this condition (“TMJ vs TMD: Know the Difference” 2017). They can get TMD—sometimes named TMJ erroneously—by a variety of means, such as “[grinding] or clenching [their] teeth, which puts a lot of pressure on the joint;” “[stress], which can cause [them] to tighten facial and jaw muscles or clench the teeth;” “[movement] of the soft cushion or disc between the ball and socket of the joint;” “arthritis in the joint;” and much more (Friedman 2017). With this condition, they can experience symptoms, such as “jaw pain and problems with chewing and talking… trouble sleeping, back and neck pain, ear aches, and headaches… behavioral and mental aspect of depression and anxiety,” etc. (“TMJ vs TMD: Know the Difference” 2017). While treatments can be expensive depending on the severity of TMD and the provider treating it, people can receive coverage for medical and dental treatment for this condition (“TMJ Treatment Cost” 2018).
However, people may find different policies with varying coverage or even no coverage for TMD treatment. People receive benefits for TMD mainly through medical insurance because “a joint [e.g. TMJ] is a joint anywhere in the body, as is muscle, tendons, and ligaments,” but dental insurance can cover other parts of the treatment process (“Medical Insurance Coverage for TMJ Disorders (TMD)”; “Treatment Costs and Insurance Coverage”). In some states, insurance policies must include benefits for TMD, while in other states, they may include them as an “option of coverage” (“How Much Does TMJ Treatment Cost?”). Furthermore, while some insurance companies may not pay for certain procedures for TMD, they may cover other options, such as oral appliances, physical therapy, acupuncture, arthrocentesis, arthroscopy, and much more (Candelaria 2014). Some medical insurance companies would not cover the treatments since they view the treatments as dental treatments (“Treatment Costs and Insurance Coverage”). They may also exclude treatments for TMJ, but people could add them to their policy “as a special option” by paying more premiums (“Treatment Costs and Coverage”).
People can receive coverage via their doctor and/or dentist, who can help them get their benefits in the event of a denial. Insurance companies may only provide coverage after people undergo “diagnostic scans such as MRI or CT” (Candelaria 2014). When patients go to dentists for treatment, dentists must establish dental-medical necessity in order to convince the insurance company to provide coverage for the treatments they offer (Digangi and Taxin 2014). Dentists can even help patients receive coverage from medical insurance for “[evaluation] and some treatment for temporomandibular joint disorders (TMJ)” (Philhower and Blair 2016). When patients are denied coverage, they should try to reverse the decision and receive help from their doctor, who can establish the medical necessity of the treatment, and the doctor’s insurance specialist (Stacy 2013).
Although health and dental coverage for TMD treatments may vary, it could help them pay for their procedures.